A. A vasectomy is an office based procedure that is considered a method of permanent sterilization. During this procedure, the vas deferens (the muscular tube that transports sperm from the testicle to the outside world) is cut and sealed (see below). Although this procedure is considered permanent, modern microsurgical techniques have enabled experienced surgeons the ability to reverse a vasectomy.

A. A vasectomy reversal is an outpatient surgical procedure which is performed under general or epidural anesthesia. The procedure is performed under an operating microscope due to the small size of the structures involved. The stitches used for a microscopic vasectomy reversal are smaller than a human hair and the procedure requires an experienced surgeon who is familiar with microsurgical techniques.

Q. What factors affect the success rates of a vasectomy reversal?

A. Success of a vasectomy reversal depends upon several factors:

• Surgeon experience
• Length of time since the vasectomy
• Anatomical factors

Since microsurgical skills are different than those utilized during other surgical procedures, the surgeon performing the vasectomy reversal should have considerable experience with these techniques.

In general, success rates following vasectomy reversal depend upon the time interval since vasectomy (see below).

Q. What is an epididymovasostomy?

A. In certain patients, the vasectomy may result in "back-pressure" in the vas deferens which may be transmitted up-stream to the epididymis. If pressure in the epididymis builds up over a prolonged period of time, the epididymal tubule may rupture, causing an "epididymal blowout". Once an epididymal tubule ruptures, scarring occurs at that site. Under these circumstances, sperm can not travel beyond the point of scarring and will never reach the vas deferens up-stream. In these cases, a vasovasostomy will not be successful since the site of blockage is in the epididymis, not the vas deferens. These situations require that an epididymovasostomy be performed i.e. a surgical connection between the vas deferens and epididymis.

Q. How do I know if I need an epididymovasostomy?

A. Although the interval since vasectomy and physical examination may suggest which patients will require an epididymovasostomy, the final decision can only be determined at the time of surgery. The decision to perform a vasovasostomy or epididymovasostomy depends upon the gross quality of the vasal fluid (watery vs. pasty) and microscopic quality (whole sperm vs. no sperm or sperm parts). The decision may also depend upon the patient's anatomy and whether or not the surgery is the initial or a subsequent attempt at vasectomy reversal.

Q. Do antisperm antibodies affect pregnancy rates after vasectomy reversal?

A. Nearly 75% of men who undergo vasectomy will develop antisperm antibodies. Since pregnancy rates may approach 75%, most patients with antisperm antibodies will establish a pregnancy without difficulty. Thus, testing for antisperm antibodies is not routinely performed. Some patients who have a good sperm count and motility following vasectomy reversal, who have difficulty initiating a pregnancy, may be tested post-operatively for antisperm antibodies.