The actual operating time can range from 1–4 hours, depending on the anatomical complexity, skill of the surgeon and the kind of procedure performed.
In order to assess for the presence of possible obstruction above the vasectomy site the testicular end of the vas deferens can be compressed and inspected for fluid.
Other, more subtle findings that can be observed in the fluid—including the presence of sperm fragments and clear, good quality fluid without any sperm—require surgical decision-making to successfully treat.
Additional information: Another issue to consider is the likelihood of vasoepididymostomy at the time of vasectomy reversal, as this technique is generally associated with lower patency and pregnancy rates than vasovasostomy.
Web-based, computer models and calculations have been proposed and published that described the chance of needing an vasoepididymostomy at reversal surgery.
It is important to appreciate that female age is the single most powerful factor determining the pregnancy rate following any fertility treatment and vasectomy reversal is no exception.
No large studies have stratified the results of vasectomy reversal by female age and hence assessing outcomes is confounded by this issue.
There are small chances of infection or bleeding, the latter of which can result in a hematoma or blood clot in the scrotum that needs surgical drainage.
If there is significant scar tissue encountered during the vasectomy reversal, fluid other than blood (seroma) can also accumulate in a small number of cases.
Very rare complications include compartment syndrome or deep venous thrombosis from prolonged positioning, testis atrophy due to damaged blood supply, and reactions to anesthesia.
Published research attempts to identify the issues that matter most as couples decide between IVF-ICSI and vasectomy reversal, two very different approaches to family building.
[16] Since it is difficult to perform randomized, blinded prospective trials on couples in this situation, analytic modeling can help uncover what variables affect outcomes the most.
[15] In the special instance of couples with advanced maternal age (defined as a female partner > 38 years old), case series’ have reported that pregnancy rates with vasectomy reversal are competitive with IVF-ICSI.
[17] When Markov modeling was applied to probe the issue of pregnancy rates after reversal surgery in more depth, the results revealed that female reproductive health is far more important than: (a) the age of the vasectomy, (b) the age of the man, or (c) the vasectomy reversal patency rate.
Every patient who is considering vasectomy reversal should undergo a screening visit before the procedure to learn as much as possible about his current fertility potential.
The epididymis is a single, 18-foot-long (5.5 m), tightly coiled, small tube, within which sperm mature to the point where they can move, swim and fertilize eggs.
From the epididymis, a 14-inch, 3 mm-thick muscular tube called the vas deferens carries the sperm to the urethra near the base of the penis.
If the surgeon simply reconnects the two freshened ends of the vas deferens without examining for a second, deeper obstruction, then the procedure can fail, as sperm-containing fluids are still unable to flow to the place of the connection.