Common Myths About Vasectomy Reversals

 

Myth #1 - Vasectomy reversals have little to no chance of success after 10 years

Actually, success rates for quite high for men who are 10 or more years out from their vasectomy, if the reversal is performed by a fellowship-trained specialist who knows how to perform an expert vasoepididymostomy (vas-to-epididymis connection). The often-quoted (but now inaccurate)  10-year cut-off for reversal success dates back to a medical paper published in 1976.  Using 40 year-old reversal techniques (when vas-to-epididymis connections were much less successful and were rarely performed), this 1976 paper found low success rates for reversals in men who were >10 years out from their vasectomy.  Fortunately, 40 years of microsurgical innovation have completely transformed the field of vasectomy reversals.  Although the chance of needing a vas-to-epididymis connection increases with time, the latest microsurgical techniques now offer excellent success rates for men >10 years from their vasectomy.  The key is to find a surgeon who has been fellowship-trained and routinely performs vas-to-epididymis connections.


Myth #2 - Anti-sperm antibodies decrease fertility in a large percentage of men following a vasectomy reversal

Sperm are produced in what is called an “immunologically privileged” area in the body where the sperm are protected from the body’s own immune system.  However, sperm can be exposed to the body’s immune system following scrotal surgery, infection, or significant trauma to the area.  Studies have shown that about 70-80% of men develop anti-sperm antibodies following a vasectomy.  However, in the vast majority of men, these antibodies are not clinically significant and do not appreciably decrease pregnancy rates after a reversal.  In about 5% of men who have a successful vasectomy reversal, anti-sperm antibodies can cause fertility problems by causing sperm to clump together (called “agglutination”).  Because the sperm are all stuck together, they do not swim well and cannot effectively make their way up the fallopian tubes where fertilization takes place.  However, the majority (95%) of men do have any negative impact of anti-sperm antibodies on their post-reversal fertility.  There is no way to predict beforehand which men will fall into the 5% who will have anti-sperm antibody problems, and their presence is not known until clumping of sperm is seen on post-reversal semen analysis testing.  Potential treatments for clinically significant anti-sperm antibodies include sperm washing and short courses of corticosteroids (such as prednisone).


Myth #3 - Sperm production temporarily stops following a vasectomy

A common misconception is that after a man has a vasectomy, he stops producing sperm.  Actually, a man continues to make sperm and these sperm are reabsorbed by the body (usually in the epididymis).


Myth #4 - Couples should not try to conceive right after a vasectomy reversal

I commonly get asked if getting pregnant right after a vasectomy reversal risks fertilizing an egg with “old” or defective sperm that can increase the odds of birth defects or a less healthy child.  This is not the case.  As it relates to Myth #3, new sperm are constantly being made and then reabsorbed by the body, so men do not have sperm that are several years old still in their system.  Also, the journey to reach the egg high up in the fallopian tube is extremely difficult, and fewer than 0.1% of sperm actually achieve this goal.  Only the strongest, best-swimming sperm make it to the egg.  Right after a reversal, the sperm that are a little older and in the process of being broken down quickly lose their motility, and are not going to be in the “elite” group of swimmers that actually make it to the egg.  Accordingly, there is no good evidence that an early pregnancy following a vasectomy reversal is associated with an increased risk of miscarriage, birth defects, or health problems in children.


Myth #5 - Some vasectomies are not reversible because of how they were performed 

I have lost count of the number of patients who were originally told by their urologist that their vasectomy was performed in a way that was not reversible, but then went on to have a successful reversal.  Whether it is any combination of the ends being cauterized (burned), blocked with metal clips, or an extra large piece taken out, it is extremely rare for a vasectomy to be performed in a way that is not able to be repaired by a trained microsurgical reversal expert.