Microscopic Vasectomy Reversals 

The goal of the vasectomy reversal procedure is to surgically re-establish the normal flow of sperm.  Factors that influence success rates include the type of connection needed (vas-to-vas vs. vas-to-epididymis) as well as the types of surgical techniques used.  Another factor is the man’s individual genetics, as some men are prone to form more or less scar tissue in this area as they heal. Sperm counts and quality often take time to improve following a reversal as the system adjusts to its new, non-obstructed environment.  Typically, sperm return to the ejaculate within the first 2 to 6 months following reversal surgery, but it can take longer or shorter amounts of time in individual circumstances.  

By the latest WHO criteria, normal sperm counts are defined as 15 million sperm/cc with a motility (% of sperm swimming) of greater than or equal to 40%.  Morphology (the % of sperm with perfectly normal shapes) is highly lab-dependent and its association with fertility outcomes is less clear.  The goal is to get the highest number of the best quality sperm possible for optimal rates of pregnancy.  As mentioned above, sperm are usually returning within the first 2 to 6 months, and the numbers and quality of sperm tend to improve over the first 6 to 12 months.

Dr. Russell's Success Rates

(defined as enough sperm returning to the ejaculate to allow a high chance of natural conception)
 

90-95%

Vas-to-vas connection on each side

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80-85%

Vas-to-vas on one side and vas-to-epididymis on the other side

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55-60%

Vas-to-epididymis on each side

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Patency & pregnancy rates.

The numbers listed above are the chances for sperm returning in good numbers and quality (called “patency”).  Some doctors list post-reversal success as the presence of “live motile sperm” or really low numbers like “1 or 2 million motile sperm”.  

The problem is that men who have less than 5 million motile sperm in their ejaculate generally need a $14,000 in-vitro fertilization procedure to establish a pregnancy.  If a man has sperm counts this low following a reversal, Dr. Russell does not consider that to be a “success”.  A successful reversal should result in returning enough sperm to the ejaculate to allow a high chance of conceiving naturally.

Predictions of actual natural pregnancy rates are always less accurate for a particular couple than patency rates (i.e. sperm returning in good numbers).  Patency rates indicate a technically successful procedure and relate only to the procedure performed and a man's natural (genetic) tendencies for scar tissue formation in the vasal area during the healing process.  On the other hand, natural pregnancy rates reflect a much more diverse range of factors, including potential female fertility issues which might be present and elements of chance associated with the process of natural conception.  In general, when sperm has returned in good numbers, then a couple can expect to conceive a child naturally around 2/3rds of the time, with a higher percent conceiving a child by adding assistance from the female side with such “low tech” treatments as Clomid and/or intrauterine inseminations.


Actual Reversal Outcomes Data

As discussed in the “How To Choose a Vasectomy Reversal Doctor” section of this website, the personal success rates that doctors claim cannot be truly validated and on-line reviews have the potential to be manipulated. However, good old-fashioned verifiable data is as close as it gets to the hard facts as possible. It is currently August 2019 (when I am updating this website section), and I thought that I would do a look-back at the outcomes of a month’s worth of my recent vasectomy reversal data. I decided to go back 6 months, as these patients should have had 2 semen analyses completed by this time. In the data chart, I have included the clinical activity of all of the working days of February 2019 (6 months ago) and all of the post-reversal semen analysis data that we have on file for the 6 months following the procedure.

In looking at the data, you will notice that some vasectomy reversal men have had only one semen analysis, and some have opted to have no testing at all performed during this time period. Admittedly, semen analysis testing is not something that most men generally look forward to doing! However, we try our best (including reminder phone calls) to have all of our post-reversal men get the initial 6 week semen analysis with repeat testing every 10 weeks until pregnancy. We feel that this post-reversal testing is important for 2 reasons. First of all, we like to have this data so that we can accurately track our reversal outcomes. The second reason is that there are other interventions that we can utilize after a reversal (such as courses of anti-inflammatories) that can potentially increase the chances of fertility success, and we do not know if we should use these interventions unless we are getting the feedback from the semen analysis numbers.


The following is my complete schedule of February 2019 Vasectomy Reversals, including the number of years since vasectomy, what type of reversal was performed, and follow-up semen analysis data. All of the Feb 2019 reversal patients who have had testing were contacted, and each has graciously agreed to allow their 6 months of post-reversal semen analysis data to be published on this website anonymously.


Notes on Semen Analysis Testing Following a Reversal

WHO 5th Edition Criteria: Normal sperm count is >/= 15 million sperm/cc. Normal sperm motility >/= 40%

Sperm counts and motility generally improve over the first 6 to 12 months following a reversal. The most common scenario is for sperm counts and motility to be initially low at 6 weeks post-reversal and then gradually improve with time. This increase in semen parameters is due to the subsiding of post-procedure inflammation following a reversal, which allows the sperm to more efficiently flow through the genital duct system. The rate at which this occurs can vary significantly between men.

Outcomes Data Feb 2019.png

Guide to Data Chart Abbreviations

VV = vasovasostomy

VE = vasoepididymostomy

Note: VV/VV is vasovasostomy on both sides, VE/VE is vasoepididymostomy on both sides, and VV/VE is vasovasostomy on one side, and vasoepididymostomy on the other