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%

Vas-to-vas connection on each side

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75-80%

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 $12,000 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.