Indications

 

click to enlarge

Reanastomosis is performed under general anaesthetic and you will spend one or two nights in hospital after the operation, on the ward in UZ Brussel.

   
Indications

If you have previously had a vasectomy and decide at a later stage of your life that you would like more children after all, perhaps with a new partner, then a vasectomy reversal operation could be the answer. Alternatively, a sperm extraction operation, such as FNA or TESE would be a simpler option, when performed as part of an IVF-treatment with ICSI.

You may well ask then, why undergo a reversal operation, when alternative techniques exist and provide good results?

Firstly because reanastomosis restores your fertility and you will not be dependent on assisted reproduction techniques to be able to father children. Secondly, because even a sperm whose quality is not optimal, obtained from a normal ejaculation following a reversal operation, for use in ICSI will be of a better quality than a sperm obtained surgically directly from the testicle. 
Incidentally, sperm can be harvested during the reversal procedure itself and stored for later use, should the operation not be successful.

   
Preliminary investigations

Up to 50% of men who have a vasectomy develop antibodies against their own sperm. This causes the sperm to adhere to one another and become immotile. The presence of these antibodies dictates whether or not you would benefit from a reversal operation. Therefore, before the operation, you will undergo a series of immunological analysis to determine whether there are antibodies present. This way a more realistic prognosis can be made regarding your fertility after the operation.  

However, reanastomosis is, even if antibodies are present, preferable to any sperm extracting technique. That is unless your partner has an important fertility problem as well.

    

Vaso-vasostomy (vas to vas) [operation, day case]

During this operation, the two severed ends of the vas deferens are joined back together through an incision in the scrotum. This is done on both sides.

It is first checked as to whether there is sperm in the end of vas deferens which starts in the epididymis. If this is the case, then it can be assumed that there are no obstructions between the testicle and that point, which increases the chances of the operation being a success to 90%. This success rate only concerns the chances of the re-connection being successful. The chances of a pregnancy occurring after the operation are around 60% if your partner is younger than 35 years old.

 

     

Vaso-epididymostomy (Vas to epididymis) [operation, hospitalization]

If there is an absence of sperm cells in the end of the vas deferens which comes from the epididymis, it can indicate a blockage in that area. The epididymis consists of 30 metres of tightly coiled tubules. Under the high pressure of sperm production, sperm cells can pile up and cause an obstruction. A swollen epididymis can result.

In this case the surgeon will attempt to connect the other end of the vas to a point beyond the blockage.
Technically, this operation is more difficult because a connection has to be made between a tube with a miniscule diameter (the coiled tubule of the epididymis) and the vas which has a much bigger diameter.
This method of reanastomosis has a smaller chance of being successful. Just one case in four results in a restoration of sperm flow through the vas deferens.

The procedure is sometimes performed to repair a blockage caused by infections such as chlamydia (see STD's and infertility).