Low majority of vasectomy reversals take

Tue., Dec. 23, 2014

Anthony L. Komaroff M.D.

DEAR DOCTOR K: I had a vasectomy many years ago. I’ve since remarried, and my new wife wants to have children. Can my vasectomy be reversed?

DEAR READER: Normally, sperm – the male reproductive cells that fertilize a woman’s egg – are made in the testicle. Sperm travel away from the testicle through a tube called the vas deferens. There are two vas deferens, one for each testicle on each side. The vas deferens connect with a reservoir where the sperm is held, ready to be ejaculated during sex. The sperm also mixes with secretions from the prostate gland that keep the sperm alive. When the sperm is ejaculated, it travels through another tube, the urethra, inside the penis.

A vasectomy cuts or blocks the vas deferens. Once the vas deferens are cut or blocked, sperm cannot pass from the testicle to the reservoir where semen and secretions from the prostate gland are stored.

During ejaculation, this sperm-containing fluid is ejected through the penis during orgasm. After a vasectomy, a man continues to have normal ejaculations of semen, but the ejaculate no longer contains sperm.

In a traditional vasectomy, the surgeon uses a scalpel to make small incisions in the skin of the scrotum near the base of the penis to reach both vas deferens. (The scrotum is the fleshy sac that contains the testicles.) The vas deferens are cut or blocked to prevent sperm from traveling. The incisions in the scrotum are then closed with two or three small stitches.

The other surgical option, no-scalpel vasectomy, is less invasive. The surgeon makes one or two punctures to access the vas deferens. The puncture is widened slightly, then the surgeon cuts or blocks each vas deferens. The puncture site can be covered with a tiny dressing. No stitches are needed.

A vasectomy is intended to produce permanent sterilization. Special microsurgery can reverse a vasectomy and restore fertility in some cases. Vasectomy reversal is a delicate, expensive procedure. And it is only successful in about 60 to 70 percent of cases.