Reversing vasectomy.

Advances in surgical techniques have made the reversal of vasectomy a realistic prospect. Currently, some 3% of patients request the reversal of vasectomy. Reversal techniques include macroscopic vasovasostomy, vasovasostomy with optical loupe magnification, and microsurgical methods. All of these methods have demonstrated acceptable rates of patency and pregnancy. Common to the success of these methods is the accurate apposition of mucosa to mucosa. The results of uniting the straight segments of the vas are better than those obtained with vasoepididymostomy. Recent reports indicate up to 80% patency and 30% pregnancy rates after macrosurgical anastomosis and up to 90% patency and 40% pregnancy rates after microsurgery. Operation failure could result from the following: poor anastomotic surgical technique, infection leading to fibrosis, formation of anastomotic sperm and suture granulomas, more than 10 years elapsing between the vasectomy and the reversal, and the removal of either too long a portion of the vas or part of the convoluted portion of the vas during the initial vasectomy. Although uncommon, some complications during the reversal procedure have been reported. As the reports indicate, pregnancy and patency differ significantly. Several explanations exist: 1) semen quality after reversal may be poor; 2) a secondary anastomotic stricture in the vas may gradually develop; 3) pressure mediated local changes may affect the testis and epididymis; 4) there might be a an injury to the sympathetic nerve fibers in the vas sheath; 5) antibodies to sperm may be present. While reversal is possible, the article cautions that the public should not consider vasectomy a reversible method of birth control.