Vasectomy is an intervention that many men undergo to remain sterile and, therefore, avoid pregnancy. Although vasectomy is considered a permanent contraceptive method, there is the possibility of reversal. Even with this, the natural pregnancy is not always achieved.
In the event that reversal is not possible or does not allow recovery of seminal quality, assisted reproduction offers other possible solutions to achieve pregnancy after vasectomy.
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Becoming a father again
Vasectomy consists of blocking the vas deferens so that the sperm, produced in the testicle, cannot form part of the ejaculate. If there is no expulsion of sperm during ejaculation, pregnancy will not occur.
This permanent male sterilization intervention is usually recommended only to those men who are clear that they do not want to have more children. However, due to different life circumstances (change of partner, change of priorities, etc.), a man may change his mind. For this reason, many men wonder if they can be a father after undergoing the vasectomy procedure.
The answer is yes. When a man has a vasectomy, he continues to produce sperm, only they can't get out because the path they have to follow to the outside is blocked. Therefore, if we unblock or allow the passage again, in principle, fertility will be recovered and pregnancy would be possible. This procedure to try to restore fertility after vasectomy is what is known as vasectomy reversal or vasovasostomy.
What is Vasovasostomy?
This is a surgical procedure that consists of rejoining the ends of the vas deferens that were blocked during the vasectomy. In this way, the spermatozoa are allowed to form part of the ejaculate and, with this, the possibility of a natural pregnancy is reopened. Vasovasostomy is a complex surgery that lasts about two hours, although the patient does not feel pain since it is performed under anesthesia.
First of all, we must keep in mind that, even if the reversal procedure is successful, it is not certain that the man will be able to conceive a child naturally. There is a certain probability that the seminal quality will not be good, or at least not good enough to achieve fertilization.
The chances of getting pregnant naturally after a vasectomy reversal or vasovasostomy are about 64%.
Also, it may happen that the procedure is unsuccessful: The passage of sperm through the vasa deferentia continues being blocked. Actually, the chances for this technique to be successful depend on the way in which the ends of the vasa deferentia were sealed, as well as the expertise of the surgeon who performed it.
Vasovasostomy results
The time that has elapsed since the vasectomy was performed greatly influences the probability of natural childbearing. The less time has passed since the vasectomy, the greater the probability of regaining fertility.
Thus, in patients who have had a vasectomy for more than 15 years, the probability of pregnancy after vasovasostomy is low. On the other hand, 90% of men who have had a vasectomy in the last 5 years have recovered their fertility after reversal.
To check if the vasectomy reversal operation has been successful, it is necessary to perform several serial semen analyses. In this way, we can study if spermatozoa appear again in the ejaculate.
The first seminogram is performed 2-3 months after the operation. From here, the seminogram is repeated every 2-3 months until the number of sperm is considered normal or pregnancy is achieved.
Pregnancy is usually achieved 12 months after performing the vasectomy reversal. However, sometimes the time may be longer and some fertility treatment may even be necessary to achieve paternity.
Other vasectomy pregnancy options
Although vasovasostomy is a possible solution for men who want to become fathers after vasectomy, there are other options. Assisted reproduction offers other alternatives to fatherhood.
Each of them is discussed below.
Vasoepididymostomy
A less common alternative to vasovasostomy is vasoepididymostomy. This is a much more complicated procedure that is performed when vasovasostomy has not worked or when there is no possibility of performing it.
Vasoepidididymostomy consists of joining one of the ends of the vas deferens directly to the epididymis. This procedure usually lasts about 5 hours and is approximately 40% effective.
As with vasovasostomy, it is necessary to wait about 12-15 months to find sperm in the ejaculate after this procedure. If this is not possible, the surgery can be repeated, although the probability of success is reduced compared to the first time.
Regarding recovery, the patient will be able to return to his daily routine and have sexual relations after a few weeks. However, it is not recommended to pick up heavy objects. In addition, the man can use ice packs to help reduce swelling in the area.
Sperm aspiration
This is a low complexity surgical procedure in which spermatozoa are extracted by aspiration directly from the epididymis or testicle.
This procedure consists of puncturing the epididymis or testicle and aspirating the contents inside. Then, in the laboratory, spermatozoa are sought in the liquid obtained and one per egg is microinjected using the ICSI technique (intracytoplasmic sperm injection). The viable embryos obtained can then be transferred to the uterus of the partner of the male who underwent the vasectomy.
If you want more information on this subject, I recommend you consult this article: What is Epididymal sperm aspiration? Procedure and Techniques.
Testicular biopsy
This technique consists of extracting a small portion of the testicle in order to find sperm that can be used to fertilize the egg using the ICSI technique.
Testicular biopsy is very similar to sperm aspiration. The only difference is that instead of aspiration, an incision is made in the testicle and a small piece is removed. This procedure is performed under local anesthesia and takes approximately 15 to 20 minutes.
Want to learn more about this method? Check this article out: What Is a Testicular Biopsy?
Sperm freezing
Another option offered to men who are going to have a vasectomy is to freeze a semen sample prior to sterilization. In this way, if, after some time, the patient wants to become a father again, he will be able to use this sample to apply an assisted reproduction process.
Depending on the quality of the semen after thawing, artificial insemination (AI), conventional in vitro fertilization (IVF) or sperm microinjection (ICSI) will be indicated.
Sperm donation
The option of resorting to donor sperm is generally the last alternative, since it implies the renunciation of genetic inheritance. In any case, it is one more way and may be the only one when the previously mentioned techniques fail.
If you want to learn more about this fertility option, do not hesitate to visit the following post: How Does Sperm Donation Work?
Costs
All the options mentioned throughout this post require the couple to undergo fertility treatment, even if the woman does not have any issues related to her fertility.
Cost in the USA
If you opt for an epididymal aspiration or a testicular biopsy, it is required that the woman undergoes ovarian stimulation, followed by ovum pick-up (egg retrieval), and finally, fertilization occurs by means of ICSI. The overall cost of this procedure ranges from $4,000 to 6,000 on average, without including medications.
On the other hand, sperm freezing is a more cost-affordable option: between $350 and $450. If you produce high-quality sperm, pregnancy is likely to occur by IUI. The average price of IUI with the husband's sperm is $500-1,000.
With donor sperm, the cost of intrauterine insemination would be higher—around $1,000-3,000 depending on the fertility clinic chosen.
If you need to undergo IVF to become a mother, we recommend that you generate your Fertility Report now. In 3 simple steps, it will show you a list of clinics that fit your preferences and meet our strict quality criteria. Moreover, you will receive a report via email with useful tips to visit a fertility clinic for the first time.
Cost in the UK
All the options mentioned throughout this post require the couple to undergo fertility treatment, even if the woman does not have any issues related to her fertility.
It should be clear that vasectomy reversal is rarely available on the NHS, and the operation can be quite expensive if done privately—about £2,800 on average.
If you opt for an epididymal aspiration or a testicular biopsy, it is required that the woman undergoes ovarian stimulation, followed by ovum pick-up (egg retrieval). Finally, fertilization occurs thanks to ICSI. The overall cost of this procedure ranges starts from around £5,000. This price does not include medications, which can add up to £1,500 or so more. Again, IVF after vasectomy may not be available on the NHS.
On the other hand, sperm freezing is a more cost-affordable option: The average annual cost is £175-£450. If you produce high-quality sperm, pregnancy is likely to occur by IUI. However, you will have to do it privately (starting from £800 to £1,300), as the NHS does not include this as an indication for covering IUI procedures.
With donor sperm, the cost of intrauterine insemination would be higher—around £3,000 depending on the fertility clinic chosen.
FAQs from users
Can I get pregnant if my husband had a vasectomy 10 years ago?
If the vasectomy was done properly, the chances of getting pregnant are almost non-existent. In any case, it is usually confirmed after several seminograms in a row. Should the result of all of them confirm the total absence of sperm in the ejaculate (zero sperm count), we can say that you can't get pregnant naturally if your husband had a vasectomy 10 years ago.
Why is ICSI the only technique that can be used in cases of testicular biopsy?
In cases of testicular biopsy, ICSI must be used as an oocyte insemination technique, because these are immature spermatozoa that have not matured physiologically on their way to the epididymis. Moreover, the sperm count after the biopsy is usually low, insufficient for artificial insemination or conventional IVF.
Are there cases of pregnancy with vasectomy?
Yes, there are cases of poorly performed vasectomies that have resulted in pregnancy. For this reason, it is essential to perform several seminograms, in different months, to confirm the absence of spermatozoa in the ejaculate.
In any case, this is something exceptional, since advances in surgery make it possible to obtain the desired results through vasectomy.
What are the risks of vasovasostomy?
Vasovasostomy is an intervention that rarely leads to alarming complications. Despite this, the possible risks that could arise are:
- Bleeding from the scrotum
- Infection (something that can happen in any surgery)
- Persistent pain
How is the recovery from vasovasostomy?
When a male undergoes a vasectomy reversal, he may feel discomfort for 2-3 weeks after the intervention. Therefore, the specialist will prescribe some painkillers.
However, the patient will be able to continue with his daily routine 3-4 days after the vasectomy, avoiding work involving great physical effort, driving, and sports.
In addition, it is recommended not to have sexual intercourse until at least 10 days after the vasovasoctomy.
When will I have sperm after a vasectomy reversal?
After a vasovasostomy, it is necessary to perform seminograms every two or three months to evaluate the number of spermatozoa in the ejaculate. Normally the patient recovers his total sperm concentration after a few months.
There are men who have good sperm values 3 months after the reversal, while others have to wait a year.
Recommended readings
As we have just read, vasectomy reversal surgery or vasovasostomy is not always effective. For this reason, you should think about it twice before deciding that you will not want more children in the future. To help you make such a decision, we recommend that you read carefully the following post: What Is Vasectomy & What Does It Involve?
Finally, in case a vasectomy reversal does not give you the possibility of becoming a father again, you can be sure that there's a fertility treatment that can allow you to achieve it. To learn about the different techniques available nowadays, click here: What Are Infertility Treatments? – Definition, Types & Costs.
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References
Ahmad Majzoub, Nicholas N Tadros, A Scott Polackwich, Rakesh Sharma, Ashok Agarwal, Edmund Sabanegh Jr. Vasectomy reversal semen analysis: new reference ranges predict pregnancy. Fertil Steril. 2017 Apr;107(4):911-915. doi: 10.1016/j.fertnstert.2017.01.018. Epub 2017 Mar 7 (See)
Catherine Deneux-Tharaux, Erum Kahn, Hanif Nazerali, David C Sokal. Pregnancy rates after vasectomy: a survey of US urologists. Contraception. 2004 May;69(5):401-6. doi: 10.1016/j.contraception.2003.12.009
Denise J Jamieson, Caroline Costello, James Trussell, Susan D Hillis, Polly A Marchbanks, Herbert B Peterson, US Collaborative Review of Sterilization Working Group. The risk of pregnancy after vasectomy. Obstet Gynecol. 2004 May;103(5 Pt 1):848-50. doi: 10.1097/01.AOG.0000123246.11511.e4
Edward R Gerrard Jr, Jay I Sandlow, Robert A Oster, John R Burns, Lyndon C Box, Peter N Kolettis. Effect of female partner age on pregnancy rates after vasectomy reversal. Fertil Steril. 2007 Jun;87(6):1340-4. doi: 10.1016/j.fertnstert.2006.11.038 (See)
Joyce van Dongen, Fetene B Tekle, J Herman van Roijen. Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post-surgical use of assisted reproductive techniques. BJU Int. 2012 Aug;110(4):562-7. doi: 10.1111/j.1464-410X.2011.10781.x. Epub 2012 Jan 5
Valerie Uvin, S De Brucker, M De Brucker, V Vloeberghs, P Drakopoulos, S Santos-Ribeiro, H Tournaye. Pregnancy after vasectomy: surgical reversal or assisted reproduction? Hum Reprod. 2018 Jul 1;33(7):1218-1227. doi: 10.1093/humrep/dey101 (See)
FAQs from users: 'Which fertility treatment is most recommendable in patients with a vasectomy?', 'Can I get pregnant if my husband had a vasectomy 10 years ago?', 'How soon can you get pregnant after a vasectomy reversal?', 'Why is ICSI the only technique that can be used in cases of testicular biopsy?', 'Are there cases of pregnancy with vasectomy?', 'How common is it to get pregnant after a vasectomy?', 'What are the average IVF success rates after vasectomy?', 'What are the risks of vasovasostomy?', 'Can you get pregnant after a vasectomy after a year?', 'Is IVF possible after tubal ligation and vasectomy?', 'How is the recovery from vasovasostomy?' and 'When will I have sperm after a vasectomy reversal?'.
Authors and contributors
More information about Cristina Algarra Goosman
Hi, my husband has just had a vasectomy. We’re from the US and our doc said this procedure can be reversed. It was just 3 weeks ago and just wondering if I could have fallen pregnant during this time frame… Thx
Dear Duox,
The first months after a vasectomy there’s still some failure risk, as it is possible for sperms to still be present on the seminal ducts of the man. My advice is that he goes for another semen analysis just to check if everything is going as expected, especially to check your husband’s sperm count. The risk of getting pregnant will disappear as soon as the sperm count is zero.
I hope this helps,
Best