Vasectomy reversal: how it works, success rates and NHS availability

Success can mean two different things: the tubes being open (patency) or a pregnancy. Fertility Network UK says that after a vasovasostomy the vas deferens is clear and unblocked in 80 to 90% of cases by the end of the operation, but only 30 to 40% of patients achieve a pregnancy, and that even in the best hands pregnancy rates are less than 50%.

NHS inform and MyHealth Devon quote a success rate of about 55% if reversal is carried out within 10 years of the vasectomy, falling to 25% after more than 10 years. They add that even if a surgeon manages to join up the tubes, pregnancy may still not be possible.

Fertility Network UK explains that even if the tubes are open, not every couple will conceive, because semen quality after reversal may be poor and scar tissue can cause a further blockage. A poor outcome can be expected if more than ten years have passed since the vasectomy or if too much of the vas deferens was removed at the original operation. Results of vasoepididymostomy are less good than vasovasostomy, and repeat reversal attempts have a very low chance of success.

Reversal is not usually available on the NHS. NHS inform says it is not available on the NHS and that the operation is expensive if done privately. MyHealth Devon says reversal is not routinely funded by the NHS and has variable results, so vasectomy should be regarded as a permanent form of sterilisation for all practical purposes. Fertility Network UK says it is not normally offered on the NHS.

The sources reviewed describe reversal as generally unavailable on the NHS rather than setting out a national rule for exceptions, so ask your GP how your local integrated care board treats any request.

A vasectomy cuts and seals the tubes, called the vas deferens, that carry sperm from the testicles. Fertility Network UK explains that after a vasectomy the testes continue to produce sperm, which collect in the epididymis, where they can cause swelling, leakage and scar formation. A reversal operation tries to reconnect the tubes so that sperm can again reach the semen.

It is a different decision from the original operation. The NHS says that although it may be possible to reverse a vasectomy, it does not always work. Fertility Network UK points out that about 3% of men who have had a vasectomy later request a reversal, and that requests are more common if the vasectomy was done at a time of personal or emotional crisis or following divorce.

Fertility Network UK describes one or two vertical cuts made in the scrotum to expose the cut ends of the vas deferens. The surgeon may check whether sperm are present in the fluid that leaks from the end of the tube. If there are sperm, the ends are stitched together, a procedure called vasovasostomy. If there are none, there may be a blockage in the epididymis and a more complicated operation, vasoepididymostomy, may be needed, where the cut end of the vas deferens is joined to a minute tube within the epididymis.

Most operations need a general anaesthetic or a regional anaesthetic such as an epidural, although some are done under local anaesthetic. The operation can take up to three hours and can usually be done as a day case, but seven to ten days of convalescence is needed.

Fertility Network UK says that very rarely the testes may shrink because of damage to the blood supply at the time of the operation. The general risks of any operation under anaesthetic, such as bleeding, bruising and infection, apply. Seven to ten days of convalescence are needed to assist healing, and your surgeon will advise on pain relief, supportive underwear and when to avoid sport, heavy lifting and sex.

After the operation, semen samples are checked to see if sperm have returned. Fertility Network UK says sperm may appear up to a year after the operation, and that if they do not the reversal is unlikely to work. Some couples consider freezing sperm after reversal so that it can be used if the tubes block again.

In vitro fertilisation (IVF) may be considered if a couple does not get pregnant after reversal, and ICSI, where a single sperm is injected into an egg, can help achieve fertilisation, according to Fertility Network UK. It describes surgical sperm retrieval with ICSI as another option, and says sperm can be frozen after reversal.

Because options differ in cost, burden and likelihood of a baby, a conversation with a urologist and, if relevant, a fertility specialist about which route fits your circumstances, your partner's age and your timescale is more useful than comparing headline success rates.

NHS inform says you should be certain you do not want any, or any more, children and talk about it with your partner if you have one, and that you should not make the decision after a crisis or big change in your life. It adds that people under 30 are more likely to regret a vasectomy. MyHealth Devon lists factors linked with regret, including being under 30, having few or no children, an unstable relationship and insufficient time to consider the decision. If any apply, sperm storage or a different contraceptive may be worth discussing.

Because the NHS does not usually fund reversal, most men who proceed do so privately, with a urologist who carries out the operation regularly. Ask about the surgeon's experience with vasovasostomy and vasoepididymostomy, the unblocked-tube and pregnancy rates in their own practice, the cost including follow-up semen analyses, and what happens if the tubes re-block.