Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS
Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS

Technical Success Rates and Pregnancy

Technical Success Rates

The term, technical success, refers to ability to restore the the vas deferens and epididymis to their normal, open state, as they were before your vasectomy, allowing the passage of sperm from the testes. This is determined by the appearance and number of sperm found in a sperm count (semen analysis) after surgery. Historically, the best technical success rates have been obtained when there is no obstruction in the epididymis, allowing a vas-to-vas (VV) repair on both sides at the site of the original vasectomy.

As time passes after a vasectomy, the likelihood of obstruction in the epididymis increases—especially after 7-10 years. However, some men, even 15 or 20 years after vasectomy, do not develop such obstruction, and may therefore expect the better technical success rates a vas-to-vas repair affords. The increasing incidence of secondary epididymal obstruction with time is the most important reason that technical success rates tend to decline as the time after vasectomy increases. With increasing time after vasectomy, the increased pressure from the vasectomy may result in rupture and internal leakage of sperm in the epididymis, with resulting inflammation, scarring and blockage. This may occur on either side, or both. The blockage is microscopic, causes no symptoms as a rule, and cannot be detected on a physical examination before surgery. It can only be detected at the time of surgery. When epididymal blockage occurs, repair of the vasectomy site alone will fail—the vas must be connected to the epididymis directly, above the site of obstruction.

This procedure — called an epididymal repair or vasoepididymostomy (VE) — is one of the most technically demanding procedures in surgery, because of the exceedingly small and delicate nature of the epididymal tubule. It is a procedure which can only be performed successfully by a microsurgeon with extensive experience in such reconstructive surgery. Even in the hands of experienced microsurgeons, epididymal repair has a lower technical success rate than vas-to-vas repairs. This is due both to the extremely small size and fragile nature of the epididymal tubule, and because the obstruction sometimes occurs very close to the junction of the epididymis and testes, where it is very difficult to repair.

Pregnancy Rates

The goal for most patients undergoing reversal surgery is achieving pregnancy. Technical success—successfully reconstructing the duct system—is a prerequisite, of course. But not all men who undergo successful reversal surgery will be able to get their wives pregnant. The problem is reduced sperm quality due to alterations in the epididymis as a result of the original vasectomy.rnrnSperm normal spend about 6-8 weeks in the epididymis after they leave the testes, where they develop their fertility capability: the ability to swim—called motility—and the ability to penetrate and fertilize the egg (called capacitation). When a vasectomy is performed, the testes continues to manufacture sperm. These are released into the epididymis, where they will eventually break down and be reabsorbed. However, the increased pressure following vasectomy causes changes in the epididymal duct which affects the development of motility and capacitation. In general, the longer the time after vasectomy, the more pronounced these changes become.rnrnWhen a successful reversal is performed, sperm will be found in the seminal fluid in most cases within a short period of time. Sperm counts often rise to normal levels within months — although in some cases it can take quite a bit longer. However, in most men, the percentage of motile sperm remains very low at first, and may take a much longer time to recover. In some men, motility and capacitation remain poor permanently, preventing successful pregnancy.rnrnAs a result, pregnancy rates after reversal are lower than would be expected given the technical success rates, and tend to decline as the time after vasectomy increases.rnrnKeep in mind that there is does not appear to be any evidence for increased genetic abnormalities in sperm following vasectomy reversal — the incidence of miscarriage and birth defects following reversal are no different than that of the general population.rnrnYou may view the 25-year historical pregnancy rates for Dr. Finnerty”s patients here. Note that current techniques of epididymal reconstruction and understanding of the function of the epididymis in fertility are resulting in much greater success and fertility in recent years, and therefore these success rates are becoming somewhat dated.

Thank you for helping our dreams come true.
J.W., Atlanta
My wife and I would like to give you and your staff a hearty "thank you" for the professionalism and care given us...following my son''s departure to our heavenly Father. Your calming manner and assurance that we had a reasonable chance at reattaching my vas deferens, which might allow us to get pregnant, was at fruition soon after our stay in Tacoma. 14 days following the procedure, my wife ... had become pregnant!. We lost our first son, and Dr. Finnerty, touched by God, enabled us to have another son ...
J.G., Washington
A child is God''s most precious gift. We joyfully announce the birth of our son.
J.C., Idaho
We have been so excited about our new son and he has been such a joyous addition to our family ... Thank you so much for your devotion and belief in vasectomy reversal, we have been so blessed by our little guy. Of course, he can never take the place of our daughter who died, but he sure brings new joy to us ... Again, thank you for all you did! We have been so blessed....
M.M., Camas, WA
Easter blessings to you and your family from us. We are having a special celebration and invite you to join us -- we celebrate the life of our new daughter.
C.K., California
The reversal surgery was a great success! We are sorry we didn''t contact you sooner. Thank you again for your willingness to provide such a special service for families.
M.F., California
We were very excited to learn just before Christmas that the surgery was a success. We saved the news for out kids until Christmas Eve and what a blessing their reaction was, it couldn''t have been a better Christmas present! We do thank you so much for providing your services at realistic fees, we could never have done it had there not been options other than what we found locally.
T.S., California
Our family now has 7 blessings, 3 of which you had a very special part in. Thank you!
G.S., Alaska
Thank you again for making possible the blessings God had in store for us in the way of children ...
T.P., Minnesota
My husband had a vasectomy reversal four and one-half years ago performed by Dr. Finnerty. Three and one half years after, we were able to conceive a child. Our daughter is such a constant joy in our lives.
C.J., California
We wanted to share our delightful news with you. We were blessed with a beautiful baby daughter in October.
D.W, Oregon
Our child is a true gift from God. God bless you for turning my vasectomy around after 30 years with so much care and love. We will always love you.
J.C., Tennessee
A little over 5 years ago, my husband and I flew from Chicago to your office to have his vasectomy reversed. We both want you to know how grateful we are -- to you, to your staff, and for your expertise. Since the surgery, we have had Michael (almost 4!) and Mary Jo (10 months) ... We feel it is important for you to know what a difference you made in our lives, and what an awesome grace it was to have you as our surgeon. Words cannot convey how much we appreciate what you have made possible for us -- we will be eternally grateful!
C. & K.P., Chicago
My husband had his vasectomy nearly 13 years before the reversal, which resulted in the birth of our daughter.
R.B., California
I am writing to send our heartfelt thanks to you for your expertise. On September 9th, you performed my husband''s procedure. Three weeks later, we conceived our first daughter. She was born exactly 43 weeks post-op. Since then, we have welcomed a son and also another daughter. We''ll always be grateful.
M.H., Vancouver, WA