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Building Bridges to Conception

Vasectomy Reversal

By Jessica Williams

A vasectomy is a simple procedure. It generally is done in a urologist's office under local anesthesia and only takes about 20 minutes. Simple. A reversal, on the other hand, can take hours of reconstruction and repair under the powerful magnification of the surgeon's microscope. Some research claims that a reversal is more successful if it is performed soon after the original vasectomy was done. But, there are always exceptions to the rule: A man who had a vasectomy 15 years ago may have better luck than a man who had his two years ago. It all depends on what type and quality of vasectomy was performed, what damage, if any, was done to the epididymis and vas deferens (the tube that was cut during vasectomy), what the man's fertility was like before the vasectomy and the skill of the surgeon. And don't forget luck. There are thousands of couples out there who are infertile for "unknown reasons," so even if everything looks good on paper, it doesn't guarantee success.

The reversal is a complex surgery with little room for error. Dr. Sherman J. Silber, who performed the world's first successful microsurgical vasectomy reversal, wrote about how microsurgery is the key to success in his book, "How Not to Get Pregnant." He developed suture that is invisible to the naked eye just for this procedure. To understand how some cases can be so complex, consider the importance of the tiny epididymis and how its integrity is vital to restoring fertility.

The epididymis is a coiled, microscopic tubule that carries sperm from the testicle into the vas deferens. This 20-foot long tubule is coiled up into the length of about one inch and is very fragile. A common occurrence in men with vasectomies is what Dr. Silber calls "epididymis blowouts." Basically, when a surgeon or urologist cuts the vas deferens during the vasectomy then cauterizes the part of the vas that is still attached to the testicle, sperm backs up and eventually blows microscopic holes in the epididymis. The repair to the epididymis can be excruciatingly difficult.