Influences on the success of vasectomy reversal
There are several factors which influence the results of vasectomy reversal surgery. The most important in determining whether sperm are present after surgery are how long ago your vasectomy was, the nature of your vasectomy and whether or not you have undergone prior sperm extraction procedures for IVF. However, the most important factor influencing chance of pregnancy each month is your partners age.
How long ago was your vasectomy?
The more recent your vasectomy the better the chance of sperm following vasectomy reversal. Results exceed 95% if your vasectomy was less than 3 years ago but encouragingly are still more than 70% if it was more than 15 years ago.
Type of vasectomy
There are numerous ways of performing vasectomy and generally the type of vasectomy has only a minor influence on reversibility. If however, the vasectomy site is close to the testis this can lead to damage the epididymis and make vasectomy reversal more challenging to perform - leading to the need to undertake a vaso-epididymostomy (joining vas deferens directly to epididymis). In this case the continued patency is lower as effectively a big pipe has been joined to a small pipe. If a large portion of the vas deferens has been removed or the vasectomy was high in your groin reanastomosis is also less likely to be achieved.
IVF sperm extraction
When sperm extraction procedures have been performed to obtain sperm for IVF prior to vasectomy reversal, patency rates (the presence of sperm after vasectomy reversal) are reduced. The procedures are epididymal sperm aspiration (PESA), testicular needle aspiration (TESE) and open testicular biopsy.
When PESA procedures have previously been attempted (on both sides) post-vasectomy reversal patency rates are less than 30%.
The American Society of Reproductive Medicine no longer recommends testing for sperm antibodies prior to vasectomy reversal as the results are neither sufficiently reliable nor specific in predicting who will and who won't have fertility restored following surgery
Ultrasound is a very poor predictor of successful vasectomy reversal. The American Society of Reproductive Medicine does not recommend its use prior to vasectomy reversal as the results are generally misleading.
Female age is the single most important factor influencing pregnancy rates and take home baby rates following vasectomy reversal with the younger your partner the higher the chance of successful pregnancy.
If your partner has a history of serious gynaecological problems such as fallopian tube infection, endometriosis or damage to her ovaries this may reduce pregnancy rates following vasectomy reversal.