Second Attempt After Unsuccessful Vasectomy Reversal

Success rate for vasectomy reversal is generally reported in two ways: sperm recovery rate (patency success rate) and pregnancy rate. Patency rate refers to the likelihood of the vas deferens remaining open and providing unobstructed flow of sperm cells. High patency rate means that flow is unobstructed and sperm has a high likelihood of returning to the seminal fluid. Pregnancy rates are always lower than patency rates, as there are multiple factors that affect pregnancy.

The single most important factor in whether a vasectomy reversal procedure will be successful is the interval in time (years) between vasectomy and vasectomy reversal. Primary failure after a vasectomy reversal means no sperm is seen in the post semen analysis tests. If the sperms showed up in the initial semen analysis after the procedure, but is not seen in the follow up semen analysis, it is called secondary vasovasostomy failure.

If you have been frustrated and disappointed with an unsuccessful vasectomy reversal, you may want to ask a microsurgeon whether another attempt might be worth it.

In general, first-time vasovasostomy failures often occur in patients that are more prone to develop heavier scars, which can narrow at the location of the reversal. In some cases, the tissue in the ends of vas deferens could be dead due to ischemia. Other reasons include an undetected epididymal blockage and epididymal dysfunction. Of course, the surgeon’s experience and techniques matters. This is why it is particularly important to choose your surgeon carefully. The success rates for a second reversal are slightly lower than for first-time procedures.
Second-attempt Vasectomy Reversal Techniques

If the patients showed evidence of healthy sperm in their seminal fluid during the first reversal procedure, or had the positive result in the initial semen analysis, they are probably the good candidates for a repeat vasectomy reversal When the vas deferens appears healthy and doesn’t have a lot of scar tissue from the previous procedure, a surgeon will usually do another vasovasostomy, and the chances of a successful second attempt are fairly good.

If the vas fluid is not favorable and no sperm was seen, if the first reversal left the vas deferens too short, if injury to the vas deferens is more extensive, or if a surgeon believes that the epididymis is scarred or blocked, a vasectomy reversal re-do becomes more complicated. In some cases, the more effective approach is a vasoepididymostomy, which is a more complex procedure than a vasovasostomy. Dr.Shu doesn’t perform vasoepididymostomy, but he will refer you to see a urologist who performs vasoepididymostomy. In other cases, however, there are a number of effective alternatives to vasectomy reversal that are worth investigating, such as In vitro Fertilization (IVF), donor sperms, and adoption.

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