Can a vasectomy be reversed? What men need to know

For many men, a vasectomy is an effective permanent form of contraception. But what happens if life circumstances change and children are desired?

Joseph Caputo, MD, a urologist specializing in men’s health and infertility, explains that, yes, a vasectomy can be reversed, but the decision is far more complicated than most men realize.

"One of the most important conversations to have before performing a vasectomy is clarifying that it should be considered a permanent form of contraception, not a temporary one,” says Dr. Caputo. “The procedure alters a man’s reproductive anatomy, so he should only undergo a vasectomy when he’s sure he doesn’t want biological children later in life.”

What is a vasectomy?

A vasectomy is a minor outpatient procedure that prevents sperm from getting into the ejaculate. During the procedure, the vas deferens — which are the tubes that carry sperm from the testicles — are cut and closed off. The procedure does not affect sexual function otherwise and is low risk overall.

How is a vasectomy reversed?

A vasectomy reversal reconnects the vas deferens so sperm can enter the ejaculate once again. However, a reversal is significantly more complex than a vasectomy, pregnancy isn’t guaranteed, and it is not covered by most insurance plans.

Are vasectomy reversals successful?

When referring to the success of a vasectomy reversal, it is important to distinguish between success in returning sperm to the ejaculate and success in achieving conception, as these are two different measures.

Success rates of returning sperm to the ejaculate after reversal surgery are typically above 90%, especially when performed within five to 10 years after vasectomy. But returning sperm to the ejaculate doesn't automatically mean pregnancy success, which is the goal.

The main factors that affect the success rate of fertility after a reversal include:

• The age of the female patient
• How long ago the vasectomy was performed
• The man’s overall health and sperm quality
• The woman’s overall health and egg quality

Is there an age limit?

There is no age cutoff for vasectomy reversal, but fertility declines with age in both men and women.

In fact, Dr. Caputo says that the female partner's age is one of the strongest predictors for whether a couple will successfully conceive after a reversal.

“The ideal male candidate is under age 40, in good overall health, with less than 10 years since his vasectomy,” says Dr. Caputo. “Of course, if it’s been more than 10 years or the man is over age 40, a reversal can still be performed, but success rates are typically lower.”

Are there alternatives to a reversal?

Dr. Caputo says that for certain couples, alternative options exist, including sperm retrieval (an office procedure) for use in in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Adoption and sperm donation are also options to consider.

“A vasectomy reversal can restore fertility for many men, but it’s not a guarantee for conception,” says Dr. Caputo. “I advise men to approach vasectomy as a permanent decision. If circumstances change later in life, reversal and assisted reproductive options are available.”

If you're considering a vasectomy reversal, the first step is to meet with a urologist who specializes in male infertility and microsurgery.