Washington Center for Reproductive Medicine

Male Infertility Vasectomy Reversal

A vasectomy reversal is a procedure commonly performed by urologists to reconnect a surgical severed vas deferens. Unfortunately, despite excellent surgical technique, and the best efforts of the surgeon, the procedure may not always result in a much wanted pregnancy. There are several reasons for vasectomy reversal failure:

  • The vas deferens may have been badly damaged at the time of the sterilization procedure and it is not possible to functionally reconnect the undamaged portion of the tube.
  •  There may be scarring around the anastomosis site.
  • The anastomosis may be patent, and sperm may be present in the ejaculate, however, it is extremely important to note that the longer a man has had a vasectomy, and the sperm lie dormant in the testicles, sperm proteins can enter the bloodstream causing the patient to develop antisperm antibodies.  These antisperm antibody cells coat the sperm and inhibit sperm function; notably, reducing motility and/or fertilizing capacity. This unfortunate scenario is quite common and reinforces the fact that although the technical aspect of the operation was a success, the patient can still be infertile.

In cases where antibodies have formed, we help couples achieve pregnancy by using in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI)

In IVF/ICSI, the female undergoes ovulation induction with FSH and once the eggs mature they are removed using ultrasound guided transvaginal egg retrieval.  Sperm are removed by making a small incision in the scrotum and directly aspirating them from the reproductive tract. The sperm are then used to fertilize the eggs in our IVF laboratory.

ICSI enables the sperm to fertilize the eggs despite very low numbers and/or antisperm antibodies that may be present in the ejaculate. We have helped many couples achieve pregnancy after a failed vasectomy reversal.  We also urge couples to consider IVF/ICSI and sperm aspiration after vasectomy if the vas deferens has been occluded for more than 2 years or if the male wishes to avoid more extensive surgery.

Oftentimes we can freeze extra sperm and use them at another time. Unfortunately, it is not possible to detect antisperm antibodies prior to vasectomy reversal as the cells are directly attached to the sperm.  We cannot predict who is at risk of developing this problem until after the operation is complete, which is a frustrating sequence of events.

In all cases, Dr. Kustin meets with each couple to thoroughly discuss their treatment options and develop a treatment plan that is most likely to result in success.







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