Why do vasectomy reversals fail?

The ultimate measure of success in vasectomy reversal surgery is a pregnancy. There are several reasons why vasectomy reversals fail to achieve this goal:

1. A pregnancy involves two partners. Although the count and quality of sperm may be high after vasectomy reversal surgery, female fertility factors may play an indirect role in pregnancy success and the reason for failure. Dr. Turek recommends that female partners age >35 years old consider a female factor evaluation to determine if they have adequate reproductive potential before a vasectomy reversal is undertaken. This evaluation can be done by a gynecologist and should include a cycle day 3 FSH and estradiol levels, an assessment of menstrual cycle regularity, and a hysterosalpingogram to evaluate for fibroids. Advanced maternal age is a common reason for vasectomy reversal failure.

2. A man without prior paternity before vasectomy may have abnormal sperm quality before the vasectomy. This could be a reason why semen quality after vasectomy reversal surgery is low and a reason for pregnancy failure. A physical examination and a blood test before the vasectomy reversal can inform Dr. Turek of the possibility that impaired sperm production is present and eliminate this reason for failure.

3. Approximately 30%-60% of men with vasectomies develop a reaction against their sperm (i.e. antisperm antibodies). High levels of these proteins directed against sperm may impair fertility, either by making it hard for sperm to swim to the egg or by interrupting the way the sperm must interact with the egg. Sperm bound antibodies can be a reason for vasectomy reversal failure and are usually assessed >6 months after the vasectomy reversal if no pregnancy has ensued. Treatment options include steroid treatment, intrauterine insemination (IUI) and in vitro fertilization (IVF) techniques.

4. Occasionally, scar tissue develops at the site where the vas deferens is reconnected, causing a blockage. In Dr. Turek’s vasectomy reversal procedure, this occurs in 5% of vasovasostomies and up to 15% of epididymovasostomies. Depending on when it occurs, it can be a reason for failure to achieve a pregnancy. It may be treated with anti-inflammatory medication or could necessitate repeat vasectomy reversal surgery.

5. If an epididymal blowout has occurred and is not discovered at the time of vasectomy reversal surgery, the vasectomy reversal will likely fail. In this case, an epididymovasostomy would need to be performed.

6. In certain patients, when the vas deferens has been blocked for a long time, the epididymis is adversely affected. Remember, sperm are nurtured to maturity within the normal epididymis. In these individuals, sperm counts may be normal, but sperm movement may be poor after vasectomy reversal. This is why Dr. Turek recommends antioxidants vitamins (A, C and E) or other supplements after vasectomy reversal surgery. Most patients will gradually recover from epididymal dysfunction. Those patients whose sperm continue to have problems may require IVF to achieve a pregnancy.

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