They sat down nervously in my office after we shook hands, primed with pen and notepad in hand like school kids before an exam. He was newly hitched, having just sorted out the four C’s of the diamond ring thing. The visit was to discuss vasectomy reversal. We dove right in. I took a thorough history to ensure that he was living what I call a “fertile lifestyle” that is so important for fertility two decades after his vasectomy. As a microsurgical Midas guy, I can properly fix the exhaust but if the engine isn’t running, well that’s a whole other issue. His exam in the office looked great too, so we moved on to a discussion of my procedure replete with a full-on PowerPoint presentation. I showed them charts and figures that outlined our published reversal success rates and finished the talk with what could (but has not!) gone wrong. As soon as I stopped talking, his partner quickly raised her hand and said: “This is great. I only have one question: How soon will I get pregnant?”
Key Puzzle Piece: Live Sperm following Vasectomy Reversal
What a great question! While the Web is dripping with information about vasectomy reversal patency (i.e. return of sperm to the ejaculate) and pregnancy rates, data about how quickly or not pregnancies will happen is as scarce as hen’s teeth. To make some headway on this relatively common question asked of me, I studied it. Figuring that since pregnancies occur only after the ejaculate harbors live sperm, I examined how quickly live sperm returns to the ejaculate in my series of vasectomy reversal patients. In my mind, time to patency has to be one of the key factors that drives time to pregnancy.
In our published study, we found that the vast majority (77{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497}) of men had motile ejaculated sperm within 3 months of having a vasectomy reversal. This reached 95{e60f258f32f4d0090826105a8a8e4487cca35cebb3251bd7e4de0ff6f7e40497} by 1 year. What this implies is that natural conceptions are possible (and occur) quite quickly after vasectomy reversal surgery. We also learned that return-of-sperm occurs differently with vasovasostomy procedures when compared to epididymovastomies, which are typically more complex. Here is a summary of expected time to natural pregnancies based on our research:
Bilateral vasovasostomy: 1-6 months
Vasovasostomy/epididymovasostomy: 4-9 months
Bilateral epididymovasostomy: 6-15 months
But there’s more. The shape of the conception curves after reversal surgery are relatively linear over time. That means that the likelihood of pregnancy is similar at each timepoint and there are no humps, lulls, or bumps in the path toward babyhood. And the final truth in all of this is that “normal” semen quality, as defined by a laboratory standard, is hardly ever needed for women to conceive after reversal surgery. Evolved over millions of years the reproductive process is incredibly efficient when it comes to working with sperm and needs very little to get the job done.
