Vasectomy reversal facts

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Are you considering a vasectomy reversal? Thousands of men undergo vasectomy each year as a permanent means of birth control, yet for some of these men life brings unexpected turns, which leads them to change their mind. For some, there is a strong desire to have another child a few years later. For others, there may be a tragic loss of a child. For many men, a new marriage brings a new opportunity for creating a family. Regardless of the circumstances, a vasectomy can be reversed.

When a man consents to undergo a vasectomy, he is usually instructed that the procedure should be considered to be permanent and irreversible. This is an appropriate admonishment, because a vasectomy reversal is not 100% guaranteed to work, and it is a significantly more complex operation than a vasectomy. Therefore, before undergoing a vasectomy, a man should be as sure as possible that he is finished having children. Nonetheless, even the most insightful, thoughtful decision can ultimately prove wrong. When that decision is a vasectomy, a man may still change his mind.

What is a vasectomy?

To understand the vasectomy reversal, it is important to understand the vasectomy. A vasectomy is the surgical removal of a small piece of the vas deferens. The vas deferens is the long narrow muscular tube through which sperm travel from the testicle to the urethra. It feels like a piece of undercooked spaghetti in each side of the scrotum. The sperm are produced in the testicle, and then they exit out the top of the testicle and into the epididymis. The epididymis is a very tiny, tightly coiled tubule, which runs along the back of the testicle from top to bottom.

It then turns a corner, heading back north towards the pelvis, and becomes the thicker, straighter vas deferens. During ejaculation, the muscular walls of the vas deferens tube contract to propel the sperm up to the urethra of the prostate. In the urethra, the sperm are then joined by fluids from the prostate and then ejaculated out of the penis.

When a vasectomy is performed, the doctor feels for these "pieces of spaghetti" and surgically removes a small segment of vas deferens from each side. The cut ends are then clipped, sutured or cauterized. Suddenly, the sperm can go no further than this new point of blockage.

So what happens to all the sperm?

What most men don't realize is that once the vasectomy is performed, sperm production does not stop! Ever! Unlike women, men produce their gametes (sperm) for their entire life. A vasectomy does not stop sperm production, rather it simply blocks the entry of sperm into the urethra. Like other cells, the blocked sperm are eventually broken down by the body and reabsorbed. New sperm are continually being produced. A variable amount of pressure can build up in the tubes behind the vasectomy scar. In some cases, so much pressure builds up that the tiny tubule of the epididymis can rupture. This is commonly referred to as an epididymal "blow out." If this happens, the site of the blow out develops scar tissue, and this actually becomes the new level of blockage to the sperm. This is neither painful or dangerous, but it is significant in that for a vasectomy reversal to be successful, it must be performed in such a way that bypasses this new level of blockage at the epididymal blow out site.

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