Time since your vasectomy
There is little doubt that the length of time since your vasectomy is an important factor influencing the ultimate success of your vasectomy reversal. The longer the duration of time since vasectomy; the lower the overall chance of achieving a pregnancy. Scientific studies vary in their reported effect on outcome. For the average patient fully trained reproductive microsurgeons such as myself achieve patency rates of the Vas Deferens in excess of 95% (as measured by sperm being present in semen), there is however an obvious decline in pregnancy rates when the vasectomy was performed more than 15 years prior to the reversal. This effect becomes quite marked beyond 20 years.
Reasons for vasectomy reversal
Achieving a pregnancy is obviously by far the most common reason for wishing to have a vasectomy reversal - but it is not the only one. Long-term pain following prior vasectomy, while uncommon, does occur (so called Post-Vasectomy Syndrome). Vasectomy reversal has a greater than 70% chance or relieving or reducing such pain and is a worthwhile indication. On the other hand there is no evidence that physical sexual dysfunction is caused by vasectomy - so reversal will have no beneficial effect.
Age
Obviously the older you are the more likelihood that you may have some additional medical problem that may influence the safety of surgery or the chance of complications. In addition, many people will think about the difference in age between parent and child as they get older.
Your partner’s age and health
The prospect of successful pregnancy dramatically declines with female age. For healthy previously fertile women over the age of 40 years the total probability of successful pregnancy is not greater than 50%. Indeed miscarriage rates at age 40 approach 40%.
Medical history
It is important to be aware of your general state of health prior to any surgical procedure. There are a variety of conditions that may affect the outcome of your operation. In particular any trauma, infection or disease involving the scrotum, penis, prostate gland or pelvic organs. Cardiovascular, respiratory and neurological disease may also be of major significance for your anaesthetic. Smoking has been shown to reduce fertility by affecting sperm function as a result of toxins. Please ensure that I am made fully aware of your past medical history at the time of your pre-operative consultation.
Pre-operative testing
Provided that you are in good general health, no specific or unique testing is required prior to your operation.
In particular, there are some who suggest that pre-operative scrotal ultrasound is of benefit in planning vasectomy reversal. This is simply incorrect. The only way to accurately assess whether microsurgical vasectomy reversal is feasible is to surgically explore the scrotum. In this context ultrasound is a waste of time and money, as fortunately, with or without pre-operative ultrasound, it is technically possible to microsurgically reanastomose both vas deferens in more than 99% of cases.
Sperm antibodies
Sperm antibodies are produced after exposure of sperm to the immune system. About 60% of men develop sperm antibodies in their blood following vasectomy. It has been proposed by some that the presence of high-level sperm antibodies may reduce pregnancy rates following vasectomy reversal. However, the presence of sperm antibodies in the blood is not closely associated with pregnancy following reversal and so the value of testing for sperm antibodies pre-operatively is both controversial and unproven. There are many other more important factors listed here.