Trent and Amy's Story
“The positive warm feeling of the office radiates to your heart. Because of Dr. Haddad, we are able to fulfill our lifelong dream of becoming parents. We are ecstatic to report that we are expecting a beautiful baby girl in November.”
Tubal Reversal and Vasectomy Reversal FAQs
In the United States, more than 1 percent of surgically sterilized women and up to 6 percent of surgically sterilized men ultimately seek restoration of their fertility. If you or your partner have had a tubal ligation or a vasectomy in the past and currently desire to have more children, microsurgical tubal reversal (also known as microsurgical tubal anastomosis) or vasectomy reversal may provide a solution. In the interest of helping you to make educated decisions regarding your health and your fertility, we are pleased to provide you with a list of the most frequently asked questions regarding vasectomy reversal and tubal reversal procedures at our Houston, Texas-area fertility clinic.
Q: What is a tubal reversal?
A: A tubal reversal is a surgical procedure during which the segment of the tube that has been tied is removed and the remaining two segments are attached together with the aid of an operating microscope.
Q: Are both tubes "untied" during a tubal reversal?
A: Yes. More often than not, your doctor will be able to reverse the ligation on both your right and left tubes. Occasionally, one side may be heavily scarred from a previous tubal surgery, and, therefore, only the other side will be amenable for a tubal reversal. Very rarely are both sides heavily scarred and the operation unable to be performed.
Q: If both sides are heavily scarred, does it mean I cannot get pregnant?
A: No. You can always undergo in-vitro fertilization (IVF) and, therefore, "bypass" the tied tubes.
Q: How successful is tubal reversal?
A: Depending on which method was used to tie your tubes, the success of microsurgical tubal reversal is anywhere from 50 to 70 percent. Your chances may be higher if the remaining total length of the tube after it has been surgically mended is more than four centimeters (a little less than two inches). Most patients who get pregnant after microsurgical tubal reversal do so in the first six months following the surgery, although some patients may take longer to conceive. If only one tube is successfully untied, your odds of getting pregnant are not decreased, but the time it will take to get pregnant may be longer.
Q: How is the surgery performed?
A: Tubal reversal at our Houston, Texas-area fertility clinic is performed using one of two methods. The classical method involves a small "bikini-line incision," about five centimeters in length (or two inches). Patients undergoing this method of tubal reversal may need to stay overnight in the hospital and will most likely be discharged the next day. The other method is done laparoscopically, and it involves four very small incisions (one-half centimeter each). Patients are typically discharged the same day. Ask your doctor which method will suit you best.
Q: Is tubal reversal surgery good for one pregnancy only?
A: No. Once your tubes are successfully untied, you are able to get pregnant as many times as you wish. However, it is important to remember that if you desire to have only one child, you will need to use some form of contraception after you deliver.
Q: If I do not wish to undergo surgery, do I have any other options to get pregnant other than undergoing a tubal reversal surgery?
A: Yes. In-vitro fertilization (IVF) is the other option you have to increase your chances of getting pregnant. The physicians at Houston Fertility Institute will counsel you on whether tubal reversal surgery or IVF is best suited to your situation.
Q: If the male partner has had a vasectomy in the past, what are your options for getting pregnant?
A: Two options exist. The first is vasectomy reversal surgery, and the second is testicular sperm extraction followed by in-vitro fertilization (IVF). There are pros and cons associated with both procedures. The doctors at Houston Fertility Institute can advise you as to which procedure is best suited to your case. In most instances, IVF will offer higher chances of pregnancy in a significantly shorter period of time.
Q: What is vasectomy reversal surgery?
A: Vasectomy reversal is a micro-surgical procedure (performed using an operating microscope) that requires up to four hours of operating time. During the procedure, the tubes (vas deferens) are reconnected, allowing sperm to pass through again.
Q: What is the success rate of vasectomy reversal?
A: In general, the success rate of vasectomy reversal is around 40 to 50 percent. However, it can take up to two years after the reversal surgery before a pregnancy occurs. The average time lapse between the reversal surgery and pregnancy is one year.
Q: How long after a vasectomy reversal will sperm start appearing in the ejaculate?
A: It takes several months (3 to15 months) for sperm to start appearing in the ejaculate.
Q: If sperm is identified in the ejaculate following a vasectomy reversal, does this guarantee a pregnancy?
A: No. Great numbers of sperm are needed in order for the male partner to be fertile. A sperm count of at least 20 million/ml is required for fertility. Oftentimes, the sperm count following a vasectomy reversal is less than 20 million/ml. In addition, about 50 percent of males who have had a vasectomy develop anti-sperm antibodies, which, according to research, can inhibit the function and movement of sperm and lead to continued infertility despite the presence of sperm in the ejaculate.
Q: What determines the success of a vasectomy reversal?
A: Success rates of both the return of sperm to the semen and subsequent pregnancy are highest when the reversal is performed relatively shortly after the vasectomy. The highest pregnancy rates are obtained when the original vasectomy surgery has been performed less than three years prior to vasectomy reversal. Pregnancy rates drop significantly after three years from the original vasectomy surgery.
Q: What are some considerations prior to considering vasectomy reversal?
A: Prior to considering having a vasectomy reversal, the female partner needs to be evaluated by a reproductive endocrinologist to rule out any infertility on her side. This is probably one of the most overlooked aspects in males undergoing a vasectomy reversal surgery. Even if the vasectomy reversal is successful, if the female partner has infertility problems, spontaneous pregnancy will be unlikely. In such case, in-vitro fertilization (IVF) rather than vasectomy reversal should be performed. In addition, fertility drops significantly if the age of the female partner is greater than 35 years; therefore, it is recommended in such cases not to undergo a vasectomy reversal, but to proceed with IVF, as time is of the essence in women who are over 35 years old.
Q: What about in-vitro fertilization (IVF)?
A: IVF involves obtaining sperm from the testicle using sperm aspiration or biopsy, injecting the sperm into the eggs of the female partner, and implanting the resultant embryos into her uterus. The pregnancy rate is higher with IVF than with a vasectomy reversal, and pregnancies occur in a significantly shorter period of time. A typical IVF cycle takes about four to six weeks from start to finish.
Q: What are some of the advantages of IVF over vasectomy reversal surgery?
A: Advantages are:
- IVF has a higher success rate in a significantly shorter duration of time.
- Oftentimes, a pregnancy can be achieved with IVF before sperm can even be demonstrated in the ejaculate following a vasectomy reversal.
- There is no need for contraception following a successful IVF; following a successful vasectomy reversal, some form of birth control is required.
- IVF can overcome almost all causes of female infertility, while a vasectomy reversal does not address any concurrent female infertility.
Q: What are some of the disadvantages of IVF compared to a vasectomy reversal?
A: Disadvantages are:
- IVF requires more monitoring during the treatment cycle.
- IVF increases the occurrence of multiples (mostly twins), which is not an issue with vasectomy reversal surgery.
Q: What are some of the financial considerations?
A: Both vasectomy reversal and IVF entail comparable costs. However, one important issue to keep in mind is that, in the event that the vasectomy reversal fails, patients may end up having to undergo IVF. In this event, your total cost would double.
Learn More about Tubal and Vasectomy Reversal in the Houston, Texas Area
If you have a question that is not answered above, or if you wish to obtain further information about vasectomy reversal and tubal reversal, contact Houston Fertility Institute, serving Texas from eight convenient locations — The Woodlands, Houston, Willowbrook, Tomball, Katy, Sugar Land, Medical Center, and Clear Lake.