Micro – Surgical Vasectomy Reversals General information

After a vasectomy a man can still ejaculate, however this semen does not contain any sperm. Semen is produced by the glands called the seminal vesicles located in the pelvis close to the prostate gland, and is added to the sperm making up the normal ejaculate. This fluid makes up about 95% of the ejaculate, so men who have had a vasectomy don’t notice any difference in the ejaculate volume.

During a standard vasectomy, the vas is tied off in the scrotum to prevent sperm passing that point. The Open ended vasectomy procedure does not tie off the testicular end of the vas, but rather leaves it open and separated from the other sealed end of the vas with layers of tissue separating the ends of the vas.

The production of sperm in the testicles is very efficient and continues after a vasectomy. For a few months after the vasectomy procedure, protected intercourse must be continued to allow a flushing out of the remaining sperm beyond the scrotal ties. Sperm cell production continues normally after a vasectomy, so if both vas have been tied off, the stream of sperm simply bank up in the vas tube. While some of these squashed sperm are absorbed into the walls of the epididymis, many millions of cells accumulate so the vas, epididymis and testicles swell as the immature sperm bank up with increasing pressure.

We have confirmed good sperm production in many men 20 years or more after their vasectomy and these men have fathered a child after their reversal procedures.

The procedure requires only a light anaesthetic and is not painful during or afterwards. The patency of the vas is first checked with fluid, which will exit through the penis proving the patency forwards. A check is then always made to confirm the production of sperm is continuing after which the tubes are joined together under the microscope with the finest sutures.

If the vasectomy was originally performed in the right place (the vas) a vaso– vasostomy will be performed, and takes up to one hour on each side. If the vasectomy was performed quite low down in the scrotum, then it may have tied off the last part of the epididymis, and the only way to repair this is to perform an epididymo-vasostomy where the operation joins the much smaller and narrower epididymis to the remaining vas. The joins are made with three layers of carefully placed microsutures with highly skilled accuracy.

The OWEN microsurgical vasectomy reversal (vaso- vasotomy) has an unmatched percentage chance of being successful and results are better the earlier the reversal is performed. However, even pooling all 4000 cases up to 30 yrs after the vasectomy, some 85% of all couples have a baby that was started from normal intercourse in the first 24 months after the OWEN procedure.

Human males produce about 35,000 sperm cells per minute from each testicle. It takes two weeks from production for a single cell to be pushed along out of the testicle. They then pass into the epididymis.

The epididymis is a soft, long coiled narrow maturation tube. It is very thin (50 microns in diameter – less than the thickness of a hair) and is surrounded by large thin- walled blood vessels which act as a heat exchange system during the time it takes for the sperm to mature. This requires a lower that normal body temperature which is why these male organs are located outside the body cavities.

The epididymis is over 8 metres long with a sperm cell taking over one month to pass along its length. During this time the sperm develops and grows a tail and tough head – only able at this stage to function as a sperm.

The sperm leave the epididymis and enter the vas. The vas is wider and more muscular than the epididymis and is 200 microns thickness (two to three hair wide). Usually sperm cells will take a few more weeks to travel down the vas prior to ejaculation with the help of the prostate gland. So the total time from sperm production to ejaculation is two weeks in the testicle, four to six weeks in the epididymis and two weeks in the vas – eight weeks all together.

Professor Owen was the first to commence reversing sterilisation in men by microsurgery in 1971, having previously pioneered by original research the technique and designed the instruments currently used. In 1975, he published the first report of his operations and has in 1978, 1983 and 1992 published successful reports in the Medical Journal of Australia. As of the year 2000, over 4000 successful cases had been performed. He developed the OWEN microsurgical technique.

Dr Chris Lekich has extensive microsurgical training with over ten years in ophthalmology. His interest in the vasectomy procedure extends to include reversals and he continues his close relationship with Professor Owen, with both surgeons performing the OWEN vasectomy reversal procedure.