Vasectomies are a common form of contraception and have gained a lot a popularity in North America and worldwide. Up to 20% of men with fertile aged partners undergo a vasectomy. However, 6% of men who have undergone vasectomies ultimately want to pursue fertility.
So, the question arises, are vasectomies reversible?
The short answer is yes. However, some important limitations and considerations are important to be aware of.
Let’s discuss.
What is a vasectomy?
Let’s first define what occurs with a vasectomy. Sperm are produced in the testicle, mature in the epididymis, and are then transported through the tube called the vas deferens. In a vasectomy the vas deferens is occluded or blocked through various techniques. This may include cutting the vas deferens tube, cauterizing the inside of the tube, tying or clipping the tube.
Therefore, to reverse the vasectomy, from a functional standpoint, we have to re-establish the transport of sperm through the blockage site(s) of the vas deferens. The majority of the time the two ends of the vas deferens tube can be stitched back together; however, there are some nuances that are important to discuss.
How is a vasectomy reversal performed?
There can be one or more blockage sites for a vasectomy reversal surgeon to identify
As previously mentioned, the goal of a vasectomy reversal procedure is to re-establish the transport of sperm from the testicle to the ejaculate. To achieve this, any and all blockages have to be addressed. Most of the time, there is only one site of blockage where the vasectomy was performed. However, the testicle continues to make sperm and fluid even after the vasectomy. This fluid production can lead to an increased pressure within the storage unit tubules (i.e. epididymis); these tubules are thin and fragile, and this increased pressure can lead to a rupture of the tubules and subsequent scarring – now introducing a second site of blockage which is more common with increasing time since the vasectomy.
How does a vasectomy reversal surgeon determine if there are blockages beyond the vasectomy site?
To figure out if there is only one blockage at the vasectomy site, or multiple blockage sites, the vasectomy reversal surgeon is required to sample the fluid in the vas deferens tube and evaluate this under a microscope. If sperm or sperm parts are identified, then this suggests no additional blockages are present and a standard vasectomy reversal can be performed connecting the two ends of the vas deferens tubules together. However, if sperm parts are not identified, it suggests another blockage is present and the surgeon will then undergo additional fluid sampling in the storage unit tubules (i.e. epididymis) until sperm are identified. A specialized connection is then required where the vas deferens tubule is connected to the side of the small storage unit or epididymal tubule.
Example of the technique that we use to connect the vas deferens tube to the small epididymal tube, ie. Vasoepididymostomy (VE) using microdot sutures and tension tension-relieving sutures. (Image from Alhamam A, Liblik K., Witherspoon L., Dorner A., Flannigan R. CUAJ 2025; Illustration by Dr. Kiera Liblik)
So, to answer the question of ‘can you reverse a vasectomy’, the answer is still yes; however, one of two types of connections may be required that will impact the chances of success. Let’s expand further on this.
What are Vasectomy Reversal Success Rates?
Vasovasostomy (VV) success rates
With standard vasectomy reversal connections where the two ends of the vas deferens are connected (VV), our reported success rate is 99% for any sperm in the ejaculate and 95.5% for at least 2 million moving sperm.
Vasoepididymostomy success rates
In some circumstances, a VV type of connection may be performed on one side and a VE may be required on the other side. In these circumstances, our reported rates of technical success are 100% for any sperm and 88.8% chance of at least 2 million motile sperm.
Blue bars indicate rate of presence of any sperm, green bars represent rate of >2 million motile sperm following reversal procedure. VE: vasoepididymostomy; VV: vasovasostomy. (Image from Alhamam A, Liblik K., Witherspoon L., Dorner A., Flannigan R. CUAJ 2025)
Increasing time since vasectomy results in higher chance of requiring VE type of connection
With increasing time since vasectomy, there is an increased chance of requiring a more specialized connection. In our study, we found that only 15% of men required the more complicated VE connection if time since vasectomy was up to 5 years. However, this number increases to over 50% of men requiring the more complicated VE connection if their time since vasectomy was between 21 and 26 years.
Blue bars indicate bilateral vasovasostomy (VV) anastomosis; grey bars indicate bilateral vasoepididymostomy (VE); and green bars indicate mixed VV-VE anastomosis. (Image from Alhamam A, Liblik K., Witherspoon L., Dorner A., Flannigan R. CUAJ 2025)
Limitations of the results in our study
When reviewing medical or surgical studies, it is important to keep a critical eye for not only the outcomes but the limitations. While there is no study without limitations, it is important to note the limitations in our study and results. We included couples that underwent vasectomy reversal for the first time, and performed a sperm test within 6 months after surgery, and have at least 6 months follow-up of sperm testing. It is important to point this out, because there are a small subset of patients that did not have adequate follow-up, and therefore, it is unclear how this may impact the outcomes. Another important limitation of this study, and many other vasectomy reversal studies, is that a technically successful vasectomy reversal may not yield high enough sperm counts for a natural pregnancy in every case, so while achieving 2 million motile sperm is a more stringent criteria than most published reports, there are still some outcomes that meet this criteria but remain low for a natural pregnancy.
With all of this in mind, there remains positive chances of natural conception and pregnancy after vasectomy reversals. Let’s review some of the medical literature on this.
What are the chances of pregnancy?
Getting pregnant and having a child is of course the ultimate goal of going through a vasectomy reversal procedure. There are a number of variables that can impact the chance of success beyond the vasectomy reversal itself. An important variable in this equation is female reproductive health. Factors that contribute to this may include the woman’s age, regularity of their menstrual cycle, and previous success in becoming pregnant. Female fertility testing is generally recommended and can be helpful in identifying any variables that could impact the success of natural pregnancy.
Pregnancy rates for couples undergoing vasectomy reversal have been shown to vary by the woman’s age
- Women under 30 years of age were reported to have pregnancy rates between 52% and 67% in one study.
- Women 30 to 34 years of age were reported to have pregnancy rates between 57% and 78% across two studies.
- Women 35 to 39 years of age were reported to have pregnancy rates between 54% and 78% across two studies.
- Women over 40 years of age were reported to have pregnancy rates of 14% to 42% across two studies.
Concluding thoughts on whether vasectomies are reversible
When the question is asked ‘is a vasectomy reversible’ at the time of pursing a vasectomy, our urology guidelines emphasize the importance of discussing that they are not always reversible and we think of vasectomies as a permanent procedure. This is because success rates are not 100% and therefore the reversibility cannot be guaranteed to work. However, if the question is asked ‘can you reverse my vasectomy’ once it has already been performed, the answer is ‘yes, in most cases’ with a reasonably high likelihood of success; however, despite this, not all cases are sufficiently successful to result in adequate sperm counts or pregnancy, and this is also important to be informed about.