Vasectomy Reversal Surgery in Singapore | Fertility Treatment

Vasectomy reversal surgery, medically known as vasovasostomy or vasoepididymostomy, is a microsurgical procedure that reconnects the vas deferens previously cut during vasectomy. The surgery restores the pathway for sperm to travel from the testicles to mix with semen during ejaculation, potentially enabling natural conception.

The procedure involves reconnecting the severed ends of the vas deferens using precise microsurgical techniques. Under high magnification, surgeons meticulously suture the tiny tubes back together, ensuring proper alignment of the inner and outer layers. The choice between vasovasostomy (connecting vas to vas) and vasoepididymostomy (connecting vas to epididymis) depends on factors discovered during surgery, including the presence and quality of sperm in the vasal fluid.

Success of vasectomy reversal depends on various factors including time since vasectomy, surgeon expertise, and the presence of anti-sperm antibodies. While the procedure can restore sperm to the ejaculate in many cases, pregnancy rates vary based on multiple factors including partner fertility. The procedure offers couples the opportunity to conceive naturally.

Ideal Candidates

• Men who have previously undergone vasectomy and wish to restore fertility
• Individuals in good general health without significant medical conditions
• Those whose partners are of reproductive age with no known fertility issues
• Men willing to wait several months for sperm production to normalise
• Couples preferring natural conception over assisted reproductive techniques
• Individuals who understand that success varies and pregnancy is not guaranteed
• Men committed to the recovery process and follow-up care

Contraindications

• Active genitourinary infections requiring treatment before surgery
• Bleeding disorders or medications that cannot be safely discontinued
• Severe scarring from previous surgeries or trauma in the scrotal area
• Absence of viable sperm production due to testicular failure
• Medical conditions that make general or regional anaesthesia unsafe
• Unrealistic expectations about guaranteed pregnancy outcomes

A thorough evaluation by an MOH-accredited urologist determines candidacy for vasectomy reversal. The assessment includes medical history review, physical examination, and discussion of fertility goals. Your surgeon evaluates factors such as time since vasectomy and previous fertility history to provide realistic expectations about potential outcomes.

Vasovasostomy (VV)

Vasovasostomy is the standard technique used when sperm or sperm parts are present in the vasal fluid during surgery. This procedure directly reconnects the two severed ends of the vas deferens. Using an operating microscope with 8-25x magnification, the surgeon carefully aligns and sutures the inner mucosal layer and outer muscular layer of the vas deferens. The multilayer closure technique ensures proper healing and minimises scarring that could obstruct sperm flow. This approach typically results in faster return of sperm to the ejaculate compared to vasoepididymostomy.

Vasoepididymostomy (VE)

Vasoepididymostomy becomes necessary when no sperm is found in the vasal fluid or when blockage exists in the epididymis. This more complex procedure connects the vas deferens directly to the epididymis, bypassing any obstruction. The surgeon creates an opening in the epididymal tubule and attaches it to the vas deferens using microsurgical techniques. This procedure requires considerable microsurgical expertise as the epididymal tubule is extremely delicate and measures less than half a millimetre in diameter.

Technology & Equipment Used

Modern vasectomy reversal utilises high-powered operating microscopes providing up to 40x magnification for precise tissue handling. Microsurgical instruments specifically designed for delicate tissue manipulation enable accurate suture placement. Ultra-fine sutures, thinner than human hair, ensure minimal tissue trauma. Some surgeons employ tissue glues or laser welding as adjuncts to traditional suturing. Doppler ultrasound may assess blood flow to the testicles before and after the procedure.

Pre-Treatment Preparation

Before surgery, you’ll undergo comprehensive evaluation including blood tests and medical history review. Discontinue blood-thinning medications as advised by your surgeon, typically one week before surgery. Arrange for someone to drive you home after the procedure as you’ll be under the effects of anaesthesia. Fast from midnight before morning surgery or as specifically instructed. Shave the scrotal area or have it done at the hospital. Wear comfortable, loose-fitting clothing on the day of surgery. Your surgeon may prescribe antibiotics to start before the procedure.

During the Procedure

The surgery typically takes 2-4 hours under general or regional anaesthesia. After anaesthesia administration, the surgeon makes small incisions on each side of the scrotum to access the vas deferens. The scarred ends from the previous vasectomy are removed, and the surgeon examines fluid from the testicular side under a microscope. Based on the presence or absence of sperm, either vasovasostomy or vasoepididymostomy is performed. Using the operating microscope, the surgeon meticulously reconnects the vas deferens with multiple layers of sutures. The incisions are closed with absorbable sutures, and a supportive dressing is applied.

Immediate Post-Treatment

After surgery, you’ll recover in the post-anaesthesia care unit for 1-2 hours. Ice packs help reduce swelling and discomfort. Pain medication is provided as needed. Most patients return home the same day once fully awake and stable. You’ll receive detailed aftercare instructions including wound care, activity restrictions, and medication schedules. A scrotal support garment is provided to wear for comfort and support. Follow-up appointments are scheduled before discharge.

First 24-48 Hours

Apply ice packs to the scrotal area for 20 minutes every hour while awake to minimise swelling. Keep the surgical area dry and avoid showering for the first day. Take prescribed pain medications as directed, typically every 4-6 hours. Remain on bed rest with minimal walking only for bathroom needs. Wear the scrotal support continuously except when applying ice. Watch for signs of excessive bleeding, severe pain, or fever above 38°C. Keep the legs elevated when lying down to reduce swelling.

First Week

Gradually increase light activities while avoiding heavy lifting or straining. Shower carefully after 48 hours, patting the area dry gently. Continue wearing scrotal support during the day for comfort. Avoid driving for 2-3 days or while taking pain medication. Return to desk work after 2-3 days if comfortable. Abstain from sexual activity and ejaculation as advised, typically for 2-3 weeks. Attend your first follow-up appointment for wound check.

Long-term Recovery

Full healing typically occurs within 4-6 weeks. Resume normal physical activities gradually after 2-3 weeks. Return to sports and strenuous exercise after 4-6 weeks with surgeon approval. Semen analysis is performed at 6-8 weeks and periodically thereafter to monitor sperm return. Sperm may take 3-12 months to appear in adequate numbers. Continue using contraception until adequate sperm counts are confirmed if pregnancy prevention is still needed initially.

Vasectomy reversal potentially restores natural fertility, allowing couples to conceive without assisted reproductive technologies. This can be more cost-effective than repeated IVF cycles, especially for couples desiring multiple children. The procedure enables spontaneous conception attempts in the privacy of home without the scheduling demands of fertility treatments.

Many men report psychological benefits from restored fertility potential, including improved self-image and relationship satisfaction. The surgery maintains the natural hormone production of the testicles, preserving normal testosterone levels. Success can eliminate the need for surgical sperm retrieval procedures required for IVF.

For younger female partners with normal fertility, natural conception after successful reversal often provides higher cumulative pregnancy rates than alternative options. The procedure preserves the option for future pregnancies without additional interventions. Some men experience resolution of post-vasectomy pain syndrome following reversal, though this should not be the primary indication for surgery.

Common Side Effects

Scrotal swelling and bruising affect most patients, typically resolving within 2-3 weeks with proper care. Mild to moderate pain at the surgical site is expected, managed effectively with prescribed medications for 5-7 days. Small amounts of blood in the initial ejaculations may occur but usually resolve spontaneously. Temporary firmness around the surgical sites is normal as internal sutures dissolve over several weeks. Some men experience temporary changes in ejaculate volume or consistency while healing occurs.

Rare Complications

Infection occurs in less than 1% of cases and responds well to antibiotics when identified early. Haematoma (blood collection) formation may require drainage if significant. Chronic pain persisting beyond normal healing is uncommon but may need additional treatment. Sperm granulomas (small lumps) can form at the surgical site but rarely cause problems. Stricture or re-blockage of the vas deferens may occur months to years after initially successful surgery, potentially requiring repeat procedure.

Our MOH-accredited urologists minimise these risks through meticulous surgical technique, proper patient selection, and comprehensive post-operative care protocols. The use of microsurgical techniques significantly reduces complication rates compared to non-microsurgical approaches.

The cost of vasectomy reversal surgery varies based on several factors including the complexity of the procedure required. Vasoepididymostomy typically costs more than vasovasostomy due to increased technical complexity and longer operating time. The fee structure generally includes surgeon fees, anaesthesia services, operating theatre charges, and initial follow-up visits.

Additional costs to consider include pre-operative assessments, post-operative medications, and semen analyses to monitor recovery. Some patients may require hormone testing or additional fertility evaluations. When comparing costs, consider the potential savings versus multiple IVF cycles if natural conception is achieved.

Quality surgical outcomes depend on surgeon expertise and proper facilities. Choosing an experienced microsurgeon may influence initial costs but can significantly impact success rates. During consultation, you’ll receive a detailed breakdown of expected costs specific to your situation.