Vasectomy & vasectomy reversal

Cared for by Dr William Akakpo

Vasectomy is the most reliable form of male contraception: a short procedure that interrupts the vas deferens so that sperm no longer reaches the ejaculate. It does not change erections, orgasm, testosterone or the appearance of the ejaculate. It should be considered permanent — but when circumstances change, microsurgical reversal can restore the passage of sperm, with patency rates of 90% or more when performed by a microsurgeon within the first years after the vasectomy.

Symptoms and reasons to consult

  • A settled decision not to have further children
  • A wish to avoid hormonal contraception in the couple
  • A new relationship or change of life plan after vasectomy
  • Rarely, chronic post-vasectomy scrotal pain

How we assess it

  • Consultation covering permanence, alternatives and the legal reflection period in France
  • Clinical examination of the vas and scrotal contents
  • For reversal: interval since vasectomy, previous fertility, partner's fertility assessment
  • Semen analysis three months after vasectomy to confirm sterility
  • Discussion of sperm banking before the procedure if desired

Treatment options

No-scalpel vasectomy

Performed through a single small puncture under local anaesthesia in about twenty minutes, with fascial interposition and cautery for maximum reliability. General anaesthesia is available for those who prefer it.

Microsurgical vaso-vasostomy

The two ends of the vas are rejoined under the operating microscope with two layers of very fine sutures. Patency is restored in the large majority of cases and pregnancy rates depend mainly on the interval and the partner's age.

Vaso-epididymostomy

When no sperm is found in the vasal fluid during reversal, a technically demanding connection is made directly to the epididymis. The decision is taken during surgery, so the surgeon must be able to perform both procedures.

Sperm banking

Sperm can be frozen at the time of vasectomy or reversal as an additional safeguard, in coordination with the fertility laboratory.

Recovery and follow-up

  • Vasectomy: back to desk work the next day, no sport for one week
  • Contraception must continue until a negative semen test at three months
  • Reversal: day case or one night, two weeks of light activity
  • Semen analysis at three, six and twelve months after reversal
  • Scrotal support and simple analgesia for the first days

Frequently asked questions

Is a vasectomy reversible?

Microsurgical reversal is often successful, but no reversal can be guaranteed. A vasectomy should only be chosen if the decision feels definitive today.

Does vasectomy affect sexual function?

No. Hormone levels, erections, orgasm and ejaculate volume are unchanged — only the sperm, a very small fraction of the volume, is absent.

How soon after vasectomy can reversal be done?

There is no strict limit; success declines gradually with time, but good results are still achieved fifteen years or more after the original procedure.