Vasectomy reversal
A vasectomy reversal is a microsurgery that reconnects the tubes cut during a vasectomy so sperm can get back into the semen. It is done under an operating microscope with stitches finer than a hair.
Also called Vasovasostomy, VV, Vasoepididymostomy, VE, Epididymovasostomy, Microsurgical vasectomy reversal, Reverse my vasectomy, Undo a vasectomy
- Where
- Outpatient surgery center or hospital operating room
- Anesthesia
- General anesthesia; some surgeons use spinal anesthesia or deep sedation with numbing medicine
- Time in the room
- 2 to 4 hours, longer if a bypass to the epididymis is needed
- Hospital stay
- Same day
- Back to normal
- About 2 weeks for daily life; 3 to 4 weeks for exercise and sex
- Back to work
- Desk work in 3 to 7 days; heavy physical work after 3 to 4 weeks
Overview
During a vasectomy, the two tubes that carry sperm, called the vas deferens (or vas), are cut and sealed. A vasectomy reversal rejoins them. The surgeon works under an operating microscope that magnifies the tubes 10 to 25 times, using stitches finer than a human hair.
There are two kinds of reconnection. A vasovasostomy joins the two cut ends of the vas back together. A vasoepididymostomy is a bypass: the vas is joined directly to the epididymis, the coiled tube behind the testicle, because there is a second blockage further back. Over the years after a vasectomy, pressure can build up and burst tiny tubes inside the epididymis, leaving scar. Your surgeon decides which repair each side needs during the operation, by looking at the fluid that comes out of the tube.
Success depends most on how many years have passed since the vasectomy and on your partner's age and fertility. Success is measured in two ways: whether sperm come back into the semen, and whether a pregnancy follows. Sperm usually return within a few months after a vasovasostomy, and more slowly after a bypass.
The main alternative is to take sperm directly from the testicle with a needle and use it with IVF (in vitro fertilization). Which path is better depends on your partner's age, how many children you hope for, cost, and how you both feel about IVF. Many couples meet with both a reversal surgeon and a fertility specialist before deciding.
The parts of your body involved
Sperm are made in the testicle, mature in the epididymis, and travel up the vas deferens in the spermatic cord. After a vasectomy, the testicles keep making sperm, but they hit a dead end at the vasectomy site. The testicle side of the vas often widens with fluid, and some men form a small lump of leaked sperm, called a sperm granuloma, at the cut end. As years pass, the pressure can cause tiny blowouts in the epididymis. When that happens, rejoining the vas alone is not enough, and the vas must be connected to the epididymis above the blockage.
- Vas deferens
The firm tube that carries sperm. After a vasectomy it has a testicle end and a far end, separated by scar or clips.
- Epididymis
A tightly coiled tube behind the testicle, made of one tiny tubule thinner than a thread. A bypass connects the vas to one of its loops.
- Testicle
Makes sperm and testosterone. It keeps working after a vasectomy.
- Spermatic cord
The bundle holding the vas, the testicle's blood vessels and nerves. The surgeon protects the blood supply while working.
- The old vasectomy site
Scar tissue, and sometimes clips, where the vas was closed. It is cut away so healthy tube can be joined.
Why it’s done
Most men have a vasectomy reversal because their life has changed and they now want children. A smaller number have it to treat pain that started after a vasectomy.
- Wanting a child
A new relationship, the loss of a child, or simply a change of heart are common reasons.
- Natural conception
If it works, you and your partner can try for a pregnancy at home, and for more than one child, without IVF.
- Avoiding IVF for your partner
IVF involves hormone injections and an egg retrieval procedure for your partner. A reversal places the medical burden on you instead.
- Cost over time
One reversal can cost less than repeated IVF cycles, especially if you hope for more than one child. Neither is usually covered by insurance.
- Pain after vasectomy
Some men with long-lasting pain after vasectomy improve after the tubes are reconnected. Results for pain are less predictable.
Other options
- Sperm retrieval with IVF
Sperm are taken directly from the testicle or epididymis with a needle or a small cut, and a single sperm is injected into each of your partner's eggs in the lab (called ICSI). This is often favored when the female partner is older or has her own fertility issues, or when many years have passed since the vasectomy.
- Donor sperm
Insemination with sperm from a donor is simpler and less costly than IVF, though the child is not genetically yours.
- Adoption or fostering
Some couples choose to grow their family this way.
- Not having more children
After talking it through, some couples decide not to pursue a pregnancy. That is a valid choice.
Getting ready
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Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep
You lie on your back on the operating table. The anesthesia team gives you medicine to sleep through the operation. The scrotum is cleaned and draped, and the operating microscope is wheeled into place.
More detail
Some surgeons inject long-acting numbing medicine around the spermatic cord at the start, which helps with pain when you wake up.
After the operation
Right afterward
- Recovery room
You wake up in the recovery area, usually within an hour of the end of surgery. The scrotum feels tight and sore under the support.
- Pain control
You get medicine for pain and nausea if needed. Ice packs are often started right away.
- Passing urine
The team may want you to pass urine before you leave, since anesthesia can make it harder at first.
- Going home
Most men go home 1 to 3 hours after surgery with a driver, a pain plan and written instructions.
At home
- Pain
Soreness is worst for the first 2 to 3 days. Most men use acetaminophen and, if allowed, ibuprofen. A short supply of stronger medicine is sometimes given for the first nights.
- Ice and support
Use ice on and off for 48 hours. Wear the scrotal support or snug briefs day and night for about 2 weeks, then during activity for a few more weeks.
- Wound care
A little oozing on the gauze is normal for a day or two. The stitches dissolve on their own in 1 to 3 weeks.
- Showering
Most surgeons allow a shower after 24 to 48 hours. Avoid baths, hot tubs and swimming for 2 weeks.
- Activity
Walking is encouraged. Avoid running, cycling and sports for 3 to 4 weeks.
- Lifting
Avoid lifting more than about 10 to 15 pounds for 3 to 4 weeks. Straining puts pressure on the new connections.
- Sex and ejaculation
No sex or ejaculation for about 2 to 4 weeks, as your surgeon advises. The joins are very small and need time to heal before they are stretched by ejaculation.
- Driving
Once you are off strong pain medicine and can sit and brake comfortably, usually after a few days.
- Work
Desk work in 3 to 7 days. Physical jobs usually need 3 to 4 weeks.
- Semen tests
The first semen test is usually 6 to 8 weeks after surgery, then every 2 to 3 months until sperm counts are stable or your partner is pregnant.
Recovery timeline
- Day 0Home the same day
You go home a few hours after surgery with a snug support and ice.
- Days 1 to 3Sore and swollen
Aching, swelling and bruising peak. Bruising can spread to the base of the penis. Rest, ice and pain medicine help.
- Week 1Up and about
Most men are walking normally and back to desk work. Soreness is much less.
- Weeks 2 to 4Back to normal life
Swelling fades. Most surgeons allow ejaculation and light exercise again in this window.
- Weeks 6 to 8First semen test
The first check for sperm. Low numbers or poorly moving sperm are common this early.
- Months 3 to 6Sperm return
After a direct join, sperm are usually back in the semen by about 3 months, and counts often keep rising for several more months.
- Months 6 to 18Slower return after a bypass
After a bypass to the epididymis, sperm often take 6 to 12 months to appear, sometimes up to 18 months.
- Year 1 to 2Pregnancy
Most pregnancies after a successful reversal happen within the first 1 to 2 years. Semen tests continue until pregnancy or until counts are steady.
What it feels like
A vasectomy reversal is a short recovery physically, and a long wait emotionally. Most men say the soreness is manageable and the hardest part is the months of semen tests and hoping.
Deciding
Many men feel a mix of hope, regret about the vasectomy, and worry about the cost. Couples sometimes disagree about reversal versus IVF.
What helpsGet the facts for your situation from a reversal surgeon and a fertility specialist. Ask each for numbers that match your years since vasectomy and your partner's age.
Waking up
Groggy, with a tight, heavy, sore feeling in the scrotum and a snug support in place. Some men feel a little nauseated.
What helpsIce, pain medicine on a schedule for the first day, and lying back with your knees slightly raised.
The first few days
Swelling and purple bruising can look alarming, sometimes spreading to the base of the penis. Sitting and getting up from a chair are awkward.
What helpsThis is expected. Keep the support on, keep icing, and call if one side swells much more than the other or keeps growing.
The weeks without sex
Waiting can be frustrating, and many men worry they will damage the repair by accident, for example with a nighttime erection.
What helpsErections are fine. It is ejaculation and heavy straining that your surgeon wants you to avoid for a few weeks.
The first semen test
Many men are nervous. A low count or slow sperm at 6 to 8 weeks can feel like failure.
What helpsEarly results are often low and usually improve. Your surgeon is looking at the trend over several tests, not one number.
The months of trying
Each month can bring hope and then disappointment. It can strain a relationship.
What helpsTalk openly with your partner. If a pregnancy has not happened after a year with good sperm counts, ask about a fertility evaluation for both of you.
How well it works
Success is measured two ways: sperm in the semen (the tubes are open) and pregnancy. The years since your vasectomy and your partner's age are the strongest predictors.
- Years since vasectomy
In a well-known study of nearly 1,500 reversals, sperm returned in about 97 in 100 men when the vasectomy was less than 3 years earlier, about 88 in 100 at 3 to 8 years, about 79 in 100 at 9 to 14 years, and about 71 in 100 at 15 years or more. Pregnancy rates fell more, from about 76 in 100 to about 30 in 100. Experienced surgeons today often report similar or better numbers.
- Type of repair
A direct join usually brings sperm back faster and more reliably than a bypass. A bypass is still often successful, but sperm return can take a year or more.
- Your partner's age
A female partner's fertility falls steadily after about 35, and this affects the chance of pregnancy as much as the surgery does.
- Late blockage
In some men, sperm come back and then disappear months later as scar narrows the join. This is more common after a bypass. Some surgeons suggest freezing sperm from the semen once counts recover, as insurance.
- Follow-up
Semen tests every 2 to 3 months show whether sperm are present, how many there are and how well they move.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Swelling of the scrotum and bruising that may spread to the penis or groin is common and fades over 1 to 3 weeks.
Aching for several days, usually controlled with acetaminophen, anti-inflammatory medicine and ice.
Sperm counts and movement are often low on the first tests and improve with time.
Less common
A collection of blood can make one side tense and painful. Most settle with rest and support; a large one may need draining.
Redness, warmth or drainage at the incision, sometimes with fever. Usually treated with antibiotics.
The join may scar closed or there may be a blockage that could not be bypassed. The chance depends mainly on the years since vasectomy and which repair was needed.
Sperm return and then fall again over months. More common after a bypass. A repeat reversal or sperm retrieval with IVF may be options.
Rare
Ongoing aching in the scrotum after healing is uncommon.
Injury to the small testicular artery can cause the testicle to shrink. Microsurgery is designed to avoid this.
Serious reactions to anesthesia are rare in healthy men.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- One side of the scrotum swelling quickly, becoming tense and much larger than the other
- Bleeding that soaks through the dressing and does not stop with 10 minutes of firm pressure
- Redness spreading across the scrotum, or pus or a bad smell from the incision
- Pain that keeps getting worse, or is not controlled by your pain medicine
- You cannot pass urine for 8 hours after surgery, or your bladder feels full and you cannot empty it
Questions to ask your surgeon
- How many vasectomy reversals do you do each year?
- Are you trained and ready to do a bypass to the epididymis if I need one?
- Based on how long ago my vasectomy was, how likely am I to need a bypass?
- What are your own rates of sperm return and pregnancy for men like me?
- Should my partner have a fertility evaluation first?
- Can you freeze sperm during the operation, and what does that cost?
- What kind of anesthesia will I have?
- What is the total cost, and does it include follow-up semen tests?
- How long should I avoid sex, lifting and exercise?
- When will my first semen test be, and how often after that?
- If sperm do not return, what would you suggest next?
- In our situation, how does reversal compare with sperm retrieval and IVF?
Words you may hear
- Vas deferens
- The tube that carries sperm from the testicle toward the prostate. It is cut during a vasectomy.
- Epididymis
- A coiled tube behind the testicle where sperm mature.
- Vasovasostomy
- Rejoining the two cut ends of the vas.
- Vasoepididymostomy
- Joining the vas directly to the epididymis to bypass a blockage. Also called epididymovasostomy.
- Microsurgery
- Surgery done under an operating microscope with very fine instruments and stitches.
- Operating microscope
- A large microscope on a stand that magnifies the surgical area 10 to 25 times.
- Patency
- The tubes being open, shown by sperm in the semen after reversal.
- Sperm granuloma
- A small lump formed where sperm leaked from the cut vas after vasectomy.
- Semen analysis
- A lab test that counts sperm and checks how well they move.
- IVF
- In vitro fertilization: eggs are taken from the female partner and fertilized in a lab.
- ICSI
- Intracytoplasmic sperm injection: a single sperm is injected directly into each egg during IVF.
- Sperm retrieval
- Taking sperm directly from the testicle or epididymis with a needle or small cut, for use with IVF.
Common questions
Is it too late if my vasectomy was 15 or 20 years ago?
Not necessarily. Many men have sperm return even after 15 or more years, though the chance is lower and a bypass to the epididymis is more often needed. Your surgeon can give you numbers for your situation.
Will insurance pay for it?
Usually not. Most plans treat it as elective. Ask for a written, all-inclusive price before you schedule.
How long until we can get pregnant?
Sperm usually return within about 3 months after a direct join, and later after a bypass. Most pregnancies after a successful reversal happen within the first 1 to 2 years.
Is reversal or IVF the better choice?
It depends on your partner's age and fertility, the years since your vasectomy, how many children you hope for, cost and your feelings about IVF. Reversal allows natural tries over many months; IVF puts the medical steps on your partner but works around blocked tubes.
Will a reversal fix my pain after vasectomy?
Some men with long-lasting pain after vasectomy improve after reversal, but it is not guaranteed. Your surgeon will discuss other pain treatments too.
Can I freeze sperm during the reversal?
Many surgeons offer this. If sperm are found during the operation, they can be frozen for future IVF if the reversal does not work. It adds cost.
What if we do not want more children afterward?
A reversal restores fertility, so you will need birth control again once your family is complete, or another vasectomy.
Sources this page draws on
- American Urological Association and American Society for Reproductive Medicine, Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline (2020)
- Journal of Urology, Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group (Belker and colleagues) (1991)
- European Association of Urology, EAU Guidelines on Sexual and Reproductive Health
- Urology Care Foundation, Vasectomy Reversal
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.