The decision of whether to perform a vasovasostomy or an epididymovasostomy when there are no sperm at the vasectomy site is very complex. Some of the factors taken into consideration include, the consistency or quality of the intravasal fluid, the duration of obstruction, the findings on the opposite side, and whether or not there have been prior attempts at reversing the vasectomy. This is a very important decision since if there is a blockage within the epididymis, a vasovasostomy will not work. However, the argument against performing an epididymovasostomy every time there are no sperm found within the vas deferens is that the pregnancy rate following epididymovasostomy is so much lower than vasovasostomy. A vasovasostomy is performed by reattaching the two free ends of the vas deferens.
Microsurgical techniques achieve the best results.
There are a variety of microsurgical techniques for reanastomosing the two ends of the vas deferens, with no one type of procedure being significantly better. The choice of the exact method is up to the individual surgeon, but microsurgical techniques have much better results than those performed without the microscope. The results of a vasectomy reversal are surgical patency, which means sperm in the semen, and pregnancy. Epididymovasostomy is a much more complicated procedure requiring a great deal more expertise at microsurgery. The site of epididymal anastomosis is chosen by examining the fluid within the epididymal tubule for sperm.