Vasovasostomy is a microsurgical procedure to restore fertility after vasectomy, a surgery that sterilizes the patient by severing the vas deferentia, the tubes that carry the sperm from the testes to the penis. After a vasectomy, a patient may have various reasons for wanting to reverse the procedure, such as new opportunities for having children or a new romantic partnership. A vasovasostomy involves reestablishing the flow of sperm through the vas deferens by reconnecting the severed ends of the tube. In 1919, in the United States, William C. Quinby performed the first recorded successful vasovasostomy. Modern improvements on the surgery have led to its adoption as a microsurgery, a procedure that involves a microscope and specialized microscopic instruments. Surgical research over the twentieth century into reconnecting a blocked vas deferens and the resulting microsurgical technique for vasovasostomy has provided a way for people to regain their fertility after a vasectomy.

No-scalpel vasectomy, or NSV or keyhole vasectomy, is a surgical method of sterilization that involves puncturing the skin of the scrotum to access the vas deferens, a tube that carries spermatozoa, or sperm, from the testes to the penis. The surgeon performing the procedure blocks the flow of sperm through the vas deferens, sterilizing the patient. NSV is a less invasive procedure, as it does not use a scalpel to make a deep cut on sensitive scrotal tissue. Typically, urologists perform NSV with the purpose of rendering the patient sterile while not altering other functions of the testes, scrotum, and penis. Li Shunqiang developed the technique in China in 1974 as a less invasive method of vasectomy for male patients. Li’s development of NSV provided an alternative method to vasectomies that rely on making incisions into the scrotum with a blade. NSV gained wide use as a sterilization technique, providing a path for males to take greater responsibility for contraception and family planning.

In December of 2016, Margus Punab and colleagues published “Causes of Male Infertility: A 9-year Prospective Monocentre Study on 1737 Patients with Reduced Total Sperm Counts,” hereafter “Male Infertility,” in the journal Human Reproduction. The study examines the main causes of severe male factor infertility, or SMF infertility, which occurs when a male’s semen has a very low number of healthy sperm cells or contains atypically low levels of sperm cells. In “Male Infertility,” the authors determine the primary cause of SMF infertility in forty percent of their participants, and among those participants, they found that the primary causes of SMF infertility were varicoceles, or enlarged veins within the loose bag of skin holding the testicles. The authors did not determine the cause of SMF infertility in the remaining sixty percent of the cases, noting a gap in the current understanding of the causes of SMF infertility. “Male Infertility” was one of the first large-scale studies to reveal certain underlying causes of SMF infertility, and its conclusions have allowed researchers to investigate fertility solutions for male patients who would otherwise not be able to reproduce.