Thank you for your email.
The spermcount after vasectomy reversal needs serveral month (up to a year) to recover. The 'old sperm material' needs to be cleaned out and the dilated tubules of the epididymis need time to recover their ability to transport the sperm cells by a pumping (peristalsis).
If the vasectomy reversal is done well the patient should be fertile within a year. If your sperm count is very low it is likely that the reason is continous obstruction that can normally corrected by a re-operation.
Most often the obstuction is eighter at the reconnection of the vas or at the epididymis ('blow-out').
As most surgeons are not very experienced in microsurgery they are only comfortable doing a vas-vas connection. They will not do a vas-epididymis connection (much more difficult) although there may be 'blow-outs' at the epididymis - but in many cases (up to 80%) the 'simple' reconnection will not result in sucess.
A proper microsurgical vasoepididymostomy should relieve all obstructions and result in normal sperm counts in most of the patients.
As the most frequented specialist for microsurgical vasectomy rerversal in Europe I frequently help patients who have had previous surgeries - in most of the cases we can help you.
To decide if a revision surgery is possible for you (you already had two reversals....) I would ask you to please send me the OR reports from the previous procedures and than we should discuss your case via phone.
With my best regards