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A vasectomy is the contraceptive method of choice for 7% of American couples. With more than 500,000 vasectomies performed yearly in the United States, it is a procedure that is shared by several fields of medicine. The variety of techniques, their successes and their complication rates make the vasectomy anything but a basic procedure. Considering this, the common goal of a vasectomy is male sterilization. The vasectomy reversal is a highly specialized procedure that requires considerable microsurgical training. There are several preoperative, intraoperative and postoperative decisions that may affect the overall success of the procedure and the main goal, which is pregnancy. Urologists may find themselves at either end of the fertility spectrum. The present review discusses the vasectomy procedure, surgical techniques and how to manage the outcomes. In addition, vasectomy reversal and its increasing success in the era of intracytoplasmic sperm injection are discussed.