- What is a vasectomy reversal?
- How is the reversal procedure performed?
- What are the chances of success?
- What factors affect success rates?
- What is a vasoepididymostomy?
- Has it been too long since my vasectomy to have a successful reversal?
- I have already had one unsuccessful reversal. Should I consider another?
- What options are there other than vasectomy reversal?
- Do I need any testing before surgery?
- What should I expect on the day of surgery?
- What should I expect after surgery?
- What are the risks of surgery?
- How much does vasectomy reversal cost?
- Is financing available?
- Why should I have my vasectomy reversal with Dr. Green?
A vasectomy reversal, also known as a vasovasostomy, is the surgical reconnection of the vas deferens. The vas deferens is the tube that carries the sperm away from the testes, and generally there is one on each side. These are the tubes that are divided when a vasectomy is performed. They are about the diameter of a strand of spaghetti. Although the sperm are no longer able to get out of the body after a vasectomy, sperm production continues. The reversal procedure allows the sperm to be ejaculated with the semen again.
A small incision is made in the scrotum, and the vas deferens is isolated and dissected microscopically. The vas is divided above and below the obstruction. The fluid from the testicular side of the vas is inspected. The vas deferens is then reconnected using multiple layers of micro suture (10-0 and 9-0 sized nylon). The vas is then placed back into the normal position, and a small drain is inserted on each side. The incision is closed with absorbable suture that will dissolve on its own. The drain is removed the day after surgery.
Success rates are generally high. If the vasectomy was less than 5 years ago, there is a >95% chance of sperm in the ejaculate; 5-10 years, about 90%; and over 10 years, 80-90%. Pregnancy rates are lower, and depend on a number of factors that we can discuss together.
As with many things, success can be defined in different ways. Surgically, success is the re-attachment of the two ends of the vas deferens. However, that does not guarantee that there will be a pregnancy, or even sperm in the ejaculate. It is widely accepted that both positive semen analyses and pregnancy decrease with time since vasectomy.
Sperm are fragile cells. It takes millions of sperm in each ejaculate for conception to occur through sexual intercourse. After reversal, the sperm may be lower in number, or not as motile as previous. There may also have been the development of “anti-sperm antibodies” that can damage the sperm. After the procedure, scar tissue can grow which can obstruct the vas deferens.
Rarely, the physician who performed the initial vasectomy removed too much of the vas deferens. In this case, there is nothing to re-attach, and the reversal cannot be done. This is very uncommon, and is evaluated prior to surgery with a physical examination.
There may also be issues with the female partner. A women’s ability to conceive generally declines with age. She may have undiagnosed fertility issues as well. Sometimes she will need the services of a female infertility specialist for assisted reproductive techniques.
Vasoepididymostomy is the surgical connection of the vas deferens to the epididymis. This can be necessary if there is a blockage close to the testicular end of the vas deferens. This can be performed at the same surgical setting if needed, at no extra charge.
As discussed above, success rates are better the less time has passed since vasectomy. However, most men continue to produce sperm for their entire lifetime. There is no defined duration since vasectomy that would prohibit reversal. Dr. Green has performed successful reversals on patients over 20 years after vasectomy.
There are a number of factors that should be taken into account before considering a “re-do” procedure. Was the surgeon a specialist in reversals? Were there sperm in the ejaculate after the procedure? Was there any infection or trauma after the reversal? Dr. Green has significant experience in the reversal procedure, including re-do operations, and would be happy to discuss your individual case with you.
If you desire to have a child with genetic material from both you and your partner, Dr. Green is able to microscopically remove sperm from the epididymis (the MESA procedure). The sperm can then be used for in vitro fertilization (IVF). Dr. Green works closely with Dr. Julio Pabon, and expert in IVF and female infertility issues.
Generally speaking, no. If you are taking a medication for high blood pressure, we will need to check a blood chemistry test, to be sure that you do not have any abnormalities that could affect anesthesia. If you have significant medical issues, Dr. Green may request a clearance note from your primary care physician prior to surgery.
Dr. Green will meet you at the Surgery Center prior to surgery. You will meet the anesthesiologist who will discuss your options. You will be taken to the operating room, and be given the anesthesia that you and the anesthesiologist have decided on. The surgery generally takes between 2 to 3 hours. Most men awaken from the procedure with minimal discomfort, as a long-acting local anesthetic is used as well. Once you are awake and alert, you can leave with a driver. This is generally 45 minutes to an hour after surgery.
Most men describe some discomfort and aching for the first 24-48 hours after surgery. They usually say that it was not as bad as they expected. Many men describe the discomfort as similar to after their vasectomy. The day after the procedure, Dr. Green will see you and remove your drains. This is mildly uncomfortable, as the drains are very small.
It is very important that you wear a snug scrotal support for the first 30 days after surgery to keep the testes from hanging down and pulling on the repair. Ice packs on and off every 20 minutes for the first day helps to keep down swelling.
Please refrain from sexual activity for at least the first 3 weeks after the reversal.
Thankfully, complications after vasectomy reversal are uncommon. While it is likely that you will have some bruising of the skin, it is also possible to develop bleeding within the scrotum after surgery. Generally, this resolves on its own with time and the use of the scrotal support.
Infection is also a known risk after any surgical procedure. Dr. Green uses IV antibiotic therapy at the time of surgery to help prevent infection, and any other infections that might arise are generally treatable with oral antibiotics.
Chronic pain and/or numbness at the incision site are also rare complications of the procedure.
The cost of the vasectomy reversal is $7,750. This includes all pre-operative and post-operative visits, as well as all surgery fees. The only other cost you can expect is a semen analysis 6 weeks after surgery at a lab close to your home.
Dr. Green offers a payment plan. Please refer to the "Costs" page for details of the plan..
There are a number of reasons why we feel that Dr. Green stands out from other doctors who perform reversals:
- Personal attention: Dr. Green takes pride in developing a relationship with each of his patients. He takes the time to personally answer any questions that you may have, and he remains available to you well after the procedure is over.
- Patient safety: Dr. Green performs all of his reversal procedures at the Doctors Same Day Surgery Center, an accredited Surgery Center. He works with a Board-Certified anesthesiologist for every procedure. The anesthesiologist works directly with each patient to determine the best option for him as an individual. This leaves Dr. Green able to focus all of his attention on the reversal.
- Attention to detail: All reversals are performed using a high-powered operating microscope. Multi-layered, watertight approximation is performed on every patient.
- Surgical Expertise: Dr. Green has performed hundreds of vasectomy reversals and is proud of his excellent success rates. The babies are his inspiration.