Surgical Options

Vasectomy Reversal


If you are looking for expertise in vasectomy reversal, you want to talk to  Dr. Joshua Green at the Center for Vasectomy Reversal. His experience and dedication to his patients have made him a leader in the field when it comes to helping men overcome infertility problems.

The procedure for reversing a vasectomy is complex, detailed, and it takes expertise and focus. At the Center for Vasectomy Reversal, you’ll find that expertise. Men have vasectomies for any number of reasons, but circumstances can occur that make them want to have them reversed. With our help, you can once again be fertile and capable of becoming a father.

Dr. Joshua Green will perform the procedure at a surgical center, and you’ll be able to go home the same day. The procedure involves creating a small incision in both sides of the upper scrotum, determining where the vasectomy is, and removing any scar tissue. Both ends of the vas are gently dilated, and the fluid from the testicular side is inspected. If all looks well, the ends are freshly cut and surgically reconnected using sutures that are one-third the diameter of a human hair.

Depending on the state of the seminal fluid and amount of sperm present, we may elect to perform a vaso-epididymostomy, where a tubule is attached to allow better sperm flow. We can also do microscopic edpididymal sperm aspiration as part of an in-vitro fertilization procedure. We’ll discuss your options with you during the initial consultation.

If you’re interested in a vas reversal, the smart choice is the Center for Vasectomy Reversal. Call us today and let’s talk about how we can help you!

The Vaso-vasostomy (V-V) Procedure

Vasectomy reversal (vaso-vasostomy) is an outpatient surgical procedure that typically takes between 2 to 4 hours, depending upon the complexity of the specific case. I like to describe it as sewing together a tunnel in the middle of a piece of spaghetti. A small incision is made in each side of the upper scrotum. The site of the vasectomy is identified and the scar tissue is excised. The abdominal side of the vas is flushed to verify patency, and the testicular side is inspected for the presence of sperm. If there are sperm present, or if there is clear, freely flowing fluid, the freshly cut ends of the vas are then reconnected using microscopic magnification. Otherwise, dissection is continued proximally until the findings are favorable for reconnection.  (See costs).

The Vaso-epididymostomy (V-E) Procedure

If the fluid expressed from the testicular side of the vas is thick and pasty, a vaso-epididymostomy is indicated. This is uncommon if the vasectomy was performed less than 10 years prior to the reversal. In this case, the vas is attached to a tubule of the epididymis, to allow flow of sperm. Sperm mature in the epididymis, so a vaso-epididymostomy is usually performed in the most distal part of the epididymis possible. For multiple reasons, success rates of V-E are lower than that of V-V.

Microscopic Epididymal Sperm Aspiration (MESA)

If in vitro fertilization is planned, many men opt for sperm aspiration. Dr. Green performs this procedure using the operating microscope. This enables him to obtain sperm directly from the epididymis with minimal contamination from blood and other fluids. Additionally, since epididymal tubules can be seen under the microscope, success rates are excellent, and the risk of damaging adjacent structures is minimal. The MESA procedure is only an option for couples using in vitro fertilization.  (See costs).


Dr. Green discusses the optimal choice for anesthesia with each patient on a case-by-case basis. While vasectomy reversals can be performed under local anesthesia alone, many men find it difficult to remain completely still for up to 4 hours. As you can imagine, when operating under a microscope, it is imperative that the patient not move. As such, most patients opt for some level of intravenous sedation. Since Dr. Green operates at an outpatient surgery center, general or spinal anesthesia are also options that are available.

Post-operative care and expectations

Within an hour of completion of surgery, the majority of patients leave the surgery center. Generally, two small drains are placed in the scrotum to evacuate fluid that can accumulate after surgery. You will be instructed on how to care for them until they are removed the day after surgery. Tight supportive underwear or an athletic supporter should be worn day and night for the first month after the procedure. This takes the weight of the testicles off of the vasectomy reversal site and decreases post-operative pain and swelling. Dr. Green will see you the day after surgery, and if you have traveled from out of town will clear you for your return home. The incisions will heal in about 2 weeks, and the stitches are absorbable and do not need to be removed.

See Vasectomy Reversal Frequently Asked Questions for more information.