Frequently Asked Questions About Reversals
- What is a vasectomy reversal?
- How common is it to have a vasectomy reversal?
- How much does a vasectomy reversal cost?
- Is a consultation prior to surgery required?
- How successful is vasectomy reversal?
- How does the time since the original vasectomy impact outcomes following a vasectomy reversal?
- How is a vasectomy reversal performed?
- What is a mini-incision vasectomy reversal?
- What type of anaesthetic is required?
- How does the surgeon decide when to perform a vasovasostomy or a vasoepididymostomy?
- Can you predict what type of reconnection is required before the operation?
- How long does a vasectomy reversal take to perform?
- Do I have to stay overnight in the hospital after my vasectomy reversal?
- Can sperm be saved or banked at the time of a vasectomy reversal?
- What can you expect immediately after the operation?
- How long is the recovery following a vasectomy reversal?
- What complications can occur with a vasectomy reversal?
- When can I exercise after a vasectomy reversal?
- At what point do you test to see if the vasectomy reversal is successful?
- How soon can we try to have a baby after the vasectomy reversal?
- Are there other alternatives to achieving pregnancy after a vasectomy?
- Should the female partner be evaluated prior to a vasectomy reversal?
- Can a vasectomy be performed again after a vasectomy reversal?
- What happens if the reversal does not work?
- Will Vasectomy Reversal be successful if the vasectomy was performed years ago?
A vasectomy reversal is a surgical procedure that re-establishes the transport of sperm back to the ejaculate. Sperm are produced in the testicles. Sperm mature and gain the ability to move or swim in the epididymis. The epididymis is a highly coiled tube that connects to the vas deferens. The vas deferens (or vas) is a muscular tube through which sperm must travel in order to come out of the penis with the ejaculate. During a vasectomy, the vas is occluded (clipped, cut, tied off, and/or cauterized), therefore interrupting the passage of sperm. A vasectomy reversal re-establishes the transport of sperm back to the ejaculate. The surgical reconnection can be accomplished in 2 ways:
- a direct vas to vas reconnection (vasovasostomy) or
- a vas to epididymis connection (vasoepididymostomy)
Approximately 5-10% of men who have had a vasectomy decide to have a vasectomy reversal.
As you may be aware, the Ontario government (OHIP) and most provincial healthcare providers do not cover the costs of a vasectomy reversal. We try to keep costs as low as possible. The cost of a vasectomy reversal is approximately $5900. including the surgeon fee, hospital fee and anaesthetic fee. There are no charges for pre-operative and post-operative clinic visits and testing as they are covered under OHIP and provincial healthcare plans. Unfortunately Canadian doctors do not have liability coverage to offer services to non-Canadian residents for elective surgery.
A single consultation prior to surgery is beneficial to go through things in detail and examine the patient. Typically, no additional visits or testing is required. For patients from out-of-town, phone consultations can be arranged.
Ultimately, what couples want is a baby. Both male and female factors contribute to that goal including timing factors, patient factors, surgical factors, healing factors, female partner factors etc. All things considered, after a vasectomy reversal, about 50% -60% of couples have a baby within a 2-year period. If a vasovasostomy is performed on both sides, there is about a 95% chance of having sperm return to the ejaculate. If a vasoepididymostomy is performed on both sides, there is about a 65% chance of having sperm return to the ejaculate. If a mixed operation is performed (vasovasostomy on one side, vasoepididymostomy on the other), sperm returns to the ejaculate in about 75% of cases.
Vasectomy reversals performed earlier have better results. The longer the vas is obstructed as a consequence of the vasectomy, the more back pressure there is on the epididymus, and the more likely this will lead to a secondary epididymal obstruction. The presence of epididymal obstruction will mandate a re-connection of the vas to the epididymis (vasoepididymostomy) which has a lower overall success rate (60% return of sperm to the ejaculate if performed on both sides). Research tells us that after about 10 years, there is about a 40% chance that a vasoepididymostomy will need to be performed on at least one side. There is a high chance that the vasovasostomy can be performed if the vasectomy reversal is performed within 10 years of the vasectomy.
The main principle of a vasectomy reversal is to reconnect the vas to an area where sperm are identified. A small incision in the scrotal skin is made where the vasectomy was originally performed. The vas is identified and brought out through the scrotal incision. The vas on the testicular side of the vasectomy is cut at a healthy segment and the fluid coming from the cut end of the vas is tested for the presence of sperm. If sperm are identified in the vasal fluid a direct vas to vas connection (vasovasostomy) can be performed. The vas on the abdominal side of the vasectomy is then cut at a healthy segment. Using an atraumatic vas approximator to stabilize the freshly cut ends of the vas, the cut ends of the vas are reconnected with the aid of a high-powered surgical microscope to ensure surgical precision. Our practice is to perform a 2-layer reconnection using very fine 10-0 sutures on this inner 'mucosal' layer and 9-0 sutures on the outer muscular layer of the vas. Following reconnection, the vas is placed back to its natural position in the scrotum and the small scrotal incisions are closed with a dissolvable suture.
If no sperm are identified in the vasal fluid from the cut end of the testicular vas, this suggests an epididymal obstruction and a vasoepididymostomy is performed. The abdominal vas is connected directly to a point of the epididymus where sperm are identified. The epididymis is a highly coiled tube that carries the sperm from the testicle to the vas.
At our centre, we recently invented an innovative procedure where the entire vasectomy reversal can be performed through mini-incisions in the scrotum by adopting the principles of a non-scalpel vasectomy. Often, the incisions are less than 1 cm. Following a mini-incision reversal, patients experience less discomfort, heal quicker and return to work or normal activity faster. You can watch our technique on www.youtube.com by searching under 'mini-incision vasectomy reversal'. VIEW VIDEO
We offer a variety of anesthetic options for vasectomy reversal. While operating under a high-powered surgical microscope, patients need to be completely still for best results. As such, most patients elect for a general anesthetic. For patients wanting to avoid general anesthesia, a vasectomy reversal can often be performed using sedation and local anesthesia.
A direct vas to vas reconnection (vasovasostomy) is the most reliable type of vasectomy reversal with the highest success rates. This is the surgeon’s procedure of choice. If sperm are identified in the cut end of the vas coming from the testicle and epididymus, this confirms that sperm are being produced and are able to swim to this point. A direct vas to vas reconnection (vasovasostomy) can be performed. If no sperm are seen within the fluid from the cut end of the testicular vas, this typically suggests a blockage at the level of the epididymus and a bypass re-connection or vasoepididymostomy should be performed. A word of caution – some surgeons who perform vasectomy reversals do not have adequate experience to perform a vasoepididymostomy. Either a vasovasostomy is inappropriately performed or the surgery is abandoned altogether. Choosing a surgeon who is experienced in microsurgical vasovasostomy and vasoepididymostomy is essential.
No doctor can predict with certainty what type of reconnection (vasovasostomy or vasoepididymostomy) will be required before the operation. This can be estimated with a reasonable degree of confidence based on the time since the original vasectomy, findings on physical examination and the patient’s age. A definitive decision as to the type of reconnection required can only be made during the surgery based on the presence of sperm and the quality of fluid from the vas. If sperm are identified from the cut end of the vas coming from the testicle and epididymus, this confirms that sperm are being produced and are able to swim to this point and a vasovasostomy can be performed. If no sperm are seen within the fluid from the cut-end of the testicular vas, this typically suggests an epididymal blockage and a bypass re-connection or vasoepididymostomy should be performed.
A vasovasostomy typically takes about 1.5 hours to complete.
A vasoepididymostomy can take 2 hours to complete.
No. A vasectomy reversal is considered 'day surgery' so patients come to the hospital and go home to recover the same day as the procedure.
Yes. Moving sperm identified in the vas or epididymus at the time of a reversal can be saved, frozen and stored in a sperm bank just in case the vasectomy reversal is not successful. This sperm can only be used with in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI).
During the first 2-3 days after the operation, there can be a mild to moderate amount of soreness and swelling. This is usually managed well with oral pain medicines. An athletic supporter or jock strap is typically recommended for about 7 to 10 days following the surgery to immobilize and support the surgical site and to provide additional patient comfort. A short course of antibiotics may be prescribed to prevent infection. Patients can shower after 48 hours and all bandages should be removed wet in a hot shower. Baths should be avoided for at least 2 weeks. All sutures dissolve on their own after a few weeks and do not need to be removed.
Typically, most men need 10 to 14 days to feel normal again.
All surgical procedures and aesthetics are associated with complications and risk. Fortunately, the risks and complications of a vasectomy reversal rare but may include: bleeding, wound infection, swelling, injury to the spermatic cord, epididymis or testicle and discomfort
It is best to wait 4-6 weeks before reinitiating strenuous exercise. Light exercise can be started 3-4 weeks after surgery.
Testing to see if sperm have returned to the ejaculate is typically performed 8 weeks following surgery. Semen analyses are then typically performed at 3-month intervals until pregnancy is achieved to ensure stable sperm quality. After a vasovasostomy, sperm quality can take up to 6 months to mature. After a vasoepididymostomy, sperm quality can take up to 1 year to mature.
Couples can resume sexual relations about 2 weeks after a vasovasostomy and about 3 weeks after a vasoepididymostomy. A pregnancy can occur any time after a reversal. Statistics tells us that about 50%-60% of couples are pregnant within 2 years of a vasectomy reversal.
Yes. Sperm can typically be retrieved from the epididymus with a needle through the skin under local anaesthetic (PESA). This sperm can only be used with advanced assisted reproductive techniques including in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). A word of caution – the epididymus may become scarred and blocked following the insertion of a needle during a sperm retrieval. Consequently, this can make a vasectomy reversal after a PESA considerably more challenging, resulting in poorer outcomes overall.
Considering the physical, financial and emotional commitment associated with a vasectomy reversal, it is good practice to recommend a female reproductive evaluation. This can be performed by most gynaecologists.
If a reversal ultimately proves unsuccessful, there are two options for couples who desire genetically related children. 1) a re-do vasectomy reversal or 2) sperm retrieval from the testis or epididymus (under local anaesthetic) with in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI). Donor sperm or adoption can also be considered by couples.