Some FAQ and information about Vasectomy and Vasectomy Reversals:

Vasectomy Reversals have become a routine operation and procedure over the past 20 years.  This has to do with the success rates.  There are two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal. The patient must have sperm.  The sperm needs to be available and able to go through the reconnection and the reconnection must be impermeable. The surgeon's goal is to accomplish a very precise circumferential reconnection of the sperm canal sides by using microsurgical sutures.

Do NOT limit your search for a surgeon to your local or regional area.  The best vasectomy and vasectomy reversal doctors will usually be close to a major city, so reach out and find the best.  A large number of cases performed by true vasectomy reversal surgeons are re-operations after another reversal surgeon's failure. Search and find the best Doctor for this operation.  

Does your surgeon also practice general urology?  You need to ask your Doctor.

Surgeons who also practice general urology are almost always “occasional” reversal surgeons and this is quickly revealed by obtaining their reversal experience.

Is the surgeon a teacher or professor of vasectomy reversal? You need to ask your Doctor.

These are usually highly skilled and respected academicians either heading or teaching male infertility fellowships. Are they personally doing their reversals, or is one of their fellows (students)? You will never know for sure.

What type of anesthesia and exactly where has your surgeon chosen for your reversal?

For the best result and the best quality of the reconnection of the vas ends is maximized when there is no patient movement during the procedure. Light general anesthesia is very safe and routinely accomplishes this. Sedation and local anesthesia often do not achieve perfect stillness of the patient and the quality of the vas end reconnections promptly decreases with patient movement. Accredited surgical facilities are the only sites you should consider for this surgery. Hospitals, ambulatory surgical centers, and only a very rare surgeon’s office provide truly accredited facilities for the patient's safety.

What size sutures does the surgeon you are considering use to reconnect the two vas ends?  Ask.

The real micro surgeons use 10-0 size sutures most commonly and never larger than 9-0. “Naked eye” surgeons and surgeons using the minimally magnifying loupes rarely use smaller than 6-0 sutures. These 6-0 sutures resemble anchor rope when viewed through the operating microscope. Post-operative leakage of vas fluid and sperm out of the vas between these relatively huge 6-0 sutures into the outside tissues routinely results in localized scarring, blockage, and reversal failure. These unfortunate patients comprise a significant percentage of the cases for the true vasectomy reversal surgeons with their re-operations. Your determination of the suture size used by the surgeon you are considering for his vas re-connections will be the quickest and most accurate question for deciding whether to bother seeing him for consultation, or not.

Does the surgeon you are considering use the operating microscope to place every suture reconnecting the tiny sperm canals inside each vas end?  You need to ask your Doctor.

By taking the time and placing these sutures is one of the most important aspects of the operation. If it is not done with the powerful magnification of an operating microscope, this is not microsurgical technique and leakage with scarring and failure is very likely.

How many total reversals has the surgeon you are considering performed in his career? How many did he/she perform last year?

Most true “vasectomy reversal surgeons” perform at least one vasectomy reversal each week and approximately fifty or more each year. A career total of fewer than several hundred vasectomy reversals indicates significant inexperience.

By searching you can find that extensive experience enables a micro surgeon to provide each of his vasectomy reversal patients with a significantly accurate pre-surgical prognosis for the restoration of sperm to his semen. Several vasectomy reversal surgeons have recently begun to provide accountability by offering concessions of various types in the event of reversal failure.

Q. What happens to sperm after a vasectomy?

A. A vasectomy creates a blockage or “dead end” in the scrotal portion of the vas. The sperm get to the point of blockage and can go no further. They age and then die. The sperm degenerate and the body breaks the sperm down into component protein molecules as it does for dead cells elsewhere in the body. These protein molecules are then reabsorbed in the bloodstream and are eliminated.

Q. When am I considered sterile?

A. Sperm can still live in the vas upstream from the vasectomy site (in the scrotum) for weeks to months. It could easily take between 6 weeks to three months for these sperm to die off of get flushed out of the reproductive tract. Men are not sterile immediately after a vasectomy therefore you must practice contraception until there are 2 consecutive semen analyses that have no motile sperm in them. We begin checking semen specimens after 20 ejaculations post vasectomy.

Q. Can a vasectomy be reversed?

A. While vasectomy is considered permanent sterilization it can certainly be reversed. Roughly 5% of men who have had vasectomies change their mind each year and want to re-establish their fertility. Options available include vasovasostomy, reconnecting the vas at the vasectomy site and sperm harvesting from the epididymis or testicle combined with in-vitro fertilization. Neither of these techniques are 100% effective so those men who may still want more children should not have a vasectomy.

Q. Will a vasectomy cause me to have problems with erection or libido?

A. Having a vasectomy should not cause any problem with erections or libido from a physiological standpoint barring any complications. It is possible for some men to have a psychological reaction to having their vasectomy as they might to having any surgical procedure and that can affect libido.

Q. Is there an increased risk of prostate or testicular cancer because I had a vasectomy?

A. In the early 1990’s a concern was raised that men who had a vasectomy were at greater risk for getting prostate cancer, a disease that will affect 1 out of 6 American men. This concern sparked great interest and research that concluded that vasectomy is not a risk factor for prostate or testicular cancer or any other disease.

Q. What are anti-sperm antibodies and what do they have to do with a vasectomy?

A. Antibodies are molecules produced by the immune system to fight off anything that the immune system perceives as being foreign. After a vasectomy many men begin making antibodies to their sperm that can be detected in their bloodstream. When present, antibodies can attach to the sperm and prevent them from moving (decrease motility) or from penetrating an egg. It has become clear that only antibodies present on the sperm may cause a problem in certain situations. Very few men actually have antibodies detected on their sperm after vasectomy reversal.

Q. What is the Post Vasectomy Pain Syndrome?

A. Most men who undergo vasectomy have no difficulties but a small group of men develop chronic testicular or epididymal pain after the procedure. This pain can start immediately after surgery and is usually due to a sperm granuloma (inflammation at the vasectomy site) or infection and most cases resolve with the appropriate medical therapy. Occasionally, pain may develop years after the vasectomy and be exacerbated by ejaculation. This pain is thought to be the result of back pressure building up in the epididymis and is known as an ” epididymal blowout” or “post vasectomy pain syndrome” While it must be stressed that these are fairly uncommon occurrences after vasectomy, they are frustrating and difficult to deal with for both the patient and the physician. We offer a range of treatments for these syndromes including non-surgical treatments, vasectomy reversal, open-ended vasectomy, and chemical sterilization.

Q. What is an open-ended vasectomy?

A. An open-ended vasectomy is a vasectomy that is performed in the exact same fashion as a standard vasectomy other than leaving the testicular end of the vas unclipped. By leaving the proximal end open, it is thought to reduce the back pressure build up on the epididymis and testicle thus making a future vasectomy reversal easier and possibly reducing the already low chance of developing post-vasectomy pain syndrome. The problem with the open-ended vasectomy is that there is a greater likelihood of the vasectomy not working and because the end is open, sperm can leak out and cause a granuloma (inflammatory mass) to form at the end of this vas. The granuloma can sometimes be the cause of pain after a vasectomy.

Q. What are the alternatives to vasectomy?

A. The alternatives to permanent male sterilization include permanent female sterilization by tubal ligation or tubal blockage and reversible contraception with condoms, birth control pills or IUD. Many researchers have been working on a “male pill” but none of the current formulations are very effective or consistent.

When should I consider a vasectomy?

Here are some common reasons when considering a vasectomy:

You want to enjoy sex without worrying about pregnancy.

You do not want to have more children.

You and your partner do not want to or cannot use other kinds of birth control.

You want to save your partner from the surgery involved in having a tubal ligation, which carries a higher risk and failure rate.

Your partner has health problems that might make pregnancy difficult.

You do not want to risk passing on a hereditary disease or disability.

Question:

How am I different after a vasectomy?

After vasectomy, a man is unchanged except for his blocked sperm tubes. Sperm make up about 1% of the ejaculate, so there will be no detectible difference in volume. The testes still produce sperm, but they are simply re-absorbed into the body. Vasectomy does not affect a man's sex drive, masculinity, testosterone levels or orgasm. His ability to have an erection is also fully unchanged.  Furthermore, most men report that sex is better after vasectomy because they no longer need to worry about an accidental pregnancy. With the security and peace of mind permanent contraception brings, sex can be more relaxed and spontaneous.

Question:

What are some of the possible risks and complications?

If you experience any problems at all, be it pain, swelling etc. see your doctor right away to receive the appropriate treatment. Should you believe you are not getting better after a reasonable amount of time then always take into consideration that seeking a second opinion from a qualified provider is a reasonable course of action.

There are no life threatening complications associated with NSV. The minor complications that can arise are generally short-lived and resolve with ice, rest, anti-inflammatory and time.

Long-term safety with vasectomy is considered excellent, although all of the following are possible (complication rate in brackets):

Mild Discomfort

Some men report a mild aching sensation to the scrotum for a few hours to a few days after the procedure.

Hematomas

Mild bleeding into the scrotum causing small tender swelling for a few days.(1/400). A major bleed into the scrotum causing a grapefruit sized scrotum which will take months to heal (1/1000).

Infection

Redness and pus from the healing site opening (1/100).

Epididymitis

Tender swelling of the epididymis, the tube connecting the vas deferens and the testes (1/100).

Sperm granuloma

A small, potentially uncomfortable, bead-like structure made of leaked sperm that may develop at the site where the tube was cut and blocked (1/500).

Post Vasectomy Pain Syndrome

A very rare complication of a persisting dull ache in the testicle where the inflammation does not settle down. It may resolve on its own or may need another surgical procedure 1/1000).

Failure

Because a doctor has inadequately blocked one or both tubes, or because one or both tubes has rejoined ( less than 1/2500).

Antisperm antibodies

Produced by the body in response to the absorbed sperm. The antibodies are thought to be non-harmful but can make fertility difficult to restore later.

Other

Other uncommon complications have been reported.
Most experienced vasectomies report complication rates around 5%.

Question:

How long will it take after a successful Vasectomy Reversal to get my partner pregnant?
On average, one year; however, it is not unusual for it to take two years.

Question:

What will a Vasectomy Reversal cost?

Somewhere between $4,000 to $20,000 all inclusive with $10,000 being the average in the USA. In Canada, $5,000 is the average all inclusive price.

Question:

What is the likelihood of a Vasectomy Reversal being successful and what are the factors involved?
While in the best hands sperm flow can be re-establish 99% of the time, vasectomy reversal will lead to natural pregnancy in 2/3 of the cases.

There are factors that make the reconnection of the vas more difficult These may include the passing of many years since the initial surgery, a large segment of the vas having been removed, cauterization or ligation (tying off) of both ends of the cut vas instead of just one (i.e. doing a closed ended vasectomy instead of open ended).

Question:

What happens if the vasectomy is not successful?

A failed vasectomy reversal is defined as having no sperm in the ejaculate subsequent to the operation. These men can consider having the vasectomy reversal repeated or another surgical procedure known as vasoepididymostomy, or sperm extraction.

Question:

What alternatives are there to Vasectomy Reversal?
In certain circumstances it may be worthwhile considering vasoepididymostomy, or sperm extraction. In these cases, the assisted reproductive techniques inducing intrcytoplasmri sperm injection (ICSI) combined with in vitro-fertilization would be utilized. See the Alternatives for Vasectomy Reversal page.

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