Vasectomy reversal FAQ

Vasectomy reversal

Who performs vasectomy reversals?

Urologists are the surgical specialists who most frequently perform vasectomy reversals. Since not everyone focuses on this procedure, make sure to ask your urologist how many he or she has done — and to what level of success. Also, if your urologist recommends a microsurgical approach, you have the right to ask about his or her experience and success rates with this technique especially since this is a technique that requires additional training.

Can all vasectomies be reversed?

Almost all vasectomies can be reversed. However, if the vasectomy was performed during the repair of a hernia in the groin, there may be more difficulty reconnecting the ends of the vas. Rarely, reconnection of the ends of the vas is not possible because such a long segment of the vas was removed during the vasectomy procedure.

Should I have a vasovasostomy or a vasoepididymostomy?

It is not possible to determine before the reversal operation which procedure will be best for you. The urologist can only determine this during the vasectomy reversal procedure. If sperm are present in the fluid that is obtained from the end of the vas that is connected to the testicle, then a vasovasostomy is performed. If sperm are absent from the fluid obtained from the end of the vas that is connected to the testicle, the urologist then uses several criteria to determine which operation is best for you. The urologist will inspect the epididymis to determine if a blockage is present in the tube within the epididymis. If a blockage is seen, then a vasoepididymostomy will be required.

If no blockage is apparent, then the appearance of the fluid that is obtained from the end of the vas connected to the testicle may help determine which operation is best for you. In general, watery appearing fluid influences the urologist to perform vasovasostomy even though sperm are not present in the fluid, while creamy appearing fluid suggests that vasoepididymostomy is required when sperm are not present in the fluid. Several other factors also may be considered to help the urologist determine which operation is best for you. Some patients may require a vasovasostomy on one side and a vasoepididymostomy on the other side.

Is age a factor in conceiving after a vasectomy reversal?

Your age should not influence the result of your vasectomy reversal. Most men continue to produce sperm from their testicles for many years after their partners have entered menopause and are no longer ovulating, or producing eggs. In fact, a woman's fertility starts declining in her mid-30s, with significant impairment beginning around age 37.

If female age is a factor, your partner should check with her gynecologist to see if she is still ovulating before you agree to a reversal. Abnormal results from a simple blood test to measure hormone levels on the third day of menstruation indicate a significantly lowered chance of fertility. However, women should not be deceived by a normal reading because it does not always guarantee that a woman will be able to get pregnant.

Are there alternatives to vasectomy reversal?

Yes. Your doctor can obtain sperm from the testicle or epididymis by either a needle aspiration or surgery. But the sperm are not useful for simple, inexpensive office artificial inseminations. Instead, the sperm that are obtained by such methods require the more complex, expensive ($12,000 to $17,000) in vitro fertilization (IVF) techniques using intracytoplasmic sperm injection (ICSI).

Most centers report a 30 percent to 50 percent pregnancy rate each time IVF with ICSI is performed if the female partner is younger than 37, but much lower rates if she is older. Since studies consistently show that vasectomy reversals are more cost-effective in achieving pregnancy than sperm retrieval and IVF with ICSI, your better option is with the reversal. However, insurance coverage for one procedure and not another, may influence a couples decision on how to proceed. Factors that may affect the decision to proceed with vasectomy reversal or sperm retrieval with ICSI include cost, years since vasectomy (and possible need for epididymovasostomy) and age of the female partner.

If a vasectomy reversal fails, should I consider a repeat reversal?

The success rates for repeat reversals are generally similar to first reversals in the hands of experienced microsurgeons. In making a recommendation, your urologist will review the record of your previous procedure. If sperm were present in fluid obtained from the lower end of the vas during that operation, he or she will probably perform a repeat vasovasostomy, a less complicated procedure than a vasoepididymostomy, but more likely to produce success.

How expensive is a vasectomy reversal?

Costs vary widely, ranging between about $5,000 and $15,000 for surgical fees, not including anesthesia and surgical center fees. Most insurance companies do not pay for this procedure. Therefore, you should discuss the finances of your operation early to see if your insurance company might be the exception to the rule.

Will a vasectomy reversal relieve pain in the testicle that developed after my vasectomy?

It is fortunate that only a very small percentage of men develop pain in the testicle after a vasectomy that is sufficiently severe for them to inquire about a vasectomy reversal to relieve pain. Because such situations are rare, there are few reports of groups of patients who undergo vasectomy reversals to relieve pain in the testicle. Most of these reports indicate that the majority of patients who undergo a vasectomy reversal for relief of pain in the testicles indeed are relieved of their pain. However, your urologist cannot determine in advance that your pain definitely will be relieved if you undergo a reversal.

Vasectomy

Can my partner tell if I have had a vasectomy?

There is no significant change in one's ejaculate after a vasectomy since the sperm contributes a small amount to the overall ejaculate volume. Your partner may on occasion be able to feel the vasectomy site. This is particularly true if you have developed a granuloma.

Will my sense of orgasm be altered by having a vasectomy?

Ejaculation and orgasm are generally not affected by vasectomy. The only exception to this is the occasional patient who has developed post-vasectomy pain syndrome.

Can I become impotent after a vasectomy?

An uncomplicated vasectomy cannot cause impotence.

Can a vasectomy fail?

First, it is important to be certain that a vasectomy has been successful and that all sperm are absent from the ejaculate prior to stopping other forms of contraception. Even if the vasectomy has been demonstrated to be effective, there is a small chance that a vasectomy may fail. This occurs as a result of sperm leaking from one end of the cut vas deferens (the testicular end) and finding a channel to the other end (the abdominal end).

Can something happen to my testicles?

Rarely, the testicles may be injured during a vasectomy as a result of injury to the testicular artery. Other complications such as a mass of blood (hematoma) or infection may also affect the testicles.

Can I have children after my vasectomy?

Yes, but if you have not stored frozen sperm, you will require an additional procedure. The vas deferens can be micro surgically reconnected (in a procedure called a vasectomy reversal) to allow normal conception to occur. Alternatively, sperm can be extracted from the testicle or the epididymis and utilized for in vitro fertilization. These procedures are costly and may or may not be covered by insurance. Additionally, they are not successful 100 percent of the time. Therefore, one should carefully consider nonsurgical alternatives for contraception prior to deciding to proceed with a vasectomy.

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