There is no way to diagnose a second blockage before surgery. In fact, most of the time the surgeons who do bypass procedures are not able to make a certain diagnosis even after viewing the epididymis, but rely on their best judgment given the fluid findings and years from vasectomy.

The reason so many men are happy for me to do the simple vas reconnect only is that they are “giving up” very little by not having the bypass option if they are less than 9 years from vasectomy. This is explained in detail below.

If your vasectomy was less than 3 years ago you have a 97% chance of return of live sperm. The pregnancy rate in my practice for this group has been 81%.

If your vasectomy was more than 3 but less than 9 years from vasectomy, then you have a 91% chance of return of live sperm based on the semen analysis results in the practice. The pregnancy rate for the group overall has been 74%.

If you are more than 9 years from vasectomy, then the odds in my practice are 72% for return of live sperm with a 42% pregnancy rate. If you fall into the greater than 9 year category, your odds may be higher if you are able to afford an expert surgeon who routinely does complicated bypass procedures. The results with the simple microscopic vas reconnection I perform are not as good for those greater than 9 years from vasectomy. The vas reconnection I perform works very well, however, for patients less than 9 years from vasectomy.

A few surgeons in the country do a lot of repeat reversals. As much as 50% of their practice may be operating on patients who have already had one reversal. Many of these patients have a second blockage that occurs over time because of the increased pressure in the system after vasectomy. These surgeons do a lot of so called bypass procedures to try to correct these obstructions. Your total cost would likely be at least $10,000 to $15,000 for you to go to a true bypass expert who routinely does this more complicated repair.

If you are less than 3 years from vasectomy
Your chance of surgery success will be decreased less than 1% if these
two conditions apply : 1. You are in the less than 3 year interval from
vasectomy.
2. The higher priced reversal you are comparing
to is being performed by an expert
microsurgeon who routinely does the more
complicated bypass surgery in addition to
the simple vas reconnection

If you are 3-8 years from vasectomy
You will be decreasing your chance of surgery success 1 to 3% if these
two conditions apply : 1. You are in the 3-8 year time interval from
vasectomy.
2. The higher priced reversal you are comparing
to is being performed by an expert
microsurgeon who routinely does the more
complicated bypass surgery in addition to
the simple vas reconnection.

If you are more than 9 years from vasectomy
You will be decreasing your odds by at least 5 to 10% if the following
two conditions apply: 1. You are more than 9 years out from vasectomy.
2. The higher priced reversal you are comparing
to is being performed by an expert
microsurgeon who routinely does the more
complicated bypass surgery in addition to
the simple vas reconnection.

In the bench mark surgical study of the reversal field (The Vasovasostomy Study Group), five expert microsurgeons performed the more complex bypass procedure on only 4% of their patients. So over all 95% of first time reversal patients will likely not benefit from the more complicated, expensive procedure.