What Is Vasectomy Reversal?

Vasectomy reversal is an increasingly popular procedure that allows men to undo a previously performed vasectomy surgery.

Vasectomy reversal surgery is sought by 5-10% of men who have had a vasectomy and now are desiring more children with a first spouse for various reasons, including loss of a child or financial changes, or who are remarrying/ beginning a new relationship. Much less common reasons for the reversal are pain after vasectomy or other supposed health benefits.

In the common vasectomy reversal procedure that I perform, the vasectomy reversal doctor re-connects the tubes that carry sperm from the testicles to a man’s semen. Those tubes, known the vas deferens, are sewn back together. In the much less common procedure, the tubes are attached to the epididymis, the tube on the back of each testicle where the sperm matures.

Vasectomy reversal is considered the best option for pregnancy following a vasectomy.
Vasectomy reversal can be performed anytime after a vasectomy, from just a few months to decades following the vasectomy, as men rarely discontinue sperm production following a vasectomy (although results do decrease over time from vasectomy).

Vasectomy reversals have a high success rate for patients a few years after vasectomy, well over 90%.

From Blood Money to Embracing Life through Vasectomy Reversal

Today’s blog is a bit of a rant. There are just some things I like to get off my chest. Perhaps you’ll relate to this.

It has nothing to do with my skill or qualifications as a surgeon, but perhaps it will give you some insight into who I am as a person. I believe you should not only trust your surgeon, but also feel a connection with him or her. It is important to “be on the same page” with your doctor on more than just the “health care” level.

So here goes…

In 2004, I saw two reliable sources report that 4,000 abortions were being performed in the U.S. every day

That’s right, every day.

It was the most common surgical procedure in the country.

Now, I know that many are convinced of the legitimacy of this procedure, but I confess I have not and will never see any sense in this. Now, my view stems largely from my biblical and spiritual views, but there are some blatant common-sense reasons as well.

First, scores of medical workers will labor heroically hour upon hour, night and day for weeks at a time to save the life of a third trimester fetus born prematurely. But at the same medical center, a third trimester fetus is aborted.

Second, if you’ve ever seen an ultrasound, I defy you to say that the fetus is not a person. A fetus is a person too.

Third, a young mother can hand over the body of her unborn to the abortionist without any charges being filed. And yet, if a murderer takes the life of a fetus he or she is charged with a felony crime.

Which is it? A life worthy of the charge of murder? Or a mass of tissue with no rights? It can’t be both.

It’s enough to make me bang my head on the table (or simply cry) – that we can be so unthinking and so cruel to these helpless ones.

Well, when I heard, in 2004, about the 4,000 abortions a day in the country, the thought occurred to me, “I’m sure those young women are not paying for all those abortions. I’m sure that some of the people I am doing business with are paying for them”.

And sure enough, when I contacted the various insurance companies and government agencies that paid for my services, they said they did pay for elective abortions. These “partners” of mine (through the provider contracts) were funding abortions.

There was blood on my money.

I made the decision to stop the provider agreements. Four months later I had to close the doors of my practice because I was no longer a contracted provider for the patients’ insurance companies.

But one door closing caused another to open. This closure opened the door of opportunity. A few months later I remember my colleague who had, years before, suggested I learn the vasectomy reversal procedure. I did. And now I embrace life. Not death.

You, too, have desires and convictions. And your decision to reverse your vasectomy is one that embraces life. You are choosing to be open to the possibility of children. Obviously, the birth of a child is not in my power to accomplish for you, but I do commit to doing all I can, the best I can, to see your reversal is a success.

Reasons You Should Look Elsewhere for Your Vasectomy Reversal

This blog will let you know who is NOT right for my practice or procedure. I’ve been doing vasectomy reversals for a number of years now. I’ve seen or talked with thousands of patients. And I’ve come to realize there are some patients who are just not right for my practice or procedure.

1. I will not perform the procedure for “health reasons”. I’ve talked to a number of men who believe that having their vasectomy reversed would be good for their health. None of these benefits have been proven. I will not perform my procedure for any reason other than the desire to have children.
2. I strongly encourage patients more than 9 years from vasectomy to go to a surgeon who does the more complicated, expensive bypass procedures. But some simply cannot afford it. These are also the patients that would not proceed with a second surgery if the simple vas reconnection did not work. If patients cannot afford to get to a bypass surgeon as I advise, then I will do the simple vas reconnect for them that offers a 72% rate of return of live sperm.
3. I will not perform the surgery for patients who are only seeking relief from post vasectomy syndrome (PVS). They should seek an expert in PVS to provide them with the specialized care they need.

If you meet one of the criteria above, I urge you to seek advice elsewhere.

But if your vasectomy was within the last nine years and you and your wife sincerely desire to be open once again to the possibility of children, then you are likely a good fit for this practice.

The Health Care Debate and Vasectomy Reversal

I don’t care where you come down on the recent health care debate in Washington. There are certainly arguments for and against universal health care.

But I think there is one thing we can all agree on: there is a lot of waste in the current system.

And some of that waste occurs in the larger hospitals.

Large facilities have high overhead. It’s just a fact. There is greater cost associated with care in a large facility than with care you receive in a small clinic or private office.

Some procedures require the equipment and services that can only be found in large hospitals.

But vasectomy reversal, within 9 years of the vasectomy, is not one of those procedures. There is no advanced or unwieldy equipment that is needed for this procedure. In fact, general anesthesia is not required.

So, part of the additional fee you end up paying for the more complicated and involved “bypass” reversals that some doctors perform, is directly due the facility in which they are performed.

But my reversals are done in a small private office using only what is required to get the job done.

+ no general anesthesia
+ no facility charge
+ personally answer calls and email thus saving labor costs
+ my office is comfortable but not large thus saving fixed costs
+ high powered scheduling and patient relation software also decreases labor costs

You can see that none of these efficiencies have any impact on surgical quality, so the costs are lower and the quality is still excellent.

Also, it’s all I do here. So, your fee does not have to help pay for a billion other services provided like at a major hospital. You pay for what you get. Your vasectomy reversal. Period.

General Versus Local Anesthesia in Vasectomy Reversal

Patients commonly inquire about pain during vasectomy reversal and the risks of general anesthesia as opposed to local anesthesia. Pain is not just a common concern; it’s a legitimate concern. To put your mind at ease and to simplify the process, ask your physician about anesthesia during your initial consultation so that you can move forward with the right information from the very beginning.

Well performed local anesthesia is plenty effective in keeping a patient comfortable during the vasectomy reversal procedure. I also know that anesthesia does not impact patency rates (rate at which sperm returns to semen). There are other benefits to local anesthesia:

• Less expensive medical costs
• Fewer side effects
• Quicker recovery time

When I started this practice nearly five years ago, my opinion about local anesthesia for vasectomy reversal was based on what I saw in the scientific studies in the field. Most importantly, research showed that the type of anesthesia used did not affect results of the vasectomy reversal.

This was proven by the acclaimed Vasovasostomy Study Group*. In this study, most first time vasectomy reversals (515 patients) were done with local anesthesia. General anesthesia was used in 454 patients. Patients with sperm in their semen were 86% for local anesthesia and 85% for general anesthesia. The percentage of patients achieving pregnancy was also 1% higher for patients who had local rather than general anesthesia.

This study should silence the worn-out argument about patients not being able to hold still enough for precision surgery unless they have general anesthesia. It should also mute concerns about pain during vasectomy reversal.

It is likely you will feel the initial pinching that goes along with the numbing injection. However, after that point you should feel very little and be quite comfortable.

The other thing I saw in the surgical studies was the safe, comfortable and effective use of local anesthesia in all types of scrotal surgery including vasectomy, vasovasostomy (vasectomy reversal), excision of epididymal cyst, orchidectomy (removal of testicles for prostate cancer), hydrocelectomy, and excision of spermatocele.

My opinion of local anesthesia for vasectomy reversal is founded on these studies, and also my own experience of having over 1,200 satisfied patients.

We have hundreds of patients who can attest to the effectiveness of local anesthesia. We can even connect new patients to those who have completed a vasectomy reversal with local anesthesia. Just contact us for the referral list.

* Belker AM, Thomas AJ, Fuchs EF, Konnak JW, Sharlip ID. Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group. J Urol. 1991 Mar,145(3):505-11.

How Much Does Vasectomy Reversal Cost?

Unlike vasectomies, the vasectomy reversal surgery is usually not covered by insurance, and several factors can drive up the cost for the procedure.

The investment required can vary among doctors, regions and states, as well as the type and complexity of procedure involved. The vasectomy reversal surgery generally is performed on an outpatient basis and does not require a costly hospital stay.

Many professionals charge $6,000 to $15,000 for vasectomy reversal surgeries, though the simpler methods can carry a much lower cost.

There are two types of reversal surgeries: The less common and more complex procedure is known as “vasoepididymostomy” and typically carries a much higher cost. It is rarely needed if the time from vasectomy is less than nine years. The most common — and more affordable – method is known as “vasovasostomy.”

I only perform vasovasostomy and recommend to patients that they should seek help elsewhere if they are nine years or more from vasectomy. I don’t incur the costs that go along with performing the more complex procedure, so if you are less than nine years out, you pay only for what you need.

Patients should ask their physicians for their success rates in performing either or both methods. Some surgeons, including myself, offer guarantees, so it is important to ask about these policies before the vasectomy reversal surgery.

The cost of vasovasostomies, the simpler method, can vary wildly as well. Whether a physician uses general or local anesthetic can affect the total investment, as well as the question of where the procedure is performed. Some physicians perform the vasectomy reversal procedure in their offices under local anesthesia as I do, which often helps control the overall cost.

Vasectomy Reversal Surgery 101

Vasectomy reversals, also known as vasovasostomies, provide millions of men with the opportunity to have children again.

It is an outpatient procedure, usually performed at a doctor’s office, clinic or hospital. Generally, it is performed by urologists, general surgeons, or other physicians trained in vasectomy reversal.

An estimated 10% of men, after vasectomy, later decide to get the procedure following divorce, death of a child or spouse, or a change in convictions or circumstances. The procedure usually takes 2 hours to complete. A local anesthesia and mild sedatives are used. Pain is mild. Most patients can resume vigorous activities in less than one month after surgery. Most men can return to a desk job in three days.

The Vasectomy Reversal Surgery Procedure

Vasectomy reversal surgery most commonly reattaches the vas deferens – the two ducts that carry sperm from the testicles to the prostate. The surgeon cuts the scrotum skin and through the one inch surgery site, reconnects the vas deferens, allowing the release of sperm when a man ejaculates.

There are two surgeries that may be used to perform a vasectomy reversal. The most common and successful method involves the surgeon suturing the cut ends of the vas tubes back together (vasovasostomy). This can be done equally successfully with either a formal two layer technique or with the modified technique equally successfully.

The less common surgery (less than 5-10% of all reversal patients) reconnects the cut vas to the epididymis, the tube resting on the testicle itself. This procedure is called vasoepididymostomy or “bypass” for short. It is less successful in resuming sperm flow and is more commonly used in patients over 9 years from vasectomy. I do not perform this procedure in my practice, but advise patients to seek help elsewhere if they are 9 years or more from vasectomy.

How Effective Is Vasectomy Reversal Surgery?

Overall, a reverse vasectomy is more effective the quicker it follows the original procedure. Sperm returns in my practice for patients less than three years after a vasectomy in 97% of patients; 91% in three to eight years; and 72% more than 9 years after the vasectomy.

In my practice, vasectomy reversals produce a pregnancy rate of 81% for patients less than 3 years from vasectomy, 74% in patients from 3-8 years out, and 42% greater than 9 years. These figures are for couples followed for 2 years who have no female fertility is

Defining Vasectomy Reversal Terms

As you begin to prepare for a vasectomy reversal or while you are researching to understand your options in vasectomy reversal, you will undoubtedly come across medical terms that are new to you and a bit unclear. Below is a list of terms my patients ask about. If there is another word you would like to understand better that you don’t see here, simply ask in the comments section of this post or contact me directly.

AntiSperm Antibodies – Proteins formed in response to sperm much like other proteins formed by the body’s immune system to protect itself from something harmful (i.e., allergy, injury). ASA have possible significance in less than 5% of vasectomy reversal patients. No need for preoperative testing.

Epididymis – A sac that lies on the testicle containing very thin walled tubes where sperm mature and are stored prior to ejaculation.

Fertility Expert – Either an Ob/Gyn physician who specializes in female reproduction or an Andrologist who specializes in male reproduction.

Local Anesthesia – Placement of numbing medication with tiny needles in the vas region to allow painless surgery on the vas deferens.

Microsurgery – Surgery using optical magnification by use of a microscope.

Microsuture – Tiny material (thread) used during vasectomy reversal microsurgery to reconnect the two ends of the vas deferens.

Patency – Rate at which sperm returns to semen following a vasectomy reversal.

Pregnancy Rate – Rate of pregnancy for couples following a vasectomy reversal. Usually defined as a two year rate (two years after reversal) for couples who have no female fertility issues.

Prostate Gland – Gland, located below the bladder in which the ejaculatory ducts, the two vas deferens and the urethra join.

Scrotum – The sac that contains the vas deferens, epididymis, and testicles

Semen or Seminal Fluid – Fluid containing sperm and glandular fluid released by the urethra with ejaculation

Sperm Count – Number of sperm per volume, also less commonly described as the number of sperm in a sampling of semen (better described as total sperm count).

Testes or Testicles – Two male reproductive glands located in the scrotum which produce sperm

Total Motile Count – Figured by multiplying the total sperm count by the percentage of sperm with motility (movement). Normal Total Motile Count is 20 million.

Urethra – Tube that runs from the bladder to the penis that carries urine or semen

Vas Deferens – The tube where sperm are transported between the epididymis and the prostate. There are two tubes, one on each side of the scrotum.

Vasectomy – A surgery that causes infertility in men. Specifically, part of the vas deferens is removed or divided.

Vasectomy Reversal – A surgery that aims to bring fertility back to a man. Specifically, the vas deferens are reconnected. Also loosely used to describe a more complicated surgery to connect the vas to the epididymis.

Vasoepididymostomy – A complicated vasectomy reversal performed in about 5% of all reversal surgeries, but more commonly in patients over 9 years from vasectomy. It connects the vas deferens to the epididymis in order to bypass a blockage in the epididymis. See vasectomy reversal definition above.

Vasovasostomy – Simple vasectomy reversal that reconnects vas deferens. It is by far the most common surgery for vasectomy reversal. See vasectomy reversal definition above.

Microsurgical Vasectomy Reversal – An Olympic Event?

You know the old saying “truth is stranger than fiction”? Well that came to mind a few days ago as I watched the Winter Olympic Games.

The same day the games began in Vancouver, I was doing the last operation of the week for a very pleasant couple from Delaware. I was listening to a symphony play “Ave Maria” in the background, and was really enjoying the surgery.

At that moment I was performing the anastamosis, the hook up between the upper and lower portions of the vas tube to repair the vas deferens. I was peering through the microscope that makes the vas look as big as a barn. I held in my right hand the titanium microsurgical needle holder that grasped the 4/1000ths of an inch needle and my left hand fingers cradled the titanium forceps with a 0.2 millimeter tip.

After running the needle precisely through the wall of the two vas ends, I was tying the microsuture (less than one third the diameter of a hair). I rhythmically intertwined the tips of the two instruments in order to tie the surgical knots. The image of a couple on the ice at the Winter Olympics came to mind as I methodically but gracefully performed the maneuvers to complete the exact reconnect.

Surgery has often been likened to an athletic event, and I was certainly enjoying the movement and execution of the vasectomy reversal maneuvers to help this couple with their dream.

Fast forward a week and a half – I walked into the living room where my wife was watching the live TV broadcast of the Winter Games. Belbin and Agosto, the veteran U.S pair were taking to the ice. They beautifully skated to the same song I had heard in the surgery room: “Ave Maria.” After the competition they spoke of their long-term commitment to excellence and the satisfaction of having done the best they could do.

So the truth really does beat fiction. I’ll never be on the ice center stage, but after years of sacrifice and preparation I know the joy of a job well done.

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