Vasectomy reversal is used to obtain sperm return to the ejaculate in men who have previously undergone vasectomy.
It is most simply achieved by re-connecting the two ends of the vas deferens (called vasovasostomy or VV), but a more challenging reconnection directly between the vas deferens and the epididymis (called epididymovasostomy or EV) may be required based on intraoperative findings. Both VV and EV require a great deal of skill due to the scale of the procedure given the average diameter of a vas deferens (0.4mm) and epididymal tubule (0.2mm). Due to the scale, the procedure should be performed with an operating microscope allowing over 20x magnification.
The need for EV can be predicted based on extended time since vasectomy and the absence of a sperm granuloma but only intraoperative findings regarding the content of the fluid in the vas deferens can dictate definitively whether EV is necessary. VV is not acceptable if no sperm parts are identified in the fluid depending on the number of years since vasectomy. Therefore, the surgeon must be confident in their abilities to perform either VV or the more difficult EV as it is not clear before surgery which will be required.
When to ask a Urologist about Vasectomy Reversal
You should speak with a Urologist about vasectomy reversal if you are considering having children following a vasectomy.
This procedure is very rarely covered by insurance, and patients should anticipate providing an upfront cash payment. We have negotiated cash pay rates for anesthesia and the facility fee as low as possible. It is our goal to keep our costs down as much as we can to be able to make this procedure accessible. Specific pricing will be discussed at the office visit. It is important to note that vasectomy reversal has been shown to be more cost effective than proceeding with in vitro fertilization for the majority of couples pursuing pregnancy after vasectomy.
Evidence supports improved success (or patency) rates of sperm returning to the ejaculate among higher-volume surgeons (87% vs 56%) and fellowship-trained surgeons (79% vs 70%). A meta-analysis of vasectomy reversal outcomes reported patency rates around 90% and pregnancy rates around 75%. This analysis included a minority of patients who underwent EV.
Patency is typically achieved about 4-6 months following VV and about 9-12 months following EV. Patency rates decrease gradually as time passes since vasectomy with patency rates around 75% after 10 years following vasectomy. Pregnancy rates are heavily influenced by partner age with steep declines for partners over 40 years old relative to partners under 40 years old (14-42% vs 56-73%).
Vasectomy reversal is superior than proceeding directly to in vitro fertilization in many cases because it more easily allows for multiple children, exposes the couple to only minimal medical risk, has favorable success rates, and is less expensive per live delivery. Pregnancy rates per cycle of in vitro fertilization are around 45% for women less than 35 years old, 30% for women between 36 and 40 years old, and 15% for women older than 40. Many women require multiple cycles, which add expense and only marginally increase the overall success rate. Vasectomy reversal appears to be more cost-effective than surgical sperm retrieval with in vitro fertilization across a wide range of expected reversal success rates and in vitro fertilization success rates. The calculated cost per live delivery is around $21k for vasectomy reversal relative to around $55k for sperm retrieval and in vitro fertilization.
Possible Side Effects
Significant risks with this procedure are extremely infrequent. There is a small risk of significant swelling due to a fluid or blood collection, infection, damage to the testicle, and a high-riding testicle following the procedure.
An alternative approach to vasectomy reversal for achieving a genetic pregnancy could entail surgically retrieving sperm directly from the testicle or epididymis to be used with in vitro fertilization. Other options include adoption and the use of donor sperm.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive, and you should wash the surgical area with an antibacterial soap.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
Patients are sent home following the procedure. In a minority of cases, a small surgical drain is left in position to prevent fluid accumulation postoperatively, and this drain is removed in the office in 2-3 days. There can be tenderness, bruising and swelling in the scrotal and groin area that dissipates over 1-2 weeks. The first follow-up semen analysis is typically obtained around four months after surgery.