Vasectomies can be reversed even after very long periods of time, sometimes after more than 25 years. Sperm are constantly being produced in men and even after time, there should be viable sperm. However, the success of the reversal, in terms of achieving a pregnancy, is dependent upon the experience of the surgeon, the age and fertility status of the female partner, and the length of time since the vasectomy.
The surgeon noted that he both cauterized and tied the vas during surgery. Would that reduce the positive outcome of an operation?
No. The outcome of the surgery is more dependent upon what is found at the time of the reversal as well as the experience of the surgeon performing the reversal surgery. During the reversal, the surgeon will check for sperm within the vas. If sperm is present, then the two ends of the vas deferens can be put back together, and the success rate should be fairly high. However, if there is no sperm at the end of the vas, there is likely a blockage closer to the testicle. Then, a more complicated surgery may be performed, but this procedure has a lower success rate.
Is there ever any nerve damage when a vasectomy is performed? If reversed, will the nerves restore themselves?
It is possible but rare that significant pain from nerve damage can occur after a vasectomy. There are some cases where a reversal will help with the pain, but these are rare. A full work-up should be performed before undergoing a vasectomy reversal as the success rate in getting rid of the pain may not be very high.
How is the surgery performed? Does it require general anesthetic and how many hours? How about recovery?
Most vasectomy reversals are performed as an outpatient surgery and can be done under local, regional or general anesthesia. It typically takes approximately 3 to 4 hours using an operating microscope to perform the surgery. Recovery is variable and can take anywhere from 5 to 14 days. We recommend avoiding heavy lifting and sexual intercourse during the first 4 weeks after this surgery.
Does insurance pay for vasectomy reversal?
The cost of the surgery, as well as whether or not it is covered by insurance, is variable, and dependent upon where the surgery is performed and the patient's individual insurance policy.
What is the typical cost?
Cost can range anywhere from approximately $2,000 to $12,000, depending upon the surgeon, the type of practice where it is performed, and what part of the country the patient lives in.
Is there anyone who is automatically NOT a candidate for vasectomy reversal?
There are certainly some patients who are better candidates than others; time from the vasectomy is not necessarily a reason not to have a reversal. However, in the case of a couple where the woman has, for instance, had a tubal ligation, sperm aspiration combined with in-vitro fertilization is probably a better choice than performing vasectomy reversal followed by tubal ligation reversal.
Please explain the probability of any side effects... impotence, urinary incontinence, etc.
Side effects are typically minimal and usually would include swelling, pain or bruising; however, the vasectomy itself and the reversal should not have any effect upon potency or urinary function.
What is the effective rate of reversal?
The success rate varies based on several factors. Time from the vasectomy certainly helps to predict how likely it would be to be able to put the two ends of the vas deferens back together; however, getting return of sperm into the ejaculate does not guarantee pregnancy, so pregnancy rates typically vary from 30 to 70 percent, whereas patency rate, that is the return of sperm, can be as high as 95 percent.
Are there other means of "fertility" that I should consider as options to reversal?
The only other option to a reversal that would allow use of a man's sperm with the woman's egg would be surgical sperm retrieval (through either extraction or aspiration) combined with in-vitro fertilization. The sperm removed from the testicle can be injected directly into the eggs that have been retrieved from the woman after she has been stimulated with hormone injections.
This is a very effective but expensive treatment with relatively good success rates. However, it is not possible to remove enough sperm from the man's testicle to inseminate the woman.
If antibodies from your immune system are present, why does this affect pregnancy rates?
There is some debate about the effects of antibodies on pregnancy rates after vasectomy reversal. Approximately 70 to 80 percent of men who have had vasectomies will have antibodies to their sperm. However, these antibodies rarely prevent the sperm from fertilizing the egg. Therefore, we counsel patients that it is unnecessary to routinely test for antibodies, as they rarely will have a bad effect upon the success rate.
What are the risks of cancer and do they increase with the reversal?
There was a report several years ago stating that men with vasectomies had a higher rate of prostate cancer. This report has since been challenged and, for the most part, disproven. There is also no evidence to show that reversal of the vasectomy would have any effect upon risk of cancer.
How many times can a reversal be done?
There is no maximum number of times that a man can have a reversal, although the success rate may decrease with increased number of reversals. However, there is good data to show that “redo-reversals” can have as high a success rate as first-time reversals. The more surgery is performed, the greater the likelihood of scarring in the scrotum, making subsequent surgeries more difficult.
What are my options if you do not find sperm in the vas at the time of surgery?
If the surgeon is experienced in doing vasectomy reversals, they should be able to find the blockage, which is likely to be in the epididymis, and perform the bypass above that point. However, if the surgeon is not able to perform this bypass, then the best thing to do is reattach to two ends of the vas and hope for the best. That is why it is important that prior to surgery, the patient question the surgeon regarding their experience in vasectomy reversals to determine if they would be able to perform both types of bypasses.
I had a reversal and checked okay at 6 weeks. Would scarring be a concern after this amount of time?
Scarring can occur at any time after a vasectomy reversal although it typically occurs within the first six months. Therefore, even if there was sperm in the ejaculate after six weeks, it is possible that scarring could occur later on. We typically offer sperm banking in case late scarring does occur.
How would I find a good surgeon for the procedure?
It is important to choose a surgeon who performs reversals on a regular basis, preferably someone with fellowship training or other special training in male infertility. Patients should ask the surgeon how often they perform the procedure, what their own personal success rate is, both in obtaining sperm and pregnancy rates, and if they have the ability to perform both types of reversals.
Are there any effects to the sperm quality after several years of a vasectomy and reattachment?
The sperm quality should return to normal 3 to 6 months following a reversal as it takes that long for the testicles to make new sperm. However, the count and the motility may be lower after reversal due to partial blockage or scarring.
How often should you check on scarring?
We typically recommend checking every 3 months, and we offer sperm banking based upon the quality of the sample. The chance of scarring is approximately 7 to 10 percent in the first 1 to 2 years following a successful reversal.
What are the statistics of men in the United States who are infertile and can that be reversed?
The incidence of male infertility is not well known, however, approximately 15 percent of U.S. couples have fertility problems and half of those are related to the male factor. Therefore, in any couple that is having fertility problems, there is a 50 percent chance that the male may be involved and therefore he should be evaluated.
Is it safe to get a boy a vasectomy for his 18th birthday then be able to switch it back later when he decides to have children?
No, we do not feel that is a reasonable option. Vasectomy reversals do not always work and in someone who is both young and never fathered children, it is probably not a good idea. We would counsel this patient to reconsider having a vasectomy. Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children.
How does one prepare for the vasectomy or the reversal?
Prior to a vasectomy, the patient and his partner should be absolutely sure that they are done having children. There are no special preparations in terms of abstaining from ejaculation prior to either the vasectomy or the reversal. The patient should be aware that a vasectomy reversal is a more expensive procedure than the original vasectomy and likely will take longer to recover.
What is the recovery for a vasectomy and the reversal?
Most men will recover from a vasectomy in a couple of days. We typically recommend taking it easy for 2 days, using ice packs and scrotal support, and then going back to work 2 or 3 days later. However, vasectomy reversals tend to take longer, depending on the type of work that the patient does. While some men can return to a desk job in 3 or 4 days, we recommend that heavy construction and lifting should be avoided for 4 weeks after a vasectomy reversal.
What is the oldest age for a male to be considered for reversal?
The success of the reversal is related more to the age of the female rather than the male. Therefore, there is no age limit for a reversal.
Have any studies been done to show what the psychological/emotional problems are for a vasectomy or reversal?
A report on psychological factors prior to a vasectomy has suggested that most men are not worried about having a vasectomy, but they are a little concerned regarding the recovery of a vasectomy. Very few men have reported serious psychological or emotional problems following their vasectomy.