What is a reverse Vasectomy
As a society, or indeed individually, we often find ourselves in a situation where we are seeking an ‘out’ to reverse one action or another that may in fact feel less popular with hindsight. When it comes to your stock standard vasectomy this may be one tattoo with an unforgiving ink? But do not confuse difficulty with impossibility. 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.
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. In addition, 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 reasonably 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. 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.
Most vasectomy reversals are performed as an outpatient surgery and can be done under local, regional or general anaesthesia. 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.
Another option to a vasectomy 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.
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. 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.
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.
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.
Vasectomy reversal cost
The cost of Vasectomy reversal surgery, 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. Costs 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.
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.
Vasectomy reversal recovery time
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.
We typically recommend checking on possible epidermal scarring 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.