The absence of sperm from the ejaculate (azoospermia) is found in 15% of infertile men and obstruction of the ductal system is responsible for approximately 40% of cases. Obstructive azoospermia may result from epididymal, vasal, or ejaculatory duct pathology. Vasectomy is the most common cause of vasal obstruction. Severe genitourinary infections, injury during scrotal or inguinal surgery such as hernia repairs are other common causes of obstructive azoospermia. Microsurgical reconstruction of the reproductive tract is preferable to sperm retrieval with in vitro fertilization/intracytoplasmic sperm injection in men with prior vasectomy if the obstructive interval is less than 15 years and no female fertility risk factors are present. If epididymal obstruction is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization/ intracytoplasmic sperm injection should be individualized. Vasoepididymostomy should be performed by an expert in reproductive microsurgery.
Sperm retrieval/ICSI is preferred to surgical treatment when:
- advanced female age is present
- female factors requiring IVF are present
- the chance for success with sperm retrieval/ICSI exceeds the chance for success with surgical treatment
- sperm retrieval/ICSI is preferred by the couple for financial reasons.
A general anesthetic and local cord block with 1% plain lidocaine are used. A 2-3 cm incision is made on both sides of the scrotum over the vas deferens at the area of prior ligation. The old scar and/or clips are removed and the fluid at the ends of the sperm tubes are examined for signs of sperm. An operating microscope is is to connect the two tubes in 2 layers with tiny suture the size of human hair. if there is concern that the blockage is at the epididymus then a bypass procedure is performed.
There may be some mild swelling and discomfort in the scrotum afterwards. Ice will help with scrotal swelling. A pain pill is prescribed to take if needed. Patients should wear a scrotal support or compression shorts for the first week to minimize swelling and discomfort. It is ok to shower but no tub soaking or swimming for 2 weeks. Patients may resume regular physical activity after 2 weeks and sexual activity at 4 weeks.
Frequently Asked Questions
How is the surgery performed? Does it require general anesthetic and how many hours? How about recovery?
Vasectomy reversals are performed as an outpatient surgery and can be done under local, regional or general anesthesia. The length of surgery is dependent on whether the vas deferens is reconnected (1 1/2 to 2 hrs) or a more complicated bypass procedure has to be performed (3 to 3 1/2 hrs). Recovery is variable and can take anywhere from 1 to 2 weeks. We recommend avoiding heavy lifting and sexual intercourse during the first 4 weeks after this surgery.
Does insurance pay for vasectomy reversal? If not, what can I expect to pay?
The cost of the surgery, as well as whether or not it is covered by insurance depends on your insurance provider. The majority of private insurance carriers do not cover this procedure. Urology Associates is in partnership with Columbia Surgical Associates (outpatient facility) and offers a comprehensive pricing plan at $5,000 and includes initial consult, Dr. Mechlin’s fee, general anesthesia, and the facility fee.
What does the comprehensive plan cover?
A vasectomy reversal consultation appointment is required prior to scheduling the procedure. The 1-hour meeting is complimentary and is collected on the day of the appointment. The comprehensive plan includes the initial consultation visit, Dr. Mechlin’s fee for performing the procedure, anesthesia, and the surgery center’s facility fee. The total cost of the Comprehensive Plan is $5000 and is due upon scheduling.
What is the success rate of reversal?
The success rate varies based on several factors. Time from the vasectomy and presence of motile sperm, and reconnecting the vas definers and not having to do a bypass procedure are the most crucial factors that predict success. However, the return of sperm into the ejaculate does not guarantee pregnancy. 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.
What should I expect after my vasectomy?
It can take several months, if not longer, to see a return of motile sperm and a normal sperm count. The return of sperm is typically faster after a vasovasostomy then a epididymovasostomy. After a bypass procedure (epididymovasostomy) it can take six to twelve months to see the presence of sperm in the ejaculate. Remember, the presence of sperm doesn’t necessarily mean a normal count or pregnancy.
Are there other means of having a child after vasectomy 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 combined with in-vitro fertilization. Dr. Mechlin performs open sperm extraction through a small 1-2cm incision under local with sedation. A reproductive endocrinologist and embryologist then take over and the sperm is injected directly into the eggs that have been retrieved from the woman after she has been stimulated with hormone injections.
Although it is often successful this option is expensive and it is not possible to remove enough sperm from the man’s testicle to inseminate the woman.
Can a vasectomy reversal be redone?
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?
In this case a bypass procedure should usually be performed. 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.
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.