FAQ's

During the reversal, the vas deferens is cut above and below the site of the previous vasectomy, and the two ends are precisely aligned. Dr. Generao uses an operative microscope and performs a “three-layer” connection. In the United States, physicians are currently performing about 500,000 vasectomies per year. About 2%-6% percent of men who have had a vasectomy will decide to undergo a reversal. The technique used for the vasectomy is largely irrelevant to the success of the reversal. The vas deferens is a long tube and it is very rare to be unable to accomplish a reconnection.

On the average, one vasoepididymostomy for every 10 to 15 standard vasectomy reversals (vasovasostomies). However, the longer it has been since your vasectomy, the more likely it is you will need this procedure.

It is very rare to find large numbers of active sperm at the cut end of the vas deferens during a reversal. It would be possible to expose the epididymis, “nick” a tubule and recover active sperm, but this increases the risk of obstructing the epididymis at the site of the “nick”. If you are interested in freezing sperm at the time of vasectomy reversal, Dr. Generao can discuss the pros and cons for your unique situation. However, if a vasoepididymostomy is required, freezing sperm becomes quite feasible. During the course of a vasoepididymostomy, the epididymis tubule is “nicked” to check for active sperm. In this setting, it is very reasonable to collect and freeze epididymal sperm. Two important points should be clearly understood: Freezing sperm cells is optional and if chosen will add additional costs. The quantity of sperm obtained is not enough for simple insemination. In vitro fertilization (IVF) would be necessary to assist the fertilization process (see question 16). In vitro fertilization (IVF), with micro-injection of sperm, (Intracytoplasmic Sperm Injection – ICSI) would be necessary to assist the fertilization process.

Contrary to popular belief, most men are not in severe pain after surgery. Ice is applied to the scrotum for about 36 hours following surgery and a pain pill may be used as needed. Most men are fine with Tylenol or ibuprofen after surgery. It is uncommon to need prescription strength pain medication after vasectomy reversal. Warm soaks are started after 72 hours. Walking and light activity are resumed quickly but heavy lifting and vigorous exercise are restricted for 2.5-3 weeks. Sexual intercourse is avoided for ten days. Most men are able to return to work after only a few days. Sperm are commonly seen at one month if a standard reversal was performed. We've had patients conceive before their semen test.

It is very rare to have a serious complication from a vasectomy reversal. The most common complications are: Bleeding (bruising is common; an internal collection of blood or a “hematoma” occurs in less than 5 percent of patients) Infection (occurs in less than 5 percent of patients and usually clears with oral antibiotic treatment) Nerve damage (occurs in less than 5 percent of patients and manifests as numbness at the incision sites or chronic pain) There is no reason why this type of surgery should affect either urination or erections.

We've had patients conceive within two weeks of surgery! However, data collected on large numbers of vasovasostomy patients show a mean (average) time between surgery and pregnancy of about 6 to 12 months, depending on female age and time since vasectomy.

Since pregnancies do not usually occur right away, most couples will not want to delay surgery. If you do not plan to conceive for several years, then a delay might be reasonable.

There are data that show a deterioration of semen quality over time in 5 to10 percent of men after vasovasostomy and in 10 to 20 percent of men after vasoepididymostomy. Sperm banking may be considered but this does not guarantee success.

Problems such as these appear to occur at the same frequency as in the general population

It is now possible to extract sperm cells from the testicle or epididymis. However, we do not recover enough sperm to produce a pregnancy by simply inseminating the woman. Instead, the sperm are used in the laboratory to fertilize eggs removed from the female partner. These lab techniques are much more costly than the reversal itself but they do represent a viable option with good success rates for couples who can afford them. Therefore, in most cases, a vasectomy reversal is more cost effective and the best first option.

If you had a previous vasectomy reversal and now have no sperm, a “re-do” reversal may be a reasonable option. Success rates for re-do reversals are still very good, declining by only about 5 percent compared with the “first try”. If sperm were ever seen after the first attempt, this is a good sign that a re-do could restore sperm to the ejaculate.

There are several techniques that can help to produce a pregnancy if it doesn’t occur at home. Intrauterine insemination (IUI) of sperm can be performed in some situations (if the sperm count is adequate). With this procedure, the woman’s cycle is monitored to detect the time of ovulation. At the appropriate time, a sperm sample is collected, washed, and concentrated. The sample is then placed into the upper uterine cavity by means of a small catheter. Depending on the quality and quantity of sperm, some couples will require in vitro fertilization (IVF) in order to conceive. IVF is a technique where eggs are removed from the woman’s ovaries and placed in a lab dish with sperm. Success rates depend upon the age of the woman and the quality of the resulting embryos. If the sperm count is very low, an assisted fertilization procedure may be necessary. Sperm may be obtained surgically from the epididymis or testicle (MESA or TESE) with minor surgery. Adoption or insemination with donor sperm are also other options for couples who are unable to conceive following a vasectomy reversal. Making the decision to reverse a vasectomy is a big step. Considering all of the options currently available, vasectomy reversal represents the most cost-effective option for having your own biological child in most cases. We will make every effort to make your experience as comfortable and convenient as possible. Please ask questions! We look forward to meeting you!