Frequently Asked Questions About
Vasectomy Reversal.

Many of our patients have questions about different aspects of vasectomy and microsurgical vasectomy reversal. While many of these are answered elsewhere on this site, we have compiled some of the more commonly asked questions which may not be covered, and these are discussed below.

Please feel free to contact us if there are other questions which are not covered here.

While several older studies suggested an increased risk of prostate cancer in men after vasectomy, more recent studies have shown no evidence for increased risk. Other potential health problems, including heart and vascular disease, arthritis, and autoimmune disorders, have also been suspected in a few studies in the past. To date there is no conclusive medical evidence, however, that vasectomy causes these or other health difficulties.

Occasionally, a man will have problems with chronic testicular discomfort after a vasectomy, due to excessive pressure in the epididymis. Vasectomy reversal does appear to be the best treatment for this relatively uncommon condition, which often responds poorly to conservative treatment such as antibiotics or anti-inflammatory medication.

Most definitely. The large majority of men, even after 20 or more years, can have their vasectomy successfully reversed. Although fertility tends to decrease with longer time after vasectomy, Dr. Finnerty has seen many couples achieve pregnancy in this time frame. He has even performed a reversal on a man over 30 years after vasectomy which resulted in pregnancy.

In most cases, no. Almost all vasectomy techniques involve removing a short piece of the vas, and sealing off the cut ends using sutures, metal clips, cautery, or a combination of these. All of the scarring from the vasectomy—regardless of technique—is removed at the time of reversal. The length of vas removed is rarely if ever a problem.

On rare occasions, a vasectomy is done at the time of an inguinal hernia repair, or an abdominal surgery. While vasectomy performed in these areas can be reversed, the surgery may be much more difficult and complicated.

Sperm in the testes and duct system are normally isolated from the body's immune system. When a vasectomy is performed, the sperm are exposed to the immune system, and the body responds as if the sperm were a foreign protein. The immune system produces substances called antibodies against the sperm.

These antibodies may be found in the blood and on the surface of the sperm in most men after vasectomy, but generally disappear after about 6 months. In some men, however, they may remain elevated for a prolonged time.

Many infertility specialists believe these persistent sperm antibodies may cause fertility problems after a vasectomy is reversed. However, not all men with elevated sperm antibodies have problems with fertility, and other men with low or absent antibody levels are unable to acheive pregnancy.

At this time, therefore, the role of sperm antibodies remains under investigation. Routine testing of sperm antibodies prior to surgery is not recommended, since it does not predict the chances for pregnancy with sufficient reliability.

The first portion of the sperm duct is known as the epididymis. The epididymis is about 1.5 inches long, is attached to the testes, and contains about 20 feet of coiled microscopic sperm ducts. Sperm become mature and active (acquiring motility) in the epididymis after they leave the testes. After vasectomy, some men will develop a leak of sperm from one of these delicate tubes, which results in scar tissue formation and a second blockage point in the epididymis. The chances of this occurring increase with the number of years after vasectomy.

If this blockage is not repaired at the time of vasectomy reversal, the vas will remain blocked and the reversal will fail. The duct in the epididymis is even smaller than the inside channel of the vas, and it has an extremely thin wall. Repair of a blockage of the epididymis is impossible without microsurgery. Microsurgical vasoepididymostomy is the most technically demanding procedure performed in surgery, in any specialty, and considerable surgical experience is required to get reliable results.

The need for a vasoepididymostomy can only be determined at the time of surgery, by evaluating the fluid from the testes for its appearance and the presence or absence of sperm.

Some surgeons use a micro laser to assist in the reconnection of the vas. Early in his reversal experience, Dr. Finnerty performed some reversals using this technique. In the laser technique, several sutures are placed to approximate the ends of the vas. A laser is then used to “spot-weld” the vas together, sealing only the outer layer. The laser cannot be used to align the inner layer of the vas.

The problem with this approach is the poor alignment of the inner lumen of the vas. While this approach may have a slightly better success rate than non-microsurgical vas reversal, the poor alignment of the inner layer often results in scarring and failure. The heat from the laser also tends to damage the delicate blood vessels in the vas required for healing without scar formation. Furthermore, if an epididymal repair is required, the laser cannot be used since it cannot perform the extremely delicate repair need for such a reconstruction.

Virtually all experienced microsurgeons have abandoned the use of the laser for reversal surgery because of these factors.

Because of the extremely small size of the sperm duct, even a perfect repair using microsurgical techniques can sometimes fail to remain open. In uncomplicated reversals where sperm is present at the time of surgery, this occurs about 3-5% of the time (about 1 in 20 men). In complex repairs involving the epididymis on both sides (the most difficult type of repair), failure is seen in about 1 in 3 men. Non-microsurgical reversals fail much more frequently than this.

A reversal which fails to produce sperm is very disappointing. Fortunately, in most cases repeat reversal can be done with good success rates. The chances for success depend on the reason for failure of the original surgery, and the type of reversal surgery originally performed.

Reversals generally fail for two reasons: scarring at the site of reconnection (the most common cause for failure after non-microsurgical reversals), and failure to recognize or deal successfully with epididymal blockage at the time of first surgery. If the cause of failure is scarring at the reconnection site after an uncomplicated vasovasostomy, success rates for repeat reversal are nearly identical to first time surgery. If there is an epididymal blockage, or if there has been previous surgery on the epididymis, then the success rate for repeat surgery is considerably lower. Repeat surgery in this situation is also quite long and may be very difficult.

The major alternative to vasectomy reversal is a technique called sperm aspiration. Sperm aspiration is generally performed by one of two means: percutaneous aspiration or open surgical aspiration. In percutaneous aspiration, a fine needle is inserted into the testes or the epididymis under local anesthesia. Since only a tiny amount of sperm can be retrieved, in vitro (IVF or “test tube”) fertilization must be used. This procedure must be repeated if the fertilization does not succeed.

Open surgical aspiration allows the retrieval of a greater quantity of sperm, some of which may be frozen for subsequent IVF attempts. The expense of each attempt at pregnancy using this approach is commonly $8-10,000 or more, and most studies show only 5-10% pregnancy rates per attempt. Therefore, vasectomy reversal is generally a much better approach for most patients.

Very rarely. Most health insurance policies specifically exclude coverage for infertility or reversal of vasectomy. If a man has chronic testicular discomfort after vasectomy which has failed to respond to medical treatment, and the treatment is documented, insurance companies will sometimes cover the procedure on this medical basis.