The mini incision microsurgical vasectomy reversal is an innovative surgical proce

dure that applies the no-scalpel vasectomy principles and instruments. The entir
e vasectomy reversal operation is performed using incisions that are less than 1
cm resulting in less post-operative pain and functional quicker recovery compar
ed to a traditional vasectomy reversal.
As in the no-scalpel vasectomy, the mini-incision microsurgical vasectomy revers
al begins by manipulating and stabilizing the vas directly under the scrotal ski
n using the three finger technique. The no-scalpel vasectomy ring clamp is then us
ed to capture the vas through the scrotal skin at the site of the vasectomy so n
ot to injure the vas itself. A small (< 1cm) opening in the scrotal skin is crea
ted and the vas is gently exposed, released and delivered out through the small
opening in the skin. Despite the small size of the incision, the scrotal skin is
compliant and flexible. It is important not to dissect too close to the vas in
order to preserve a healthy blood supply around the vas and minimize scarring fo
llowing the procedure. After the vas has been well mobilized, small windows on e
ach side of the vasectomy occlusion site (abdominal and testicular ends) are cre
ated. To prevent the ends of the vas from slipping back inside the skin, fine ho
lding stitches are placed through the outer muscular layer of the vas. The vas i
s then precisely cut at a healthy segment with a specialized surgical knife. The
fluid within the vas leading to the testicle is analyzed to confirm the presenc
e of sperm. If evidence of sperm is confirmed, a direct vas to vas reconnection
(vasovasostomy) can be completed in a manner that the surgeon is most comfortabl
e in performing. We use a 2-layer microsurgical technique using sutures that are
finer than a human hair and a vas approximator to stabilize the ends of the vas
during the reconnection. In our experience, sperm should return to the ejaculat
e in over 95% of cases. Upon of completion of the microsurgical reconnection, th
e vas is gently delivered back inside the scrotum. The small hole in the scrotal
skin is closed with a single dissolvable suture which is then covered with a sm
all band-aid. The vas on the second side is then be reconnected using the very s
ame no-scalpel vasectomy principles and mini-incision technique. We have observe
d that by minimizing surgical dissection around the vas and testicle, this decre
ases operative times, results in less post-operative inflammation and pain, allo
ws for quicker return to normal activities and accelerated return of healthy spe
rm to the ejaculate. This simple innovative technique can easily be adopted by u
rologists familiar the no-scalpel vasectomy technique.
This technique was been published in the medical journal Urology in October 2008
. Please view the detailed video of the mini-incision vasectomy reversal using n
o-scalpel vasectomy principles and instruments.
After a vasectomy reversal, about 50% to 60% of couples have a baby within a 2-y
ear period.
Keep in mind that there is much to consider and milestones to pass before reachi
ng this goal so finish the FAQ and begin at the vasectomy reversal homepage. The
se include alternatives to a vasectomy reversal, finding a doctor to perform the
surgery, seeing the doctor before surgery, evaluating the female partner, sperm
banking and what determines vasectomy reversal a success.
Time (vasectomy age) and other factors have been found to correlate with vasecto
my reversal success rate. Your surgeon will make the decision to perform one of
two techniques when reconnecting the vas, during the vasectomy reversal vasovaso
stomy or vasoepididymostomy. Vasovasostomy is a vasectomy reversal technique tha
t is simpler and offers a higher success rate. If it is necessary to perform the
vasectomy reversal using the vasoepididymostomy technique the surgery will be m
ore complicated, not all surgeons can perform this technique and success rate is
lower.
Which technique is performed is correlated with how much time has passed since t
he vasectomy. The vas tube, which was obstructed as a result of the vasectomy, i
s prone to back pressure in the epidiymus. During the vasectomy reversal surgery
, the surgeon looks to identify sperm in the vasal fluid. If sperm are identifie
d the vasectomy reversal surgeon can perform the vasovasostomy technique (a dire
ct vas to vas connection). The more time since a vasectomy, the greater the odds
the vasectomy reversal surgeon will see a "secondary epidimal obstruction". Thi
s means no sperm are identified in the vasal fluid from the cut end of the testi
cular vas. In such cases, the vasectomy reversal surgeon must perform a vasoepid
idymostomy (a re-connection of the vas to the epididymis). Vasoepididymostomy is
a more involved vasectomy reversal surgery and means reconnection of the vas tu
be will be more difficult.
There is a high chance that the vasovasostomy can be performed if the vasectomy
reversal is performed within 10 years of the vasectomy. However, research tells
us that performing a vasectomy reversal ten years after a vasectomy, has about a
40% chance that a vasoepididymostomy will need to be performed on at least one
side.
Other factors that can contribute to the technique performed during the vasectom
y reversal surgery include a vasectomy with a large segment of the vas removed,
cauterization or ligation (tying off) of both ends of the cut vas instead of jus
t one (i.e. doing a closed ended vasectomy instead of open ended).
For the best result, most vasectomy reversals require a general anaesthetic. Whi
le working under the high-powered surgical microscope, patients need to be compl
etely still.
After ten years since a vasectomy, research tells us that there is about a 40% c
hance that a vasoepididymostomy will need to be performed on at least one side.
There is a high chance that the vasovasostomy can be performed if the vasectomy
reversal is performed within 10 years of the vasectomy.
Other determining factors include a large segment of the vas having been removed
, cauterization or ligation (tying off) of both ends of the cut vas instead of j
ust one (i.e. doing a closed ended vasectomy instead of open ended).
No doctor can predict with certainty what type of reconnection (vasovasostomy or
vasoepididymostomy) will be required before the operation. This can be estimate
d with a reasonable degree of confidence based on the time since the original va
sectomy, findings on physical examination and the patients age. A definitive deci
sion as to the type of reconnection required can only be made during the surgery
based by the presence of sperm and the quality of fluid from the vas. If sperm
are identified from the cut end of the vas coming from the testicle and epididym
us, this confirms that sperm are being produced and are able to swim to this poi
nt and a vasovasostomy can be performed. If no sperm are seen within the fluid f
rom the cut-end of the testicular vas, this typically suggests an epididymal blo
ckage and a bypass re-connection or vasoepididymostomy should be performed.
A vasectomy reversal where the type of connection involves a vasovasostomy typic
ally takes about 2-3 hours to complete. A vas reconnection requiring vasoepididy
mostomy can take 3-4 hours to complete.
Yes. Moving sperm identified in the vas or epididymus at the time of a reversal
can be saved, frozen and stored in a sperm bank just in case the vasectomy rever
sal is not successful. This sperm can only be used with in-vitro fertilization (
IVF) or intra-cytoplasmic sperm injection (ICSI)..
Typically, most men need 10 to 14 days to feel normal again.
All surgical procedures and anaesthetics involve some risk and this means there
is a possibility of complications, side effects and perhaps pain. Fortunately, t
he risks and complications of a vasectomy reversal are rare but may include: ble
eding, wound infection, swelling, injury to the spermatic cord, epididymis or te
sticle and discomfort.
It is best to wait 4-6 weeks before reinitiating strenuous exercise. Light exerc
ise can be started 3-4 weeks after surgery.
After a vasovasostomy, sperm quality can take up to 6 months to mature. After a
vasoepididymostomy, sperm quality can take up to 1 year to mature. Typically sem
en analysis is performed 8 weeks following surgery and then at 3-month intervals
until pregnancy is achieved to ensure stable sperm quality.
Couples may resume sexual relations about 3 weeks after a vasovasostomy and abou
t 4 weeks after a vasoepididymostomy. Pregnancy can be achieved any time after a
reversal. Statistics tells us that about 50%-60% of couples are pregnant within
2 years of a vasectomy reversal.
It is recommended that the female partner be evaluated prior to having a vasecto
my reversal. This can be performed by most gynaecologists. This is logical, cons
idering the physical, financial and emotional commitment associated with a vasec
tomy reversal.
A failed (unsuccessful) vasectomy reversal is defined as having no sperm in the
ejaculate subsequent to the operation. These men can consider having the vasecto
my reversal repeated or another surgical procedure known as vasoepididymostomy,
or sperm extraction which involves in-vitro fertilization (IVF) or intra-cytopla
smic sperm injection (ICSI).
In certain circumstances it may be worthwhile considering vasoepididymostomy or
sperm extraction (sperm banking). In these cases, the assisted reproductive tech
niques inducing intracytoplasmic sperm injection (ICSI) combined with in vitro-f
ertilization would be utilized.
Possible circumstances can include blockage of the partners fallopian tubes, spin
al cord injury, men born without a vas deferens, testis cancer and a failed vase
ctomy reversal.
The cost of sperm extraction in conjunction with in vitro fertilization is consi
derably higher than a reversal. Therefore, very few "vasectomized" men will choo
se sperm extraction as the first procedure to restore their fertility.
If the Female is Unlikely to Become Pregnant Naturally
When considering having another child, the female should undergo a gynaecologica
l evaluation before a vasectomy reversal in order to assess her fertility potent
ial. There are situations where vasectomy reversal is not the best alternative.
Examples include where a woman's tubes are completely blocked or if she is at th
e end of her reproductive life cycle and may not want to wait the four months to
a year for the mans sperm to return to the ejaculate. In these cases, IVF (in-vi
tro fertilization) will be the preferred alternative for producing a pregnancy.
Vasectomy Reversal Failure
If vasectomy reversal fails vasectomy reversal alternatives must be considered.
The success rates for the two vasectomy reversal reconnection techniques offer d
ifferent vasectomy success / failure rates. On average, 14% of men who undergo v
asovasotomies and 40% of men with vasoepididymostomies have no sperm in their se
men after surgery. If sperm are not present in the semen by six months after vas
ovasotomy or by twelve to eighteen months after vasoepididymostomy, then the vas
ectomy reversal surgery is considered a failure.
See Types of reconnection: Two Methods
Should the vasectomy reversal fail, then the couple may consider repeating the v
asectomy reversal. The other alternative to vasectomy reversal involves Assisted
Reproductive Technologies (ART) such as invitro fertilization (IVF) with intrac
ytomplasmic sperm injection (ICSI). During the vasectomy reversal sperm is banke
d, or afterward, sperm are obtained for IVF/ICSI, via a minor surgical procedure
(sperm retrieval), where sperm is extracted directly from the testicles or the
epididymis. Sperm obtained this way do not swim well, so they must be manipulate
d as opposed to just placed inside the female genital tract with these methods.
Invitro Fertilization (IVF)
IVF is used as an alternative to vasectomy reversal used to initiate pregnancy f
or couples unable to conceive through natural methods. Routine IVF treatment has
a low rate of success. So in order to improve pregnancy rates, the process is u
sually coupled with manipulations that require special preparation of the egg an
d the sperm. It involves incubation of a female egg with a male sperm in a cultu
re dish. For this alternative fertilization technique to work, the egg must have
optimal maturity and the sperm must function normally. Once a fertilized egg de
velops into an embryo, it is transferred back into the female.
Intracytomplasmic Sperm Injection (ICSI)
ICSI is the 'gold standard' micromanipulation technique developed so far to enha
nce IVF fertilization rates, as a vasectomy reversal alternative. This procedure
involves a direct injection of a single sperm into an egg. Pregnancy rates are
very low with routine IVF - about an 18% chance of pregnancy per cycle. The fema
le partner must also undergo a surgical procedure to remove the eggs from her ov
ary before which she will receive various drug treatments and undergo numerous u
ltrasounds. A full cycle of IVF is repeated for every attempt at pregnancy. Howe
ver the pregnancy rate is high.
IVF Cost vs. Vasectomy Reversal
In one study, the cost of one cycle of IVF ranged from $8000 to $15,000, with th
e average cost to produce a pregnancy about $75,000. When comparing the alternat
ive, vasectomy reversal, has an average cost estimate of $25,000 to produce a pr
egnancy.
Vasectomy Reversal Verses IVF
Among the reasons many infertility specialists suggest that for men, there is no
t a vasectomy reversal alternative are:
A successful vasectomy reversal and subsequent pregnancy is much less expensive
than a pregnancy through IVF.
A successful vasectomy reversal provides a long term supply of sperm and multipl
e opportunities for fertilization.
Conclusion: Vasectomy Reversal Alternatives
When vasectomy reversal alternatives will be necessary, a couple will turn to as
sisted reproduction techniques which involve combining sperm and eggs to treat i
nfertility and bring about pregnancy. There are different IVT (invitro fertiliza
tion techniques) depending upon your situation. However, under usual circumstanc
es vasectomy reversal is your best alternative.
Are you considering a vasectomy reversal? Statistically, five to ten percent of
the approximately, 600,000 men in North America who annually undergo vasectomy l
ook to get their vasectomy reversed, at some point. Vasectomy reversals are, for
tunately, not all that uncommon.
Life can change unexpectedly after a vasectomy. And then the emotionally charged
question becomes, "can a vasectomy be reversed" or "can you reverse my vasectom
y"? There are emotional and medical considerations behind vasectomy reversal.
Emotional Considerations for Vasectomy Reversal:
Reasons can include the loss of a child, a new marriage, or just a desire to hav
e more children to complete the family.
Medical Reasons for Vasectomy Reversal:
Though rare, some men experience such discomfort after a vasectomy that vasectom
y reversal is the only solution. Sometimes this lasts for years following the va
sectomy procedure and is referred to as "Post Vasectomy Pain Syndrome" .
A vasectomy reversal involves reversing a vasectomy with the goal of enabling th
e man to be fertile once again, called patency. The vas deferens is surgically r
ejoined, enabling sperm to once again flow through the vas deferens, which were
blocked during the vasectomy procedure. In recent years, with the development of
better techniques and a larger pool of skilled microsurgeons to perform the rev
ersal, excellent results can be obtained with a high chance of obtaining pregnan
cy. Vasectomy reversal is generally carried out in hospital as an outpatient pro
cedure using a general anaesthetic. Success rates vary by individual patient and
the vasectomy reversal doctor. During the vasectomy reversal your doctor will c
hoose one of two techniques, depending upon the circumstances:
Reconnecting the vas deferens (vasovasostomy) - the preferred connection, or
Connecting the vas deferens to the epididymis (vasoepididymostomy) -when no sper
m are identified in the testicular vas deferens.
Keep in mind that ultimately, a vasectomy reversal will be considered successful
when a couple achieves becoming pregnant and giving birth. So there are also fa
ctors to consider before the vasectomy reversal that involve the female partner.
VasectomyMedical.com understands decision process behind whether to move forward
with a vasectomy reversal. We attempt to lay out a step by step process enablin
g you to find answers your questions and learn all the vasectomy reversal inform
ation that should be considered. Youll notice we have split the vasectomy reversa
l information into a three step process.
Step 1 - First there are the vasectomy reversal factors to consider:
Before and After Vasectomy Reversal Considerations
Vasectomy Reversal Guarantee of Success
Vasectomy Reversal Cost
Alternatives to Vasectomy Reversal
Step 2 - Knowing what the vasectomy reversal procedure is all about.
Before and After Vasectomy Reversal Considerations
Laboratory Testing and Sperm Banking
Why Vasectomy Reversal May Involve a Different Reconnections
The Vasectomy Reversal Procedure
After Vasectomy Reversal
Step 3 - You have decided to have a vasectomy reversal
Choosing your vasectomy reversal doctor that is right for you
Finding a vasectomy reversal doctor in your area
Click Here to Find a Microsurgical Vasectomy Reversal Specialist or vasectomy re
versal clinics in your area.
All this information about vasectomy reversal is laid out along the left column
and the header menu (under vasectomy reversal).
Laboratory testing & Sperm Banking
Sperm banking at the time of the vasectomy reversal can provide an alternative i
f the reversal is not successful. This is a convenient time for the vasectomy re
versal doctor to aspirate the sperm for banking. In this way, the couple may lat
er consider Assisted Reproductive Technologies (ART) such as artificial insemina
tion, in vitro fertilization and sperm microinjection. It is also possible to sp
erm bank after the vasectomy reversal, should the vasectomy reversal fail.
Learn more about sperm banking and vasectomy reversal
Here are some tests that your physician may want you to have done before your va
sectomy reversal.
FSH
FSH is a serum follicle-stimulating hormone that is produced in the pituitary gl
and that the testes use to produce sperm. Your vasectomy reversal doctor may ask
to have the FSH level tested for men with small and/or soft testes or who have
never fathered a child. Men who have a history of fertility prior to vasectomy r
arely have an elevated FSH level. Elevated FSH suggests impaired sperm productio
n and indicates a lower possibility of obtaining a good sperm count after the va
sectomy reversal.
Anti-Sperm Antibodies
Anti-sperm antibodies can be detected in the blood of most men who have undergon
e vasectomy. An anti-sperm antibody is the body's immune response that has been
activated and targeted against the man's own sperm. This has occurred because du
ring and following the vasectomy sperm have been allowed to exist in places in t
he body where they weren't normally found before the vasectomy. Although pre-ope
rative antibody levels in the blood or seminal fluid do not project the ultimate
outcome of the vasectomy reversal, the presence of sperm bound antibodies post
operatively, i.e., antibodies found on sperm in a man's ejaculation after a succ
essful vasectomy reversal does appear to predict a lower pregnancy rate. When pr
esent in the semen, antibodies can attach to the sperm and prevent them from mov
ing (decrease motility) or from penetrating an egg. However, very few men actual
ly have antibodies detected on their sperm after a reversal.
Conclusion
There are few things to discuss and consider before vasectomy reversal. Because
sperm banking is convenient during a vasectomy reversal, it is an important cons
ideration at this time. Anti-sperm antibodies are something to be aware of and t
esting FSH levels should be discussed before the vasectomy reversal.
Vasectomy Reversal Complications
Vasectomy reversal complications can occur. However this is the same for all sur
geries and this means there are risks and pain associated with vasectomy reversa
l. After your vasectomy reversal, be sure to follow your doctors instructions. Re
versals are usually a safe procedure, having comparatively low risk (just slight
ly higher risk than vasectomy procedures). The most common side-effects of the s
urgery are headache and nausea due to the anesthetic. Pain, soreness and swellin
g in the area of the scrotum can also result. Another common minor vasectomy rev
ersal complication is blood oozing from the incision, which usually resolves its
elf within 12 hours following surgery. Here are the more involved vasectomy reve
rsal complications that are possible following a vasectomy reversal procedure:
Large bruise or swelling
This can develop in the scrotum requiring 4-6 weeks to resolve. Surgery may be r
equired if the bleeding is severe.
Hematoma
A common vasectomy reversal complication is hematoma. This is an often sizeable
collection of blood that is pooled on the scrotum because of a ruptured vessel.
It can take months to resolve.
Infection of the scrotum which may require oral antibiotics
In its most serious form, intravenous administration of antibiotics and hospital
ization might be required.
Sperm granuloma
Are harmless hard lumps that develop if a small amount of sperm leak from the re
connected vas deferens and collect in the surrounding tissue. This causes an inf
lammatory reaction that could cause pain or disrupt the reconnected site. Anti-i
nflamatory drugs are prescribed to treat these vasectomy reversal complications.
Only occasionally will they have to be removed surgically.
Necrosis (death of cells) of the Testis
This rare complication can be prevented if identified in the early stages by sur
gery to restore the blood supply and prevent atrophy. It occurs when there is a
lack of blood supplied to the testes due to the blood vessels becoming damaged d
uring the vasectomy reversal procedure.
Chronic pain in the scrotum
This rare pain may range from mild to severe. Possible causes include pinched ne
rves or scarring. Additional surgery may be necessary. .
Sexual Difficulties
This is not due to the surgery itself. It is considered an emotional reaction, t
hat may be related to stress placed on achieving pregnancy. Counselling both the
male and female partner can help alleviate this problem. .
Other reversal complications
Other complications are possible including failure of the surgery for any number
of other reasons.
Vasectomy Reversal Failure
Vasectomy reversal failure is possible. There is also a significant possibility
of later closure and obstruction of the vas even after a successful vasectomy re
versal.
Couples often bank semen specimens as soon as moving sperm appear in the ejacula
te, so that if there is a failure they can proceed with invitro fertilization (I
VF) at a later time. See Alternatives
For this reason, its worth discussing storing you semen Semen can be retrieved d
uring the reversal procedure for storage. There are facilities available to stor
e sperm in a cyrogenic freezer for a fee.
Vasectomy Reversal Risks
Of course, all surgeries carry risk that require sober evaluation. When you see
your vasectomy reversal doctor for the first time, be sure to go over all possib
le risks. Vasectomy reversal risk is considered low compared to most surgeries.
Compared to the vasectomy procedure, the risk is slightly greater because vasect
omy reversals require more time and can result in more bleeding. This has the po
tential to increase the risk of infection.
One concern to consider, is the risk of cancer, be it prostrate cancer or testic
ular cancer after a vasectomy reversal. There is no known increase in the risk o
f developing these cancers as a complication of vasectomy reversal.
Conclusion
We have attempted to provide a list of vasectomy reversal complications. Yes the
re is vasectomy reversal risk and vasectomy reversal failure is possible. Should
you experience any one of these vasectomy reversal complications, dont hesitate
to contact your doctor. The success of this surgery is obviously very important
to you and there is no point in taking a chance.
Types of reconnection: Two Methods
The doctor will choose to perform one of two methods to reconnect the vas - vaso
vasostomy or vasoepididymostomy. But a definitive decision as to which reconnect
ion will be required can only be made during the surgery based upon the presence
of sperm and the quality of fluid from the vas. If sperm are identified from th
e cut end of the vas coming from the testicle and epididymus, this confirms that
sperm are being produced and are able to swim to this point and a vasovasostomy
can be performed. If no sperm are seen within the fluid from the cut-end of the
testicular vas, this typically suggests an epididymal blockage and a bypass re-
connection or vasoepididymostomy should be performed.
1. Vasovasostomy, which is for the simpler cases, reconnects the two cut and blo
cked ends of each vas deferens.
Diagram:
A. two cut and blocked vas deferens.
B. finished vasovasostomy - vas deferens are reconnected.
2. Vasoepididymostomy is performed for more complex cases, connecting the vas de
ferens to the epididymis
Diagram:
A. vas deferens are connected to the epididymis.
B. completed vasoepididymostomy.
No matter how long after a vasectomy, there is always a chance to obtain a succe
ssful result.