The cost of vasectomy reversal varies depending on the physician’s office, your geographic location, and the type of procedure performed. It is not inexpensive, but there are a few options that may help you fit it into your family budget.
Most insurance plans won’t cover the cost of reversal surgery, which can range anywhere from $5,000 to $15,000. (However, now that success rates have increased, some insurers are reconsidering this policy so be sure to check with your provider.) For now, reversal is usually an elective, fee-for-service procedure and it is still less expensive than many of the alternatives. Read More…
Atlanta—If you’re going to perform a vasectomy reversal, use a microscope. Despite the additional time and cost involved, microsurgical vasovasostomy is superior to the loupe-assisted macroscopic technique, findings from a recent study from Korea confirm.
In the retrospective study from Bundang CHA Hospital in Sungnam, researchers found a 24% higher patency rate in patients who underwent microsurgical vasovasostomy using 9-0 nylon compared with those who underwent a loupe-assisted technique using 8-0 nylon. However, the improved patency rate of the microsurgical technique did come at the expense of a significantly longer operation time than that of the loupe-assisted approach. Read More…
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. However, 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. Read More
This particular patient had his vasectomy 8 years before the reversal. When the area of the vasectomy site is excised fluid then emanates from the testicular side of the vas. The presence of fluid and the character of the fluid can determine the success of the reversal. In general-the shorter the time period from the vasectomy to the reversal the better the success rates are for pregnancy.
Although vasectomy should be considered a permanent form of birth control, around 6 percent of men will eventually decide to undergo a vasectomy reversal. This procedure is done to restore a man’s fertility and allow him to father a child through natural means.
One method for reversing a vasectomy is a vasovasostomy. During this surgical procedure, the two cut ends of the vas deferens are sewn back together using very fine sutures viewed through a powerful surgical microscope. If successful, this procedure will enable sperm to flow from the testicles once again.
Several surgical techniques exist for rejoining the vas deferens. Some work better than others, but the best results are always obtained by doctors with training in microsurgical reconstruction. One of these methods is known as a two-layer vasovasostomy. Read More
If one of the things that makes you uneasy about a vasectomy is the idea of a needle near that very sensitive area, fear not. One of the newer techniques allows physicians to apply anesthetic needle-free, with virtually no pain whatsoever.
Technical advances in vasectomy reversal mirror those in microsurgery over the past 100 years. As a discipline, microsurgery was first performed by Carl Nylen in Sweden for middle ear surgery in 1910, but grew most rapidly as a discipline in the 20th century stimulated by its success in microvascular reconstruction of war-injured soldiers.
The first microsurgical vasectomy reversal was performed by Earl Owen in 1971.
To get some idea of the size of the structures repaired, take a look at a penny. The “o” in God is approximately the diameter of the inner layer of the vas deferens (0.2-0.3 mm); the epididymal tubule is about half this size — and far more delicate.Read More from Dr. Finnerty’s Reversal Website.
Major complications associated with a microscopic vasectomy reversal are uncommon.
In many ways the complications that do occur are similar to that associated with a vasectomy.
As the picture above illustrates, there is a large and intricate complex of blood vessels associated with vas deferens.
One can see that is removing the inch or so segment of the post-vasectomy vas deferens involves severing numerous vessels including the vasal artery.
Surgeons fear veins more than arteries because a vein has a thin outer covering and it is not pulsatile.
The bleeding from a vein is more sneaky than an artery; the vein slowly oozes but an artery by having a pulse is easy to detect when it is bleeding.
So the most common complication of a vasectomy and a vasectomy reversal is a hematoma or a collection of blood, which will accumulate until the space around it has enough pressure to make it stop. It is important for the surgeon to thoroughly inspect the reversal site before finishing the reversal to detect even the slightest amount of bleeding. Using the microscope for this purpose allows for detection of bleeding that might not be noted with the naked eye.
If a hematoma occurs the usual treatment is conservative i.e. allow for it to resolve and be absorbed by the body on its own. Hematoma occurrence can be minimized by the patient following the post-operative instructions of limited activity and the use of compression underwear. It is important to stop any aspirin or ibuprofen well in advance of the procedure.
There two areas that have to heal after a vasectomy reversal procedure.
The subcutaneous tissues and the skin which have been incised to reach the vas tubes has to heal.
What the patient sees is the skin sutures. These sutures dissolve and go away in about two weeks.
Although the skin will appear healed on the surface, microscopically full healing occurs at approximately six weeks.
The scrotum is not like an abdominal incision where excessive straining prior to complete healing could cause extrusion bowel or create a hernia.
The skin of scrotum healing is independent of straining but excessive activity and motion could delay the healing process.
Sometimes the sutures dissolve prior to complete healing of the skin. Some areas of the suture line may open minimally and this is of no concern and will close over (epithelialize) within a week.
In regards to the skin healing process, a patient can shower in a few days with care for water not to hit the site directly, and one should place Neosporin ointment on the site daily.
The Reversal Site
The repair is done with 12-14 permanent sutures in a tension-free and water-tight fashion.
Compression shorts are recommended for approximately three weeks.
This allows for the inner and out layers of the repair to heal without the undue stress of the testicles and hence the vas deferens moving up and down and potentially delaying the healing process.
So though the two primary areas that need to heal before strenuous physical activity or sexual activity are different in character, the magic number of time is around three weeks-four weeks.
Anecdotally, I have had a patient present to my office the day after a reversal stating that he was having bleeding at the incision site. He confessed that he had had sex the night of the procedure. I reassured him the bleeding was from the skin edge and nothing to be concerned about.
This couple had a baby almost 9 months later to the day. Go figure!