Vasectomy Reversal
A vasectomy reversal is a surgical procedure where the vas deferens is reconnected after a patient has had a vasectomy. This procedure is done for each vas deferens (two). The purpose of the vasectomy reversal is to return sperm back into a man’s semen to allow chances for natural conception after a vasectomy was done earlier in his life. Although rare, it’s also used to relieve pain associated with congestion that may occur from a vasectomy. Dr. Clavijo is fellowship trained to perform this and other microsurgical procedures having had focused training in male reproductive tract reconstruction at the University of Miami . A few common questions as well as a description of the surgery are addressed below.
Operating time for a vasovasostomy or epididymovasostomy is approximately 3 hours. A general anesthetic is preferred in most circumstances. We prefer that out-of town patients stay in Sacramento for at least 1 day after surgery.
Postoperative follow-up includes an evaluation of wound healing at 2–3 weeks and a semen analysis at 6–8 weeks postoperative. Insurance will typically not cover this semen analysis fee. Subsequent semen analyses may be needed to monitor return of sperm.
Please email Dr. Clavijo at riclavijo@ucdavis.edu for inquiries regarding current price package for vasectomy reversal. Sperm banking at the time of surgery is also available (see below). A 2-week postoperative wound evaluation is included in the surgical fee. Charges for the hospital and anesthesia are billed separately from the surgeon’s fee.
At the time of the procedure, you have the option to harvest sperm to freeze for future use. The fee changes and it's best to contact our office for current pricing or email Dr. Clavijo at riclavijo@ucdavis.edu.
Any additional office visits and semen analyses, including postoperative semen analysis, will be charged at the usual rates. Also, if you choose to have sperm cryopreserved, you may incur costs of infectious disease testing required by the FDA.
The area where the vasectomy was done is identified and the tissues around are dissected off.
The vas deferens is then cut above and below the vasectomy site exposing healthy, unscarred vas deferens. The top side goes to the abdomen and the bottom side to the testicle.
The fluid from the bottom side (testicular side) of the cut vas deferens is tested for quality and sperm content. This will determine whether I will reconstruct using a vasovasostomy or vasoepididymostomy (see figures above).
This patient required a vasovasostomy. The sites where I will place my sutures are marked prior to starting the reconnection.
This photo shows the use of a single layer (9-0 nylon) to approximate the vas deferens cut ends. Currently Dr. Clavijo has transitioned to a 3 layer closure using 10-0 nylon to bring the lumens of the tubes together more precisely.
The sutures are carefully tied to bring the lumens of the tubes together.
Care is taken to keep the knots out of the lumen.
The final result is shown here, re-approximation of the vas deferens in this case.
What is the success rate?
The success of a vasectomy reversal depends on a combination of:
- The skill of the surgeon.
- The findings at the time of surgery.
When the vas is opened, fluid will flow from the testicular side of the vasectomy site. If sperm are present, a vasovasostomy will be performed (see figure). We expect about 95% or more of these patients to demonstrate a return of sperm to the ejaculate, with an associated 60%–70% pregnancy rate. If no sperm are present, but the vasectomy fluid appears to be abundant and ultimately suitable for sperm production (e.g., clear, watery), then a direct vasovasostomy is performed, with the expectation of a successful outcome such as that described above.
If poor-quality fluid is present (e.g., thick, pasty) and sperm are absent, or no fluid at all is found, then an vasoepididymostomy (connection of the vas to the epididymis, see figure) is performed, with return of sperm to the ejaculate in 65% of our patients.
(Left) Vasovasostomy: Connecting vas deferens to vas deferens
(Right) Vasoepididymostomy: Connecting vas deferens to tubules in epididymis