Male Infertility
Dr. Cassidy offers a full range of infertility services. FAQ and costs and fees of Vasectomy Reversal are below.
Mini-Incision Microscopic Vasectomy Reversal
Vasectomy
Reconstruction of congenital genital tract obstruction
Testicular biopsy
Hormonal therapy
Full evaluation of abnormal sperm counts
Vasectomy is the most common urologic surgery performed in North America with over 500,000 vasectomies performed each year. Due to a variety of changing social circumstances 5-10% of men will desire a restoration of their fertility.
A man who desires his own genetic child after a vasectomy currently has 2 options, in-vitro fertilization with intra-cytoplasmic sperm injection (IVF-ICSI), or vasectomy reversal and spontaneous pregnancy.
A vasectomy reversal involves bypassing the blockage created by the vasectomy by reconnecting the ends of the healthy and non-obstructed vas deferens (vasovasostomy) or less commonly connecting the healthy vas deferens directly to the epididymis (vasoepididymostomy) in cases of secondary epidydimal obstruction which can occur in 25-50% of men following
It is universally accepted that microsurgical vasectomy reversal using a dedicated operating microscope yields superior results to traditional vasectomy reversal techniques which use little to no magnification at all.
The mini-incision technique for vasectomy reversals was developed at the University of Toronto and has adopted the principles of the ‘No-Scalpel’ vasectomy and applied them to the vasectomy reversal which allows for a much smaller incisions (<1cm) and proven benefits in terms of recovery with no change in success rates. This is clearly the best approach.
Very few centres in Canada offer microsurgical vasectomy reversal by trained surgeons but the University Hospital of Northern British Columbia is now one of those centres.
Success rates, measured as patency rates (return of sperm into the ejaculate) and pregnancy rates have improved by 400% as these microsurgical techniques have evolved. Surgeons who have formal microsurgical training have been shown to have patency rates of over 9o% compared to rates of less than 50% in surgeons without such training, which has obvious implications on overall pregnancy rates.
This expertise is especially valuable in cases requiring a vasoepididymostomy, which occurs in 25-48% of vasectomy reversals. Without the ability to confidently undertake this technically demanding procedure, upwards of 50% of all men undergoing vasectomy reversal will receive the wrong operation resulting in vasectomy reversal failure. Unfortunately, the decision of whether an individual patient requires a vasosvasostomy or vasoepididymostomy can only be made based on intraoperative findings, therefore any surgeon offering vasectomy reversals must be prepared to confidently do both.
If you are interested in viewing the surgical procedure being performed please click on the video link below.
Frequently Asked Questions and Costs of Vasectomy Reversal Procedure
What is a vasectomy reversal?
A vasectomy reversal is a surgical (or microsurgical) procedure performed by a urologic surgeon to reverse sterility caused by a vasectomy. Vasectomy reversal surgery reconnects, in either single or multiple layers, the cut ends of the vas deferens, the small tubes that carry sperm from the man’s testicles. The rejoined vas them becomes an open passageway for semen.
There are generally two types of vasectomy reversal options. The first is a procedure known as vasovasotomy. This procedure is done when sperm is identified inside the vas fluid after the initial incision. The second is vasoepididymostomy. This procedure is done where sperm have not been detected which is usually suspected to occur due to a blockage in the epididymis.
A word of caution – some surgeons who perform vasectomy reversals do not have adequate experience to perform a vasoepididymostomy so it is crucial to choose a surgeon who is experienced in microsurgical vasovasostomy and vasoepididymostomy.
What is a mini-incision vasectomy reversal?
Mini-incision vasectomy occurs when the entire vasectomy reversal is performed through mini-incisions in the scrotum by adopting the principles of a non-scalpel vasectomy. Often, the incisions are less than 1 cm. In most cases, patients experience less discomfort, heal quicker and return to work or normal activity faster. It is universally accepted that microsurgical vasectomy reversal using a dedicated operating microscope yields superior results to traditional vasectomy reversal techniques which use little to no magnification at all.
How long does a vasectomy reversal take to perform?
Typically, a vasovasostomy takes about 2 hours while a vasoepididymostomy can take 3 hours to complete.
Can my sperm be saved or banked at the time of my vasectomy reversal?
Yes. If moving sperm are found in the vas or epididymus, they can be saved, frozen and stored in a sperm bank just in case the vasectomy reversal is not successful. Please note that this sperm can only be used with in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI
Can a vasectomy be performed again after a vasectomy reversal?
Yes
What happens if the reversal doesn’t work?
There are two options for couples who desire genetically related children there are two options available. A re-do vasectomy reversal can be performed or sperm retrieval from the testis or epididymus (under local anaesthetic) with in-vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI).
Can a vasectomy be performed again after a vasectomy reversal?
Yes.
Is a consultation prior to surgery required?
A consultation prior to surgery is beneficial to discuss details and go examine the patient. Typically, no additional visits or testing is required. For patients from out-of-town, phone consultations can be arranged.
At what point do you test to see if the vasectomy reversal is successful?
Testing to see if sperm have returned to the ejaculate is typically performed 8 weeks following surgery. Semen analyses are then typically performed at 3-month intervals until pregnancy is achieved to ensure stable sperm quality. 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.
Costs & Fees