About Vasectomy Reversals

A vasectomy reversal is a technically challenging procedure due to the small size of the opening within the vas deferens. Magnification (microsurgery) is used to reconnect the tube, and the suture used is finer than a human hair.

Major technical improvements over the past 30 years dramatically improved success rates for vasectomy reversals as measured both by the return of sperm to the ejaculate and by pregnancies.

Innovations such as the use of the operating microscope and the development of extremely fine needles, sutures and instruments allow for precise suture placement for aligning the two ends of the vas deferens or the vas deferens to the epididymis.

• Who performs vasectomy reversals at Minnesota Urology?

  Dr. Aaron Milbank specializes in vasectomy reversal. After his urology residency at the Cleveland Clinic Foundation, he completed a formal fellowship in microsurgery and male fertility there. He has performed more than 500 vasectomy reversals.

• What technique is used?

  Dr Milbank performs all of his vasectomy reversals under a high-powered microscope. This enables the best visualization possible of the tiny channels of the vas deferens and even tinier channels of the epididymis, the ductwork that leads from the testicle to the vas deferens. He is equipped to perform a direct re-attachment of the vas deferens to the vas deferens, as well as the more challenging attachment of the epididymis to the vas deferens. Anyone performing a vasectomy reversal must be adequately trained to perform both of these procedures, since it is not known until the middle of the operation if the more complex surgery will be needed.

• What is the success rate?

  An analysis of the most recent 500 patients who had surgery with Dr. Milbank showed that 95% of men had sperm in their ejaculate after the vasectomy reversal. For those men who had a reattachment of the vas deferens to the vas deferens (vasovasostomy), 98% had sperm in their ejaculate. For patients who followed up, 68% reported a pregnancy. The most important determinant of pregnancy is the age of the female partner.

• What does a vasectomy reversal cost?

  The cost a vasectomy reversal varies from institution to institution and is influenced by the experience of the surgeon, the setting (outpatient or hospital), and the complexity of the technique (use of microscope). Should you choose to have your vasectomy reversal performed at Minnesota Urology, the following two charges would apply:

  • Surgical Fee: $4,000.
  • Facility Fee: $4,100. This is a package that Dr. Milbank has arranged with High Pointe Surgery Center. The price includes all costs for the facility, including anesthesia. High Pointe is not affiliated with Minnesota Urology, and it may change its prices at any time, so please verify this facility fee with them

  Dr. Milbank does not charge additional fees for the in-house semen analyses and office visits after the surgery.

• What if my vasectomy reversal does not work?

  While it is rare for men not to have sperm in their ejaculate after a vasectomy reversal, it can happen. For these men, Dr. Milbank offers a refund of a portion of the surgical fee. The refunded amount is determined by a sliding scale based on the years between the vasectomy and vasectomy reversal. Contact the business office at Minnesota Urology for more details regarding the vasectomy reversal money-back guarantee.

• How common are vasectomies?

  Approximately 500,000 vasectomies are performed annually in the United States. While a vasectomy is an effective means of birth control, it is intended to be permanent. The reality is that as many as 6% of men who undergo vasectomies will seek a consultation for a vasectomy reversal. Despite the fact that vasectomies usually entail the destruction of the two ends of the vas deferens and removal of a piece of the vas deferens, most of these men and their partners will be candidates for either vasectomy reversal or sperm acquisition with in-vitro fertilization.

• What is the anatomy and physiology behind a vasectomy?

  Sperm are made in the testicles within tiny spaces called seminiferous tubules. After leaving the testicles, the sperm travel through the epididymis, a tightly coiled tubule, which occupies a small space alongside the testicle, but if unwound would be 10 feet long. After traveling through the epididymis, the sperm enter the vas deferens, a thick-walled tube which conducts the sperm from the scrotum into the pelvis. Within the pelvis, the fluid containing the sperm is joined by fluid from the seminal vesicles behind the prostate in the ejaculatory duct. The fluid is expelled from the ejaculatory duct during ejaculation.

  A vasectomy is performed by interrupting the vas deferens within the scrotum. The testicles continue to produce sperm, and these sperm are ultimately reabsorbed. Most urologists believe that the blockage produced by a vasectomy and the higher pressures within the vas deferens and epididymis can result in secondary blockages within the epididymis. If this occurs, simply reversing the vasectomy by hooking up the two ends of the vas deferens would fail to return sperm to the ejaculate, and a more complex operation would be required.

• What are fertility options after a vasectomy?

  There are two options for couples who wish to have their own biologically related children after a vasectomy: they can pursue a vasectomy reversal or in-vitro fertilization. Any couple considering having children after a vasectomy should learn as much as possible about both options. The decision is a personal one. Should you opt to have IVF, Dr. Milbank will work with your partner’s reproductive gynecologist. Typically, we are able to retrieve sperm through a minimally invasive outpatient procedure called a percutaneous epididymal sperm aspiration. Other options include intrauterine insemination with donor sperm and adoption. Of course, with these two options, the children will not be genetically related to the father.

• What is the actual vasectomy reversal procedure like?

  A vasectomy reversal may be performed using general anesthesia or with sedation and local anesthesia. This surgery is performed on an outpatient basis. You would return home within a few hours of the procedure.

  The procedure begins with an examination of the two ends of the cut vas deferens through a tiny incision in the scrotum (about ½ inch). The vas deferens on the testicular side is opened, and the fluid is examined for the presence or absence of sperm. If sperm are identified, or if there is a large amount of watery fluid, the two ends of the vas deferens are then sewn together – a procedure known as a vasovasostomy. If there are no sperm in the fluid, and the fluid is pasty, a secondary epididymal blockage is suspected. If confirmed, the vas deferens is sewn to the epididymis – a procedure known as an epididymovasostomy or vasoepididymostomy.

  Once the decision is made to perform either a vasovasostomy or epididymovasostomy, the operating microscope is positioned over the scrotum. These microscopes allow for tremendous magnification of the operative field and, in properly trained hands, significantly more precise suture placement and better results. The inside diameter of the vas deferens is only ½ of a millimeter (0.02 inches). For comparison, a human hair is 1/10 of a millimeter. Most male infertility specialists join the two ends of the vas deferens in multiple layers (“multilayered anastomosis”) or with a modified one-layer technique. Male infertility specialists use very fine suture material, which is 1/3rd to 1/5th the diameter of a human hair and almost impossible to see without a microscope. To perform an epididymovasostomy, an epidiymal tubule containing sperm is identified and attached to the vas deferens, thereby reestablishing continuity of the genital tract. This is an exceedingly delicate operation. The epididymis has a very thin and fragile wall and a tiny channel containing sperm.