Vasectomy Reversal Surgery
The meticulous microsurgical technique is the latest ‘minimally invasive’ surgical technique for vasectomy reversal surgery. It is involves creating a tiny incision in the scrotum to operate through using a microscope and tiny instruments.
The Meticulous “Minimally Invasive” Microsurgical Technique
This new microsurgical technique is considered superior to the older, large-cut “open surgery technique”. The old technique involves cutting open the entire scrotum and ‘exteriorising’ the testes with the use of clamps, which is still practiced by some surgeons in Sydney today.
The meticulous microsurgical surgical approach takes longer to perform (usually around 1.5 – 2 hours) but offers the patients superior outcomes in terms of patency and pregnancy rates when compared to the open technique (takes less than 1 hour).
The Gentle Approach
Dr Lok is an sub-specialised microsurgeon who offers this new minimally invasive approach to performing microsurgical vasectomy reversal surgery. There are significant benefits to this approach when compared to ‘open’ surgery.
A single midline or two 0.5 cm “keyhole” small scrotal incisions are required, similar to when the initial vasectomy was performed (but often smaller in reversal surgery as done by a microsurgeon while initial vasectomy often done using scalpel). See Photos Below *.
Previous vasectomy site is dissected with dead scar tissues removed (we don’t leave lumpy tissues behind), the tied-off part identified and excised, the ends refashioned, and patency of each lumen tested. The vas openings with diameter less than ½ millimetre are re-joined in two overlapping layers achieving water seal effect with sutures that are hardly visible to the naked eye (magnified under operative microscope up to 40x of normal vision) with very fine 8-9 O sutures, without holding clamps (minimise tissue handling and trauma).
The advantages of this technique over the “open” method includes:
- Minimally invasive approach
- Meticulous overlapping double layer re-join using very fine sutures
- Small incision and no need for a drain
- Day surgery with same day discharge
- Rapid recovery and return to work
- Reduced pain and post operative complications
- Reduced costs
Seven published series including a total of 2,330 patients available for follow-up showed an average patency rates of 88% and pregnancy rate of 62%.
Our own audit (with Dr Petrucco) of 120 men operated over 3 years with follow-up for up to 3 years has demonstrated the presence of sperm in the ejaculate following surgery in 90%. 50 % of these men had a child following the procedure (with varying intervals between having had a vasectomy and a reversal).
Factors That Influence A Successful Outcome
The Interval Between the Initial Vasectomy and Reversal Surgery
The increase in pressure, which results from tying off the vas, is transmitted to the much finer and thin walled duct, which attaches to the vas called the epididymis (around 6 meters long). After variable periods of time (about 10-15 years following original vasectomy), the dilatation may cause a rupture or a “blowout” of the duct leading to a blockage.
Because it is a single duct, sperm will no longer reach the site where vasectomy was performed. Re-joining the vas under these circumstances will not be successful as the rupture site(s) are difficult to identify and often bilateral. Ruptures rarely cause symptoms and are not easily diagnosed by examination or imaging.
Finding the spontaneous flow of fluid when the vas is open at reversal is a good but not absolute prognostic sign for a successful outcome. The presence of live sperm in the fluid of the opened vas is the best finding for success.
The Vasovasostomy Study Group (ASRM) found that in 1,247 patients the patency and pregnancy rates to be 97% and 76% if the obstructive interval was less than three years, 88% and 53% if three to eight years, 79% and 44% if nine to 14 years, and 71% and 30% if 15 years or longer.
Particularly in the first two years after vasectomy it is not unusual to find the presence of “antibodies” to sperm in blood tests. When persistent in high levels in later years they may interfere with sperm function by causing sperm to clump or stick together following ejaculation thus interfering with their ability to fertilise oocytes (the female’s eggs).
Tests on ejaculated sperm give the best indication of the significance of sperm antibodies and overall their presence is not a contraindication to surgery, as often antibody levels drop once the continued leakage or challenge to immune system is eliminated after flow restored by reversal surgery. Hence the majority of reversal surgeons are not currently carrying out antibody tests before surgery.
Post-Reversal Sperm Quality
The quality and normal fertilising capacity of sperm following vasectomy declines proportionally to the length of time following vasectomy, likely attribute both to aging and the back-pressure of obstruction on spermatogenesis. This again is a variable phenomenon. As these are men with proven fertility, often conception occurs relatively easily despite the poor semen analysis results.
Photos of the Minimally Invasive Microsurgical Approach
Photos: The Microsurgical Vasectomy Reversal "Keyhole" Surgical Procedure
Either single midline or two 0.5 cm “keyhole” small scrotal incisions, similar to when the initial vasectomy was performed.
Vasectomy site was dissected with dead scar tissues removed (we don’t leave lumpy tissues behind), the tied-off part identified and excised, the ends refashioned, and patency of each lumen tested. The vas openings with diameter less than ½ millimeter are re-joined in two overlapping layers achieving water seal effect with sutures that are hardly visible to the naked eye (magnified under operative microscope up to 40x of normal vision) with very fine 8-9 O sutures, without holding clamps (minimise tissue handling and trauma).
Vasectomy Reversal Techniques and Expertise
The Vasovasostomy Study Group (ASRM) also found that with meticulous microsurgical techniques sperm appears in the semen of 85-90% of men and 50-70% of their wives become pregnant; while with less ideal approaches (eg: open surgical approach) even when sperm appears in the semen of about 80% of men, only 20-40% of their wives conceive.
The success rates of vasectomy reversal correlates with the operative frequency. A number of studies reported that surgeons who operate at high frequency of >= 15 vasectomy reversals per year reached a cumulative patency rate of 70% and a pregnancy rate of 33%; while those operate with a comparably low frequency of <= 6 cases per year obtained a cumulative patency rate of 45% and a pregnancy rate of 8.8% only.
Frequently Asked Questions
When can I have sex after vasectomy reversal surgery?
Sex or straining should be avoided in the first 1-2 weeks after surgery (depending on individual recovery – the smaller the incision and less the tissue manipulation the quicker the recovery). Sexual intercourse can be resumed once the wound discomfort settles. Condom should be used for the first 5-6 ejaculations as qualities of the sperm initially come out may be of poor qualities with high DNA damages after the long stasis in epididymis.
How do I know if the operation has been successful and how long does it usually take to conceive?
Vasectomy reversal success can be assessed by semen analysis which is usually first done around 1.5 month and 3 months after the surgery. Sperm qualities will continue to improve for most over the subsequent months, the test can be repeated at a later stage if the initial results being suboptimal. As these are group of men with proven fertility, often conception occur despite the semen results being poor. Most pregnancies occur in the first year following surgery. In situations when sperm counts do not return to normal a longer interval of time may be required.
What complications can occur?
Complications are the same as for the original vasectomy procedure, most commonly bleeding and associated swelling and pain. These will be discussed prior to the procedure. Instructions that will guide you postoperatively will be given to you on discharge.
Do you need to request any specific tests if you want the option to reverse it?
When a couple is considering vasectomy reversal, the goal is not only to see sperm in the ejaculate after the surgery but to have a healthy baby in the shortest period. While the factors influencing the former are discussed above, the latter can in addition determined by many other factors such as female’s age and fertility history. It is the combination of the both female and male factors which determine the latter so it is highly worthwhile to have both assessed properly by a fertility specialist with the relevant experiences, to be best informed of all the options to make a more sensible decision.
We regard ourselves as a medical service, not a commercial business, and charge according to the complexity and length of the surgery, in line with Australian Medical Association (AMA) recommended Fees.
*** Dependant on Medicare eligibility, health fund, level of cover & gap cover.
If you have top-level health insurance, then it is highly likely that your insurance will cover all of your hospital fees(but not the doctors’ fees). As all funds do not rebate the same you should contact the Hospital of your preference to ascertain the exact amount and method of payment and/or rebate.
If you do not hold health insurance will have to pay for the entire hospital cost, currently at $2992 at Genea Day Surgery. Unfortunately the procedure is not supported by State Governments so cannot be performed in public hospitals.
Surgical booking payment for vasectomy reversal surgery
A payment is required 2 weeks prior to the date of your operation to confirm your place on Dr Lok’s operating list (or at the time of confirmation of date of surgery if booking is made less than 2 weeks before your operation).
A cancellation fee of $500 is payable for cancellation of surgery less than 2 weeks prior to the date of operation. This amount will be refunded if a future booking for surgery is made.
When and where
Dr Lok has 2 operative lists a week, including some Sat, and will be able to fit you in within a week or
Two of your choice, in one of the following Hospitals:
- Sydney City at Genea Day Surgery: Level 4, 321 Kent St, Sydney
- Strathfield Private Hospital
- Sydney South at South West Private Hospital
About Your Doctor
Dr Lok has 20+ years of experience performing microsurgical surgery, having performed hundreds of vasectomy reversal surgeries using the microsurgical keyhole approach.
Dr Lok is a reproductive microsurgeon performing large number of microsurgeries in addition to vasectomy and tubal reversal surgeries, and the more technically demanding microTESE sperm retrieval for patients with azoospermia.
Have a Question or Enquiry?
If you have a question on enquiry related to vasectomy reversal surgery, please get in touch and we will get back to you.