table of contents
- What is a vasectomy reversal?
- Why is a vasectomy reversal done?
- How to prepare for a vasectomy reversal
- Vasectomy reversal procedure: what to expect
- Vasectomy reversal success rates
- Vasectomy reversal risks
- Can all vasectomies be reversed?
- How much does a vasectomy reversal cost?
- Are there alternatives to a vasectomy reversal?
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
A vasectomy is a common and permanent form of birth control that many men in the United States seek when they want to stop having (or never want to have) children. While vasectomies are considered to be permanent, there is a surgery called a vasectomy reversal that some men choose to undergo for a few reasons.
Here’s what you need to know about vasectomy reversals, including how effective they are, what the surgery is like, and how much you can expect to pay.
What is a vasectomy reversal?
A vasectomy cuts the tubes that carry sperm from the testicles to the penis. These tubes—called the vas deferens—are then sealed to keep sperm from making it into a man’s ejaculate (Patel, 2016). A vasectomy reversal—as the name suggests—reverses this by reconnecting the vans deferens.
Why is a vasectomy reversal done?
Every year, more than 500,000 men in the United States undergo vasectomies. During that same time period, up to 30,000 men are choosing to reverse them (Kirby, 2017; Reddy, 2021).
Why? The biggest reason is that they’ve decided they want kids. Life events or the passing of time can change a man’s desire to have a child (Patel, 2016).
But some men have a reversal because the original vasectomy is causing pain. Up to 2% of men who have vasectomies experience post-vasectomy pain syndrome—testicular pain that lasts for more than three months. It can be constant or sporadic. Fortunately, a reversal procedure often stops the pain (Leslie, 2022).
How to prepare for a vasectomy reversal
If you’re opting for a vasectomy reversal, you’ll want to find a urologist trained in this type of microsurgery. A physical exam and a discussion about your medical history and goals will be the next steps. If you’re hoping to conceive with a partner, here are some questions you may have to answer during your visit (Patel, 2016):
- Have you had any biological children?
- When was your vasectomy?
- Have you had any previous groin surgeries?
- Do you have any medical conditions?
- How old are you? How old is your partner?
- What are your reproductive goals?
- Have you used testosterone recently?
Your answers to these questions may prompt additional tests. For example, while your semen should not contain sperm following the appropriate waiting period after a vasectomy, your testicles still produce sperm, and the use of testosterone can lower your sperm count. This may be problematic if you want to have a biological child, which is why providers ask about recent testosterone usage.
Semen analysis: test process and results
An in-office testicular sperm aspiration—in which sperm is obtained from your testicles in a procedure usually done with a local anesthetic—can be used to check the quantity and quality of your sperm. And blood tests can help check your hormone levels and see if you need hormone therapy to improve sperm counts (Kirby, 2017).
Vasectomy reversal procedure: what to expect
A vasectomy reversal can be done at a clinic, surgical center, or hospital. While your healthcare provider will tailor your pre- and post-op instructions to your specific needs, the following is a general rundown of what to expect before, during, and after your procedure.
Before the procedure
Your surgeon will have specific instructions for you, typically including:
- Avoid blood-thinning medications or pain relievers the week before surgery.
- Arrange a ride following surgery.
- Pack a tight-fitting undergarment to hold your scrotum in place after surgery.
During the procedure
A vasectomy reversal usually takes about 2–3 hours. It’s performed using local anesthesia or general anesthesia. There are two approaches your surgeon may take (Kirby, 2017):
- Vasovasostomy (VV): This surgical approach is the first choice for a vasectomy reversal and involves reconnecting the ends of the vas deferens using a surgical microscope and tiny sutures.
- Vasoepididymostomy or epididymovasostomy (EV): If there is scar tissue from the original vasectomy, your surgeon may perform this procedure, in which one or both tubes may have to be connected directly to the epididymis, an organ behind the testicle that holds sperm.
What is in vitro fertilization (IVF)?
After the procedure
Following the procedure, you may be advised to (Kirby, 2017):
- Use ice packs to reduce swelling.
- Use pain medications as needed (non-steroidal anti-inflammatory medications like ibuprofen may be discouraged due to increased bleeding risk).
- Avoid getting the site wet for two days.
- Use an athletic supporter for the first two weeks for scrotal support.
- Avoid sexual intercourse and ejaculation for two weeks.
- Avoid activity that puts pressure on the scrotum (running, heavy lifting, etc.) for the first month or more.
After about 6–8 weeks, you’ll return to the clinic for a semen analysis. Sperm checks may be done about every three months until there is a pregnancy or semen quality stabilizes.
Vasectomy reversal success rates
Vasectomy reversal has a fairly high success rate when performed by a fellowship-trained urologist using a surgical microscope. Studies show being trained in vasectomy reversal using an operating microscope makes a big difference (Nseyo, 2017).
Sperm usually returns to the ejaculate about 2–6 months after surgery. It can happen faster or slower, depending on the individual.
Cases using the VV procedures have a 90% to 99.5% success rate, and EV procedures have a 48% to 92% success rate. It’s important to note that these success rates refer to finding sperm in a man’s ejaculate and not to successful pregnancies. Pregnancy rates for basic vasectomy reversal (VV) range from 42% to 92% (Witherspoon, 2021).
This range shows that just because a vasectomy reversal is successful, that does not necessarily mean achieving pregnancy is easy for all men. Male infertility problems with sperm quality and the fertility of the female partner may make it harder to conceive. In other words, just having sperm in your ejaculate does not ensure a pregnancy (Witherspoon, 2021).
Male fertility: supplements, foods, tests to take
Vasectomy reversal risks
Vasectomy reversal is considered a safe procedure with few complications. However, your surgeon may advise you to watch for the following after your procedure (Kirby, 2017):
- Signs of infection (pain, redness, pus, or bleeding)
- Fever over 100-degrees
- Hematoma (blood in the scrotum)
- Loss of feeling around the scrotum
Hematomas and bruising typically go away on their own, and you may receive antibiotics if there are any signs of infection.
Can all vasectomies be reversed?
Vasectomies can almost always be reversed.
If it’s been less than 10 years since your vasectomy, the results are better. However, successful pregnancies have been achieved after more than 20 years of having a vasectomy (Witherspoon, 2021).
While most vasectomies can be reversed, vasectomy reversals do sometimes fail. In these cases, there is often an underlying issue with the testicle, or a blockage develops. Fortunately, second-attempt vasectomy reversal can often fix blockages (Witherspoon, 2021).
How much does a vasectomy reversal cost?
The cost of a vasectomy reversal varies based on your surgeon, your location, and the type of facility where you have the procedure done. It’s also not usually covered by insurance.
For example, in a clinic under light anesthesia, you may pay around $5000–$6000. But, if done under general anesthesia in a hospital, a vasectomy reversal may cost more than $15,000.
Compared to in vitro fertilization (IVF) and other assisted reproductive techniques, which can cost $20,000 or more, vasectomy reversal is considered cost-effective, especially for those planning to have more than one child after a reversal (Nseyo, 2017).
How to increase semen volume
Are there alternatives to a vasectomy reversal?
Yes. There are alternatives to reversing a vasectomy that can lead to a successful pregnancy.
Sperm retrieval techniques can take sperm directly from your testicles. The sperm can be frozen or used right away as part of an in vitro fertilization or intracytoplasmic sperm injection (ICSI) procedure. This can be a good option if you have other male fertility issues like low sperm motility (ability to move) or if waiting months for sperm to return to the ejaculate misses an ideal fertility window (Witherspoon, 2021).
Ultimately, it’s best to discuss each partner’s fertility when deciding to reverse a vasectomy, especially if age is a factor.
- Kirby, E. W., Hockenberry, M., & Lipshultz, L. I. (2017). Vasectomy reversal: Decision making and technical innovations. Translational Andrology and Urology, 6(4), 753–760. doi:10.21037/tau.2017.07.22. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5583052/
- Leslie, S., Sajjad, H., & Siref, L. (2022). Chronic testicular pain and orchalgia. StatPearls. Retrieved on April 27, 2022 from https://www.ncbi.nlm.nih.gov/books/NBK482481/
- Nseyo, U., Patel, N., & Hsieh, T. C. (2017). Vasectomy reversal surgical patterns: An analysis of the American Board of Urology Case Logs. Urology, 107, 107–113. doi:10.1016/j.urology.2016.08.066. Retrieved from https://pubmed.ncbi.nlm.nih.gov/27866968/
- Patel, A. P. & Smith, R. P. (2016). Vasectomy reversal: A clinical update. Asian Journal of Andrology, 18(3), 365. doi:10.4103/1008-682x.175091. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854082/?report=reader
- Reddy, R., Fernandes Negris Lima, T., Ory, J., et al. (2021). Cross vasoepididymostomy: A step-by-step guide. Urology Video Journal, 11, 100090. doi:10.1016/j.urolvj.2021.100090. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8291749/
- Witherspoon, L. (2021). Fertility treatment options after vasectomy. British Columbia Medical Journal, 63(2), 62–66. Retrieved from https://bcmj.org/articles/fertility-treatment-options-after-vasectomy
Dr. Steve Silvestro is a board-certified pediatrician and Senior Manager, Medical Content & Education at Ro.