General
Can I come for consultation and operation on the same day?
Yes. There is a small chance that we find something that makes reversal unlikely to succeed or dangerous at the pre-op examination. We will gather as much information about you over the phone to give you the best advice we can as to the likely outcome. We will ask you for a higher than usual deposit to cover the very unlikely chance that we don’t advise proceeding on the day.
What different types of microsurgery are there?
Many, but principally Single, double and multilayer vasovasostomy. We perform the Microdot Multilayer Microsurgical vasovasostomy (MMMV). The layers referred to are the structures forming the vas. So from the inside out the layers are 1.skin lining the inner sperm tube of the vas (lumen) 2. Muscle, (involuntary), forming the thick wall of the vas and 3. Connective tissue, including blood vessels, on the outside of the vas.
Will I be asleep during the procedure?
Yes. The sedation is so relaxing that you will drift off to sleep. We keep the level of sedation ‘topped-up’ until the operation is finished at which time you will gradually wake up without any of the general anaesthetic problems (such as nausea etc.). Long acting local anaesthetic is used to completely numb the operating area. This straightforward sedation and local anaesthetic has been proven to be very much safer than GA.
Which sutures do you use?
We use special vasovasostomy sutures specifically manufactured for this operation by Sharpoint in the USA, size 10-0 for the inner layer and 9-0 for the outer two layers.
Will I feel unwell after the anaesthetic?
NO! Unlike General Anaesthesia. The only effects are forgetfulness and clumsiness. Many men find the sedation very relaxing, ‘the best sleep i’ve had in months’!
How long does the op take?
From 2 ¾ hours to 3 ½ hours. Fortunately for the patient this feels just like a few minutes.
When can I go home?
About an hour and a half after the operation. Patients gradually wake up and rest for half an hour or so, then dress and have a comfortable seat in the waiting room whist enjoying tea or coffee and biscuits prior to going home.
How soon will I be fertile?
Good question. For many people the answer is ‘within weeks’. Many of our couples have become pregnant within 3 months! In general the longer the vasectomy has been done the longer it may take to return to fertility.
Could there be complications?
Yes, but fortunately only the same sort of complications that can arise during the vasectomy itself, ie swelling. Swelling can be either early (day 1-3) or later day (5-10. Early swelling is due to haematoma, ie internal bruising or bleeding ( chance2-3%), late swelling is due to infection (much less than 1%). Fortunately elective surgery centres such as ours do not attract patients prone to hospital acquired infections and we have never had such a case.
Will it be painful afterwards?
No! Our patients score the post op discomfort at around 2 out of 10. This is because we have not disturbed the tissues to any great extent, we lift the vas above the skin, repair it and return it with no trauma to the testis.
Shall I bring pain killers?
No! We send you home with the only pain killers you will could possibly need, Paracetamol and Ibuprofen.
Can I come on my own?
Only by prior arrangement. By law we must discharge you to the care of a responsible adult. If absolutely necessary we can arrange nursing care during your stay on the evening of the op.
When can I have sex again?
Not before 21 days post op. And this applies to ejaculation not just sex. The reason is that ejaculation pressurises the fluid in the vas which can force it’s way out through the unhealed join causing scarring and narrowing of the join.
What do I do about tests afterwards?
We recommend semen tests at 2 monthly intervals after the op. We are delighted to do these at the clinic for you as often as you would like. Alternatives are through the GP or through a fertility clinic.
I’ve had a reversal before, is it worth having it done again?
Yes, almost always. The most common problem with reversal surgery is the formation of scar tissue at the junction. Removal of the scarred tube and microsurgically re-joining the vas is highly effective. We advise prior assessment and consultation here at the clinic.
I’ve had IVF before, is it now worthwhile having a reversal?
Certainly, yes. Your chances may be reduced slightly below the average if you have undergone PESA sperm extraction but we have many cases of successful outcome after PESA / IVF.
Will I know if the op is going to be successful on the day?
Yes, because we will know the result of the sperm test done during the op and that the connection was successful. With a positive finding of sperms in the vas fluid your chances of returning to fertility are around 98%.
Will sex be any different after the reversal?
We hope so. Most men report some change for the better.
Should I have sperm freezing after reversal?
Yes, definitely. There is a chance that after some time, possibly from 6 months onwards that some narrowing of the junction may occur. We suspect that certain factors such as subtle damage inflicted on the vas by diathermy may make scarring more likely. We do not have definite statistics on this but estimate the chances of scarring being 30% over 5 years.
We want a baby in 2 years time. Should we delay the reversal?
If you do you risk developing blow out if you don’t you may have scarring. Scarring is treatable (by re-operation) whereas blow out is not. So on balance have it done now and have some sperm frozen. Or, change the plans, throw caution to the wind and have that family now!
Can I have another vasectomy after the baby is born?
Yes, we have done this on probably 10 occasions now.
My wife is 40+. Is it too late?
Probably not. We have had quite a number of pregnancies where the wife is 40 plus the oldest to date being 44. The classic way of determining whether or not it is too late is to have the FSH blood test at day 0-3 of the menstrual cycle. Conventional wisdom would have it that if the result is more than 12-15 you have a minimal chance, yet we have seen 2 ladies one with FSH at 18 and the other at 25 both happily becoming mums.
I am age 50+. Am I too old to become a dad again?
No, not too old at all. Men only very rarely slow down their sperm production and we usually pick that up at consultation. We have over 10 patients over the age of 60 most of whom have become very fertile again and enjoying being dads again!
How much does the operation cost?
We work on a fixed fee basis so you know exactly how much you are going to pay and there will be NO extra charges, ever. The complete fee is a total of £3950. Consultation only costs £200 and is deducted from the full fee if you decide to go ahead with the procedure.
Is there any increased risk of an abnormal child after vasectomy?
No, just the standard, routine chance unlike IVF babies over whom there are questions over their long term health.
What is the waiting list?
We can arrange a consultation within a week or two, almost any day of the week. Time to surgery is from 1-3 months. But we sometimes have operation slots at short notice, so give Barbara a call.
I’ve got medical problems; can I still have a reversal?
Probably yes, but tell us all about your medical history and most importantly tell us all the medication you take. We will want to see you for consultation and discuss the matter then. Any medication that thins the blood such as Aspirin or warfarin is especially important and should be stopped 7 days before surgery.
What if reversal doesn’t work?
Two possibilities. Either elect to have IVF or visit the USA for vaso-epididymostomy (VE). VE is a desperately sophisticated procedure which must be performed by a super specialist. The best UK surgeon in the UK claims no better than 7% success. We strongly recommend just 3 centres in the USA where the success rates are around 70%.
I have seen a clinic that advertises microsurgery. He does about 30-50 cases per year, is a general urologist and he is less expensive than you, should I go there?
Do not even contemplate having a reversal with a surgeon who does not use microsurgery (some use ‘loupes’ which magnify 2-3 times – it is just not good enough. The operating microscope magnifies up to 25 times and we often use all that power). If the surgeon gets the operating microscope out just once a week he is unlikely be proficient and confident as it takes repeated practice and familiarity to be competent and accurate with this little practice.
