We have accumulated quite a few of the questions we are often asked about the vasectomy reversal procedure and provide these with their answers below.
We hope you find them helpful.
Can I come for consultation and operation on the same day?
Yes. For men who desire to have vasectomy reversal for regaining fertility, we will gather as much information as possible by asking them to fill the consultation questionnaire and have further discussion in detail over the phone. Then we give the best possible advice about the likely outcome. It is extremely unlikely that we will be unable to go ahead with the procedure on the day, after the face to face consultation. It happened in only once out of 250 patients who did not disclose a significant medical history.
We mostly advise men who seek surgical procedures for testicular pain to come for face to face consultation. In those men, the clinical examination will determine the choice of micro-surgical procedure either reversal or other approipriate procedures. Still they can have free telephone consultation at the first instance.
Click below to
What different types of microsurgery are there?
Many, but principally Single, double and multilayer vasovasostomy. Many places in UK, they do single layer technique that is easy to perform and usually done by thicker sutures 6-0. Higher the number, finer will be the suture. Single layer techniqe can be done in about one and half hours. This works well for the surgeons and the hospitals as reducing the theatre time and surgeon's time is increasing the profit. This technique works to some extent, but when the disparity in the diameter of the vas-ends is more, the joint will not be as good as our techniqe mentioned below.
We always 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.Inner (mucosa) lining of the vas (lumen) 2. Muscle layer, forming the thick wall of the vas and 3. Connective tissue, including blood vessels, on the outside of the vas.We use extremely fine microsutures (10-0 & 9-0) used in eye surgery. These fine sutures and the needle which are barely visible to naked eye, help to acheive good approximation with minimal trauma to vas.
By approximating the cut ends of the vas in three layes, there is better chance of achieving a perfectly aligned leak proof joining of the cut ends of the vas.
In the event of any blockage to epididymis that is diagnosed by microscopic examination of the fluid from the end of the vas attached to the testicle, we will perform a bypass procedure called vaso-epididymostomy. This means connecting the distal (outer) end of the vas directly to one of the coiled tubule (fine tube <0.5mm) in the epididymis. This is even finer and more delicate procedures than the vaso-vasostomy. One in five men who come for the reversal with us require this bypass procedure at least on one side. Most other clinics in UK do not perform the necessary microscopic examination of the fluid and you can decide how they could choose correct procedure i.e. strait connection of the vas to vas (vaso-vasostomy) or bypass (vaso-epididymostomy).
What anaesthetic do you use? What will be my experience like?
Type of Anaesthetic used for the Vasectomy reversal procedures in Best Life Clinic
We use the local anaesthetic and conscious sedation. The local anaesthetic medication is injected in steps right through the procedure (over three hours in small amounts) to make the procedure literally painless. Average dose of local anaesthetic we use is similar to the dosage used for procedures such as circumcision.
As soon as men walk into the clinic on the day of surgery, the surgeon will consult, examine and apply local anaesthetic cream after marking the line of cut for the operation.
After that, premedication will be given that will include mild oral sedation. You do not need to fast for this procedure. In fact, if men turn up to the clinic with empty stomach, we will give some thing to eat before the procedure. We only ask to avoid any coffee, tea and fizzy drinks for up to three hours before the procedure to reduce the need for going to the toilet during the procedure.
Once you come into the operating room, a cannula will be placed into your vein in your arm and we will give a mild sedation through this in small quantities to give you a very relaxed state. You will not become unconscious at any stage. You may feel yourself awake but you will reach a more relaxed state. Even the most anxious men become very relaxed after this. It is understandable, men can be anxious at the beginning fearing the unknown. But once we progressed through the procedure and once they realise that the procedure is painless they drift off to sleep. You are likely to forget most of the events during the procedure which is an effect of the sedation used.
The preparation of the vas tubes on both sides can take up to 45 minutes. The microscopic part of the operation will take about an hour on each side. Final preparation and closure may take another 30- 45 minutes. Of course, for redo-procedures, the preparation can take as much as 90 minutes depending on the state of scarring and altered anatomy from previous procedures. Therefore the overall operating time can vary from 3.5 hours to 4.5 hours.
Such a long span of time to be under general anaesthesia will be a heavy undertaking. It will definitely make hospitalisation for a night necessary. Prolonged general anaesthetic carries the increased risk (however small) of complications such as blood clot in the veins & lungs, heart attack, stroke and pain in the throat do to a tube into your windpipe.
On the contrary, with our technique of local anaesthesia and sedation, the long reversal procedure is performed seamlessly. Men stand up on their legs and walk out of the clinic within an hour after the procedure. No inconvenience of fasting before the procedure. Out of nearly 300 men we operated, not even a single man was in a situation of not being able to tolerate the procedure to completion. Most men commented that the procedure was painless when compared with their original vasectomy even though the reversal operation is much more invasive and longer procedure than the original vasectomy. Therefore the tolerance and compliance of our patients is 100%.
You can see the experience off our growing list of feedback at the following links. We have started collecting a third party (Doctify) verified feedback since the beginning of 2021.
The feedbacks prior to that time is published in our Testimonials page as the collection of ‘free text’ comments given in the paper feedbacks. So we can assure you that a combination of local anaesthetic and conscious sedation is a perfectly suitable and safe option for the reversal service with the advantages of quicker recovery, elimination of the risks of general anaesthetic, 100% tolerance and good patient experience.
So, if other surgeons claim that reversal could not be or should not be done under local anaesthetic, you ask them why they can’t develop the skills to master the local anaesthetic techniques for the scrotal operations.
Links to see the feedback:
For proceeding further by a free telephone consultation:
Which sutures do you use?
We use special vasovasostomy sutures specifically manufactured for this operation by Sharpoint in the USA, size 10-0 and Nylon 10-0 for the inner layer and Nylon 9-0 for the outer two layers and Nylon 8-0 for tissues around the vas tubes. These sutures are expensive and they are the best for the vasectomy reversals.
In many other places they use 6-0 nylon which has a much larger needle and thicker sutures. Larger the needle and thicker the suture, more trauma to the delicate tubes (vas)
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 3 hours to 4 hours. Fortunately for the patient this feels just like a few minutes.There is no painful effects of having a tube or laryngeal mask put in the throat required in the general anaesthetic.
When can I go home?
You can go home in about an hour after the completion of the procedure. You will be awake towards the end of the procedure. Once you are able to have a light meals and a drink, you will be ready to go. If you have to travel more than 2 hours to reach home, we would advice you to stay overnight in a nearby hotel.
Could there be complications?
Yes, but fortunately only the same sort of complications that can arise during any other scrotal operations. i.e. 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.
Will it be painful afterwards?
It will be an achy pain for the first few days. We dont get any calls regarding pain as an issue. This is because we have not disturbed the tissues to any great extent, we lift the vas and testis witht he coverings above the skin, repair it and return it with no trauma to the testis. Occasionally we may have to open the coverings of the testis to deal with difficult situations and challenges regarding the quality and length of vas. If there is a blow out, we will have to open the coverings of the testis to perform the bypass. Even those men have not reported any greater bother with the pain.
It is common to see bruises spreading up to penis and groin. The scrotum may feel lumpy for few weeks. This is due to thickening in the tissues called post operative induration.
Shall I bring pain killers?
No! We send you home with the only pain killers you will could possibly need, Paracetamol and Ibuprofen.
We will recommend use of low does painkillers for few weeks for those with higher likelyhood of inflammation. Private prescriptions will be provided for this from our end.
Can I come on my own?
By law we must discharge you to the care of a responsible adult. It is absolutely necessary you get accompanied by an adult since you prefer to have sedation. Unless you have the procedure fully under the local anaesthetic without sedation, you need to have an adult with you to be discharged home. If you arrive at the clinic not escorted by an adult, you will have to avoid any sedation. But we can do the procedure without sedation and some men had it that way.
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 joint(anaestamosis) causing scarring and narrowing of the joint. Ofcourse, one can not help night time spontaneous emissions.
What do I do about tests afterwards?
We recommend semen tests at 2 monthly intervals after the op. We will give the request forms to have this arranged through the GP or through a fertility clinic. The cost of doing the test will have to be paid by you as our procedure cost does not include this cost. It would be unfair to include this cost as many of our patients come from distant places and they will not be able to avail the facility of sending the samples to our local lab..
I have had a reversal before, is it worth having it done again?
Reasons for failure of Reversals
There are two reasons for the failure of the Vasectomy reversal operations.
1. The most common problem with reversal surgery is the formation of scar tissue at the junction. This is due to malalignment of the minute openings of the vas or leakage of sperms from the joint. Removal of the scarred tube and microsurgically re-joining the vas is highly effective. Our method of multilayer microsurgery achieves the best possible alignment of the minute canals (openings )of the vas with the least risk of leakage.
2. The other cause of failure of reversal is due to undiagnosed blockage at the epididymis (blow out) at the time of the initial reversal. Unfortunately most clinics in the UK do not take the necessary steps to diagnose this and choose the appropriate procedure. We are capable of performing the bypass procedure called vaso-epididymostomy that is necessary to deal with the blow-out of epididymis.
One in ten patients we operate are for redo-reversal procedures. We achieve a overall success of 60% in establishing patency for the redo-procedures though variable depending on the factors such as time since original vasectomy and cause of the failure of the previous reversal.
The following information from your previous reversal may be helpful to more accurately predict the outcome after a redo reversal. Please write to the previous clinic or the surgeon to get the following information if you can.
- Did they conclude the procedure on both sides?
- What was the quality of vas on both sides and any difficulty during the procedure
- What was the appearance (colour&texture) of the fluid from the vas end attached to the testis on each side?
- Did they do microscopic test of the fluid during the procedure? What were the findings of the microscopic tests if done for each side?
- Results of the semen tests done months after the procedure
As you can see from above questions, this information should be available from any clinic that provides proper reversal service as per current best standards.
Once you get this information, if you are interested to speak to our surgeon by a free telephone consultation, please fill the questionnaire at the following link.
I have 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.
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 above 90%.
Will sex be any different after the reversal?
Not on any scientific basis. Most men do report some change for the better. But this is not our selling point!!
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, that can be done.
My wife is 40+. Is it too late?
Probably not. After vasectomy reversals, pregnancies do happen where the wife is 40 plus. 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. If the level is within the normal range for your lab, then it shows that the woman may be still fertile.However there is steady decline in the pregnancy rate with increase in the age of the female partner.You may also wish to get some advice on the IVF option if your partner is older than 40 and you and your partner are considering to have only one child.
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.
How much does the operation cost?
We prefer to work on a fixed fee basis so you know exactly how much you are going to pay and that there are be NO extra charges, ever.
Our current fees are;
- Consultation is £240 ( face to face consultation if required. This fee will be reduced from the procedure fee if choose to have the procedure with us.
- Vasectomy reversal £3200.
- Re-do vasectomy reversal £3600.
For full details of cost and what the fee includes please click here
Full terms and conditions of the fee will be provided prior to booking a date for 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 have 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 with appropriate precautions to manage your underlying condition that needed the use of blood thinners.
What if reversal doesn't work?
If the reversal by our Vaso-vasostomy or vaso-epidydimostomy doesn't work, then the next option is to consider IVF unless there is definite signs of secondary failure after a good sperm count initially. If that is the case, then the failure may be due to blockage by scarring. In such selected cases, redo-reversal may be considered.
I have seen a clinic that advertises microsurgery.
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 in a blue-moon he is unlikely be proficient and confident as it takes repeated practice and familiarity to be competent and accurate with this little practice.
What are your fees?
Schedule of fees
Consultation in the clinic £240. The consultation fee will be reduced from the procedure fee whan you book for the procedure.
|First time Reversal procedure (includes consultation)||£3200|
|Re-do reversal (includes consultation)||£3600|
|Initial deposit (payable on confirmation of your procedure date)||£ 600|
|Balance: First time (payable one week prior the appointment)||£2600|
|Balance: Re-do (payable one week prior the appointment)||£3000|
This fee covers the following
1. Full Consultation on the day or if you had previous face-to-face consultation
2. Sedation and Local anaesthetic
3. Full procedure irrespective of the choice of procedure i.e. Vaso-vasostomy or Vaso-Epididymostomy, We use the most expensive sutures that are designed for vasectomy reversals.
4. Multiple sampling and Testing of the seminal fluid from the vas during the operation
5. Discharge Medication to take home
6. Upto four follow up telephone consultation or face to face consultation for twelve months to support you
7. Dealing with any complication by us in our clinic
We have not included the fee for post-operative semen test or any supplements that may be adviced to enhance the sperm quality. Since patients come to us from far away places, they will have to go to a local fertility clinic to check the semen from 12 weeks after the procedure.
Methods of payment:
- Credit card (No extra cost).
- Debit card (no extra cost).
- Building society cheque made payable to ‘Best Life Healthcare Ltc’
- Bank transfer (BACS) - please contact the clinic for details
Does Vasectomy(Snip) Reversal work?
The answer is resounding 'Yes'. You might have heared that vasectomy is irreversible and it is the final step etc. That is not true in the age of Micro-surgery. With increasing expertise in microsurgery, the surgeons pushed the techniques further and further from single layer to multilayer surgery and even more difficut ' Invagination Vaso Epidydimostomy'. It is recognised that multilayer Vaso-vasostomy is the most difficut micro-surgical procedure even when compared with joining fine blood vessels in hand surgery or plastic and reconstructive surgery. Thanks to that technique of Micordot Multilayer Vaso-vasostomy, as long as there are two tube ends to connect, we can connect any vas inspite of the common challenges.