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. 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. The usual deposit paid to book an operation date will 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. 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 doen 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 soem 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.skin (mucosa) 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.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 leak proof joining of the cut ends 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 especially for the prolonged procedures like this advanced micro surgery that can take upto four hours.
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. These sutures aer very 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 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.
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. 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.
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?
By law we must discharge you to the care of a responsible adult. If absolutely necessary you get accompanied by an adult since you will 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.
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 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?
Yes, almost always if you had some sperms in the semen after the inital operation. 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 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?
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, 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 £150 ( 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 £2450.
- Re-do vasectomy reversal £2700.
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.
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 £150. The consultation fee will be reduced from the procedure fee whan you book for the procedure.
|First time Reversal procedure (includes consultation)||£2450|
|Re-do reversal (includes consultation)||£2700|
|Initial deposit (payable on confirmation of your procedure date)||£ 450|
|Balance: First time (payable 2 weeks prior the appointment)||£2000|
|Balance: Re-do (payable 2 weeks prior the appointment)||£2250|
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
We appreciate that your circumstances may change and you may need to delay or cancel your appointment. However cancellation or deferment can seriously disrupt our operating schedule.
Our policy is therefore as follows: 4 weeks or more notification - £300 refund (£150 administration fee). Less than 4 weeks notification – refund at our discretion if you book another date and pay the full amount.