Procedure For Reversing A Vasectomy

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Real Facts about Vasectomy Reversals

Welcome to the Right Place for Facts about Vasectomy Reversal


If you are considering to become a dad again after a previous vasectomy or a previous failed reversal, you are at the right place to learn all you need to know about the vasectomy reversal.  We believe that the information in this page will benefit you to choose the right clinic and surgeon for the reversal. The standard of the services provided are very variable in different clinics. If you have this information about the best possible standard, then you can  ask the questions and make the fully informed decision.

What is Vasectomy Reversal ?

Vasectomy reversal (Snip Reversals or Reversal of Male Sterilisation) is the operation to identify the cut ends of the vas (which has minute diameter of 0.2mm - 0.4 mm)  that carries sperms from Testis to the penis and reconnect  them to transport the sperms again.
The main principles of this operation include the following 

  •  Achieve the best possible alignment of the minute openings (lumens) of both cut ends that could be of different diameters
  •  Connect them in a leak proof manner as leakage can cause blockage of the connection
  • Preserve the blood supply to the vas  throughout the procedure as careless handling may compromise the blood supply and cause scarring & blockage.
  • If there is blockage upstream at the level of epididymis, then a procedure of connecting the vas to the epididymis (Vaso-Epididymostomy) will be needed. A reversal service cannot be a complete service, if the surgeon does not take steps to diagnose the blockage and perform this procedure. Simply connecting the vas end to the other end will not work in this situations.

If these principles are not adhered to, the operation is likely to fail due to blockage at the connection.

 

Seven  Facts You must Know about Vasectomy Reversal


1.Vasectomy is a reversible operation with good success rates majority of the times contrary to the wrong opinion even from healthcare professionals. 


As first point of contact, many couples do seek advice from local fertility clinics for advice. Unfortunately, most fertility clinics offer them the only option of IVF. Couples are not usually told about the option of vasectomy reversal that could offer them a possibility to conceive naturally.  IVF does involve invasive and intrusive procedures for both partners and it's not a natural way of conceiving. Vasectomy reversal may be the appropriate first line option for many couples and give them the opportunity to conceive naturally. Of course IVF will be more appropriate option for some couples as mentioned below at the last fact.


2. How to identify if the clinic you are considering is doing the real microsurgery?


Real Micro-surgery is the game changer in the outcome of Vasectomy reversal. Multilayered Technique of the reversal is the current Gold-Standard which is described with diagrammatic illustrations at the last section of this page. 

Do not hesitate to ask the surgeon or the clinic the following questions.

  • How long does it take to perform the operation and how many layers is the connection?  Proper three layer procedure both sides will demand a theatre time of atleast 3.5 -4 hours.
  • Do they connect the inner layer (mucosal layer) separately? This is the important, technically demanding and time consuming part of the operation.  In some places they seems to do a second layer with tissues around the vas after a full thickness connection  and calling it multi-layer procedure. 
  • What stitches (sutures) do they use?     Finest sutures are called 10-0 or 9-0 stitches which contain needles as thin as the hair. To connect the inner layer separately, most will need 10-0 stitches. These needles cause minimal or no trauma to the tubes.  Bigger the number before 0 (zero) finer the stitch. 
  • How many procedures the surgeon and team perform? The recommended critical minimum number is atleast 12 per year. Bigger the number of procedures done in right way, better will be the outcome. At Best Life we perform 10-20 procedures per month

Many  surgeons use 6-0 stiches, which contain much bigger needle. Using bigger sutures with bigger needle causes more risk of trauma to the fine vas  which  can cause blockage after the reversal. Three layered technique provides better alignment and leak proof connection of the vas ends


3. Does the surgeon check for blockage upstream or Blow out and examine the fluid from the end of the vas attached to testicle under the high power microscope? 


Blow-out or obstruction of the epididymis happen after vasectomy due to back pressure build up in the long thin tube called epididymis before it continues as vas. Simply reconnecting the ends of the vas will not work if there is a blow out. This situation will need even more delicate operation called  Vaso-Epididymostomy. The surgeon and the clinic should have  skills and resources to perform  Vaso-Epididymostomy to deal with blockage upstream that can happen in 2 out of 10 men who had vasectomy more than 10 years ago. There can be  other challenging situations during the reversal procedure. Please see our separage page on Difficult Situations (Click Here)

This microscopic examination of the fluid is so vital for following reasons. 
a. It will help to dignose blockage at the level of epididymis and decide the appropriate procedure either vaso-vasostomy (connecting vas to vas ) or Vaso-Epididymostomy (connecting vas to the epididymis. 
b. It will be helpful to more acccurately predict the outcome  
c. If there is a failure, it will be helpful to more accurately decide the reason for failure and counsel the patients if  a redo-reversal  will be helpful. For most patients who come to us for redo-reversal, unfortunately we dont get  this information.

Unfortunatelly, many surgeons do not perform this necessary test and blindly perform the same procedure of vaso-vasostomy in all patients.

4.How are the Reversals done in the UK?


 Not all surgeons do the operations to the same excellent standards due to various reasons. Check out below to learn more and don't hesitate to ask what method they are doing.
Unfortunately there is no standardised way of doing the vasectomy reversal in the UK. The reversal operations are done in the following ways. The type of procedure is chosen mostly due to limitations in  surgeon's experience, resources, need to limit the operation time and the need to offer the procedure in a cost effective way. Therefore it may not necesssarily be only  at the interest of the patient. So you need to make your research and choose the clinic and surgeon diligently.

Reversal without Microscope and using larger stitches with bigger needles (substandard currently and don't even consider this option)


Surgeons use magnifying loupes that give atmost 2-3 times magnification and they use bigger  6-0 stitches that contain needle that is as thick as the half of the lumen of the vas. This is a very basic way of doing this procedure. The tube ends are joined with 6 stiches on a single layer. It may take 60 to 90 minutes to do this procedure. This is a no-go area if you want to have a predictable result. 

Reversal using Operating Microscope but larger needles and stitches (Not current Best Standard)


Surgeons use similar material as above but with the help of an operating microscope. Here the operating microscope provides bit more magnification. But its power of magnification is not put to full use as surgeons choose the easy and less demanding way of using larger sutures (with larger needles) and  conventional instruments. The operation is done in one layer of 6 - 8 stiches and will take just about 90 minutes. This technique is widely used in the UK to drive down the costs by limiting the expensive operating theatre and surgeon time while claiming it as microsurgery (arguably incorrect in our opinion). This procedure will work only  if the quality and dimension of the tubes are relatively strait forward. But the patient or the surgeon cannot assure that until at the time of the operation. 

Reversal using operating Microscope and Advanced Multilayer  Microsurgery (Current Best Standard) and ability to do the correct reversal procedure including Vaso-Epididymostomy


The best possible alignment of the tubes can be only  achived by multilayer microsurgery reversal using very minute 10-0 or 9-0 stitches. It is so important to connect the inner layers (mucosal layer) of the vas separately to keep the connection site (anaestamosis) open or patent. In real life, during the operation, the inner layer can look very collapsed with diameter of the opening varying from 0.2-0.4mm. That is the reason, the multilayer surgery carries a distinct advantage. This method using two layers was initially described by two different surgeons (Silber and Owen) in 1977. They described two layer technique which raised the successful outcomes from over 40% to more than 90%. Further development brought by Professor Goldstein at New York’s Cornell University was called Microdot Multilayer Microsurgical Vasovasostomy (MMMV) which is the world’s gold standard procedure. This involves using three or more layers to reconnect the tubes. This helps to realign the tubes of varying diameters even in the midst of challenging situations such as extremely thin tubes.


5.Does the age of the man and longer time interval since vasectomy rule out the option of Vasectomy reversal?


The testicles continue to produce sperms even in older men (Guess what is 'Old'). There is age related decline in the sperm quality as men get older. But unlike women who stop being fertile after menopause, men continue to produce sperms well into old age. Of course one should think about the physical challenges of becoming a dad again as they get older. We don’t define what is old. It is upto the individual to decide that. So don't resort to IVF just because of age. Longer time since vasectomy adversely influences the outcome but not the only factor and does not compromise the results completely. With vaso-epididymostomy, the success rates can be still upto 50% even in men who had vasectomy more than 20 years ago.


6. Is the Vasectomy Reversal complete answer to my dream of having a baby?


 It is only a part of the game in your ultimate expectation of having a baby. Vasectomy reversal only address the male factor and possibly brings him to the fertile state. Pregnancy chances can be compromised by quality of sperms which is not directly influenced by the  reversal operation and any other fertility issues with the female partner. So your partner needs must  be considered before you decide about the reversal. If your partner has any fertility issues, it is better to get checked by a female fertility specialist. In such couples, IVF may be more appropriate.  But it is still worth exploring  both options. 

7. Is the meaning of success for the vasectomy reversal and IVF the same? 

One important point you need to know in making your choice between Vasectomy reversal and IVF is how you interpret the figures quoted as success. For vasectomy reversals, the success is defined as patency rate not pregnancy rate. Patency rate means the presence of sperms in the semen after the reversal operation. The pregnancy rate may be much lower than the patency rate due to the other factors including partner factors. For IVF the, success is defined as pregnancy rate. Of course, the reversal operation gives you the possibility to have a child by natural way.

 

What do we offer in Best Life Clinic? Only the Current Best Standard

We offer the same advanced Microdot Multilayer Microsurgical Vasovasostomy (MMMV). This service is unique in the UK.  We are very cost effective and may be even less expensive than some of those clinics offering basic procedures. You can very easily identify from how long the actual operation takes and what size stiches the surgeons are using. Please do not hesitate to ask that question. We have not come across many  surgeons in the UK fully transparent that they do this multilayered procedure though this is the standard of care in most male-infertility centres in the United States. This operation usually takes four hours using very minute 10-0 and 9-0  sutures. The full magnification power of the operating microscope will have to be used during the difficult and minute steps of the procedure. 

We also perform Vaso-Epididymostomy in the event of Blow-out that is diagnosed at the time of the operation. So there is hope even if there is a blow-out. At the time of the procedure, we check multiple samples of the fluid from the testicular end of the vas. This is to ensure that the procedure we are doing carries the highest possible chances of success. 

Which Clinic should you choose?

Please do your research and read through the materials on our website. Based on that, it is upto you to make your informed choice. You may wish to choose a clinic close to you geographically, but ensure you get the best standard of care. The surgeons using basic techniques may claim that their techniques are working. It is true, the nature's healing mechanism is so wonderful,  there is even a chance of spontaneous natural reversal in one out of 2400 men undergoing vasectomy. So all procedures will work to some extent, but do you want to settle for some thing less than the current best-standard. If the surgeon can do only one type of basic reversal procedure, the outcome is left to  the chance of you being the right patient for that surgeon. But it should be other way round. The surgeon should have skills and resources to make the procedure right for you as per the needs arising at the time of the operation. The needs can be very challenging such as loss or damage to long segment of vas, extremely thin vas, varying diameters of the cut-ends of the vas, vas being cut very close to the epidydimis and blow outs. 

We can assure that we are capable and resourced to deal with all of these Challenging situations because of our unique factors and resources mentioned below.

  • Ability to offer Advanced Multilayer reversal
  • Allocation of four operating hours per patient. We dedicate the full four hours session for each patient. Maximum we perform two operations per day.
  • Resources & skills to do vaso-epidydimostomy at the same sitting  
  • All inclusive cost for the procedure (Click here for the information on  Cost)

Practical Aspects of the Reversal Service at Best Life Clinic. 

For more detailed information on our Reversal process please visit our web page ' Reversal Process'

Consultation

Vast majority of our patients make their decision after a free telephone consultation except those who desire to come for a fee paid face to face consultation or those who seek this operation for post-vasectomy pain or if we sense any high risk factors in thier clinical information provided. You will have the opportunity to discuss with the surgeon, Mr Manohar Jesuraj the full details of the reversal specific to your situation, possible outcome, risks and alternative. Then you will receive a written summary of the consultation with some other information including a web page link to available dates for the procedure over the coming months. There is no obligation for you to get back to us. We do not pursue patients after consultation unless they come back and book for the procedure. Our aim is to give you a balanced information and help you to make your decision. If you would like to benefit form this consultation, please fill a detailed questionnaire at this link . Consultation

Booking for the procedure

After receiving the consultation documents and information about the reversal, you may get back to us with your chosen date and pay the deposit to book a date for the procedure. Click for details of Fee and Deposit.

Operation
Lasts approx. 1½ to 2 hours  each side.

  • Usual Approach via single horizontal or vertical incision
  • We locate the vas and the site where the original vasectomy blocked the tube.
  • Then we section the tube above and below this area to locate fresh open vas. At this stage we check that the reproductive tract is still functioning by flushing the upper vas with saline and sampling fluid from the testicular vas under the microscope.
  • Vasovasostomy ie. joining the ends of vas together using special very fine stitches thinner than a human eyelash (10.0 Nylon). The medical description of our operation is 'Multi-layer, Microdot Microsurgical Vasocasostomy'. In this exquisite procedure devised by professor Goldstein, the inner layer of the vas that carries the sperms is microsurgically stitched together followed by the muscle of the wall of the vas. Then the overlying tissue is closed over the top of the repair for strength and to ensure blood supply.
  • In selected cases where there is definite signs of blow out, we perform Vaso -epididymostomy. This is even more time consuming and delicate procedure

Afterwards.
There are one of two scars approx. 3 cm long - one on each side of the scrotum. We usually close these with a dissolving stitch buried under the skin so that there is no need for further visits to the Clinic. After taking tea and biscuits the patient is accompanied home to rest.

On the night of operation
We recommend that if you live further than an hour's drive away then you stay the night in a local hotel. We can  recommend the local hotels which are relatively less expensive. 

Return to work.
You  will need to rest completely for  3-5 days and then resume back to normal activities  five to seven days after operation. You should avoid any sternuous work for three weeks and avoid contact sports or bicycling for 4-6 weeks.

How will I know if the operation was successful?
We recommend an initial semen test for 12 weeks post-operatively by which time we would expect a return of small numbers of sperm to the semen. Return to full fertility can take upto 12 months (in some cases upto 18 months).   We will request your local GP to arrange for further tests at a pathology lab near you. Your GP may decline to arraneg this as NHS patient. If that happens, we can send a request that you can take to a local fertility clinic and pay the appropriate fee to get the test done. Since most of our patients come from distant places in the UK and abroad, we have not included any cost of post operative tests including semen tests in our fee. To serve those coming from our region of North-East England, We do have an agreement with a local private fertility clinic who would arrange the Semen test by charging a reduced fee of £100 per test for our patients waiving thier usual consultation fee of additiional £150 to others. 

What are my chances of becoming fertile again?
This depends on many factors but chiefly the length of time since your vasectomy was performed. This is because the likelihood of the tubes being blocked increases with each year that goes by, however, the operation is successful in more than 80 % of men who had the reversal within up to 10 years after vasectomy. Even if the vasectomy was done more than 10 years ago there is still a worthwhile chance of success. For full details on expected outcome, please click Chance of Success 

Diagrammatic Illiustration  of Our Reversals Procedure

Reversal by Our Gold Standard Technique

Introduction – it is natural to think that a reversal is a reversal and that all operations are roughly the same so it is OK to shop around for the cheapest. So this presentation is to explain why we use the MMMV procedure which takes about  3 to 4  hours to perform using expensive materials and gives the world’s best reversal results.

1. This is a diagram of the normal vas – a tiny (0.2 mm) sperm channel surrounded in a strong muscle coat and beyond that a layer of connective sinews and blood vessels. The overall diameter is around 2 mm.

Multi-layer Microdot Vasovasostomy Step 1

2. Following vasectomy, which simply blocks the vas, there is high pressure on the lower, testis side caused by the force of the sperms trying to escape. This causes the central sperm channel on the testis side to enlarge and dilate so that when we come to remove the vasectomy scar and rejoin the tube the two ends of vas look like this;

Multi-layer Microdot Vasovasostomy Step 2

3. The simple method of reconnecting the tube is to stitch together the ends using a stitch that goes all the way through all 3 layers of the vas. This brings together the very narrow end of the body side of the vas with the dilated testicle end of the vas leaving a shelf where the two meet as shown in the diagram. The technique is quick for the surgeon who can often manage 6 or 8 operations per day. Surgeons doing this procedures usually use size 6-0 stiches with thicker needles. Such stitches can be handled by conventional instruments rather than real micro-surgical instruments. That will enable the surgeon to do the procedure quickly. ( Remember less operating thatre time, more number of procedures, more profit  for the surgeon and the hospital!!) In such procudures, the operating microscope simply works similar to a  magnifying loupe rather than being put to its full use.

Multi-layer Microdot Vasovasostomy Step 3

4. The consequences of joining the vas in this way are as shown in this diagram, a narrow channel is formed for the sperms to swim through under pressure leading to low sperm counts, poor sperm quality (because they expend too much energy swimming through a narrow junction) and early scarring and closure of the join. This technique is used all across the UK and in clinics that perform reversals quickly with up to 6-8 patients in one day.

Multi-layer Microdot Vasovasostomy Step 4

 

5.The Multi layer microdot reversal (MMMV) was developed by professor Goldstein in New York’s Cornell University to improve the pregnancy rates of reversals and make them as free from scarring as humanly possible. Results from Professor Goldstein’s trial of this method show that he has a 99.7% success rate with this technique and pregnancy rate of well over 50%. Here is how it works. Of course the dimensions of the vas are so small that special instruments have been developed for our use. First microscopic 6 ink dots are placed on the ends of the vas to be joined, each the same distance from the skin of the sperm channel. Next, a single micro stitch a needle on each end is placed through each of the 6 dots and the stitch tied together. This joins together the skin layer of the vas very accurately, opening up the narrow end of the vas and gently narrowing the wide testicular end resulting in a smooth, step-free join that is wide open allowing the maximum number of high quality sperms to pass through. Because there are no rough edges in the join, it is rare for scar tissue and closure to form.

 

Multi-layer Microdot Vasovasostomy Step 5

6. The next or second layer of stitches brings the thick muscular layer on the vas together in a leak proof join and finally a third layer of micro stitches joins the outer layers of tissue and blood vessels.

Multi-layer Microdot Vasovasostomy Step 7

 

 

Telephone Consultation

Many of our patients travel from different parts of UK, Ireland and abroad and  prior face to face consultation is not usually  feasible for them. Therefore telephone consultation is the norm for most of our patients. You will have the opportunity to speak to the surgeon Mr Jesuraj directly who will take you through an indepth consultation about your medical back ground to assess your needs and give you a personalised reommendation.  Following the Telephone consultation, you will receive a detailed summary of what was discussed including the personalised chances of success, risks, alternatives and uncertainties. After this you will be able to make a fully informed choice of if and when and where you would want to have your reversal.There is absolutely no obligation to book for the procedure with us and this service is totally free. If you decide to have this consultation, please fill the detailed questionnaire at the link 'Consultation Questionnaire'  that is mandatory prior to the consultation. This will save time during the phone call and also ensure the accuracy of information you are providing to us.

 

Face to Face Consultation

Those would would like to come for face to face consultation or those patients with complex history especially those patients who desire reversal for pain, we encourage to come for face to face consultation. This will give the surgeon opportunity to  check the length and quality of the remaining  tubes and identify the potential  challenges such as insufficient tubes, blowouts etc.  As Mr Jesuraj performs  both Vaso-vasostomy and Vaso-epididymostomy, he is capable of dealing with these challenges and manage to complete  the reversal on both sides on more than 95% of our patients. The cost of face to face consultation will be £240, though this will be reduced from the procedure cost if you go ahead with the procedure in our clinic. If you decide to have this consultation, please fill the detailed questionnaire that is mandatory prior to the consultation. This will save time during the consultation and also ensure the accuracy of information you are providing to us.

 

 

Contact us today  Tel:  01642 939798 
Text:  07984448243
Email:  contact@bestlifeclinic.org

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