California Vasectomy
& Reversal Center
& Reversal Center
Can a vasectomy be reversed?
Vasectomy reversal is the most cost-effective way of achieving pregnancy after a
vasectomy. Whether a couples desires more children in a relationship or the desire for
children in a new relationship, vasectomy reversal offers the best chance of pregnancy.
There are over 35,000 vasectomy reversals performed annually in the United States.
The most common reasons for this procedure include divorce/remarriage, desire for
more children in a current relationship or death of a child. Occasionally, a vasectomy
reversal will be performed simply because a man has changed his mind and wishes to
restore continuity of his reproductive tract or he has developed pain after his vasectomy.
vasectomy. Whether a couples desires more children in a relationship or the desire for
children in a new relationship, vasectomy reversal offers the best chance of pregnancy.
There are over 35,000 vasectomy reversals performed annually in the United States.
The most common reasons for this procedure include divorce/remarriage, desire for
more children in a current relationship or death of a child. Occasionally, a vasectomy
reversal will be performed simply because a man has changed his mind and wishes to
restore continuity of his reproductive tract or he has developed pain after his vasectomy.
More information about vasectomy reversal:
 | Financial information for vasectomy reversal | |
| Frequently asked questions | |
| Contacting a vasectomy reversal specialist | |
Vasectomy Reversal
How is a vasectomy reversal performed?
What is the success rate of a vasectomy reversal?
The success rate for vasectomy reversal is greater than 95% when sperm are identified
at the time of surgery. The chances of finding sperm at the time of vasectomy reversal
is determined by two important factors: the time elapsed since the vasectomy and the
site of the vasectomy. When the time interval between the vasectomy and the
vasectomy reversal is greater than 15 years, the chances of developing a secondary
epididymal obstruction is approximately 70%. Also, when the vasectomy is performed
low on the vas deferens then these chances are compounded. If sperm are not
identified at the time of vasectomy reversal, an epididymovasostomy will be required to
reverse your vasectomy. Vasectomy reversal success with epididymovasostomy is
65-70%. Regardless of the amount of time elapsed since the vasectomy, the success
rate should be constant and only dependent on the type of surgery that is required.
at the time of surgery. The chances of finding sperm at the time of vasectomy reversal
is determined by two important factors: the time elapsed since the vasectomy and the
site of the vasectomy. When the time interval between the vasectomy and the
vasectomy reversal is greater than 15 years, the chances of developing a secondary
epididymal obstruction is approximately 70%. Also, when the vasectomy is performed
low on the vas deferens then these chances are compounded. If sperm are not
identified at the time of vasectomy reversal, an epididymovasostomy will be required to
reverse your vasectomy. Vasectomy reversal success with epididymovasostomy is
65-70%. Regardless of the amount of time elapsed since the vasectomy, the success
rate should be constant and only dependent on the type of surgery that is required.
There are two different techniques for reversing a vasectomy: vasovasostomy and
epididymovasostomy. Both techniques involve bypassing the obstruction in the
reproductive tract. Vasovasostomy is the preferred method of vasectomy reversal
when sperm are identified in the vas deferens at the time of surgery.
Epididymovasostomy is the preferred method when sperm are not seen in the vas
deferens.
Vasovasostomy
Vasectomy reversal performed by vasovasostomy is done using an operating
microscope that provides magnification 25 times the normal image size. This is
important since the size of the vas deferens is about the same as a piece of spaghetti
and should be sewn in two-layers to offer the highest pregnancy rates. Microscopic
suture (10-0 nylon) unseen by the naked eye is used during the vasectomy reversal. It
is important to use this fine suture to prevent leakage of sperm and to minimize
obstruction of the lumen of the vas deferens by the suture itself. The cost of the suture
itself is over $900 per vasectomy reversal!
epididymovasostomy. Both techniques involve bypassing the obstruction in the
reproductive tract. Vasovasostomy is the preferred method of vasectomy reversal
when sperm are identified in the vas deferens at the time of surgery.
Epididymovasostomy is the preferred method when sperm are not seen in the vas
deferens.
Vasovasostomy
Vasectomy reversal performed by vasovasostomy is done using an operating
microscope that provides magnification 25 times the normal image size. This is
important since the size of the vas deferens is about the same as a piece of spaghetti
and should be sewn in two-layers to offer the highest pregnancy rates. Microscopic
suture (10-0 nylon) unseen by the naked eye is used during the vasectomy reversal. It
is important to use this fine suture to prevent leakage of sperm and to minimize
obstruction of the lumen of the vas deferens by the suture itself. The cost of the suture
itself is over $900 per vasectomy reversal!
The initial step during a vasectomy reversal
is to identify whether or not there are sperm
in the testicular end of the vas deferens. If
sperm are identified, then a vasovasostomy
can be performed successfully using
microsurgical technique. If sperm are not
identified then a secondary epididymal
obstruction has developed and re-connecting
the vas deferens at the site of vasectomy will
universally be unsuccessful. This occurs
30% of the time and is dependent on several
factors such as the time since your
vasectomy and the site of your vasectomy. If
sperm are not seen then an
epididymovasostomy will be required in
order to reverse the vasectomy. (see below)
is to identify whether or not there are sperm
in the testicular end of the vas deferens. If
sperm are identified, then a vasovasostomy
can be performed successfully using
microsurgical technique. If sperm are not
identified then a secondary epididymal
obstruction has developed and re-connecting
the vas deferens at the site of vasectomy will
universally be unsuccessful. This occurs
30% of the time and is dependent on several
factors such as the time since your
vasectomy and the site of your vasectomy. If
sperm are not seen then an
epididymovasostomy will be required in
order to reverse the vasectomy. (see below)
The next step in a vasectomy reversal is to
re-approximate the ends of the vas deferens
in a tension-free manner. The 10-0 Nylon
suture provides a water-tight closure for the
sperm to travel through the vas deferens. If
larger sized suture is used, it can cause
obstruction in the vasal lumen itself.
re-approximate the ends of the vas deferens
in a tension-free manner. The 10-0 Nylon
suture provides a water-tight closure for the
sperm to travel through the vas deferens. If
larger sized suture is used, it can cause
obstruction in the vasal lumen itself.
Epididymovasostomy
Epididymovasostomy is required during vasectomy reversal when there is absent
sperm in the vas deferens. This signifies that a secondary epididymal obstruction has
developed upstream from the vasectomy site. This situation is encountered in
approximately 40% of individuals after a vasectomy. Epididymovasostomy can only be
performed using a high powered operating microscope, under general anesthesia, by
microsurgeons using the finest suture (10-0 nylon).
Epididymovasostomy is required during vasectomy reversal when there is absent
sperm in the vas deferens. This signifies that a secondary epididymal obstruction has
developed upstream from the vasectomy site. This situation is encountered in
approximately 40% of individuals after a vasectomy. Epididymovasostomy can only be
performed using a high powered operating microscope, under general anesthesia, by
microsurgeons using the finest suture (10-0 nylon).
The typical appearance of the vasal lumen
after it has been precisely sewn together
using 10-0 nylon suture. The suture is made
of the finest non-reactive material to prevent
scarring of the lumen after the surgery.
after it has been precisely sewn together
using 10-0 nylon suture. The suture is made
of the finest non-reactive material to prevent
scarring of the lumen after the surgery.
An outer layer of 9-0 nylon suture is placed to
reinforce the inner layer and to relieve
tension from the important inner layer.
Numerous interrupted sutures are placed
around the outer layer ensuring a
tension-free closure.
reinforce the inner layer and to relieve
tension from the important inner layer.
Numerous interrupted sutures are placed
around the outer layer ensuring a
tension-free closure.
The epididymis is opened and a single
tubule is isolated to bypass the obstruction
that has developed.
tubule is isolated to bypass the obstruction
that has developed.
The vas deferens is then attached to the
epididymis using fine sutures (9-0 nylon).
This attachment brings the vas deferens
into close proximity of the single epididymal
tubule.
epididymis using fine sutures (9-0 nylon).
This attachment brings the vas deferens
into close proximity of the single epididymal
tubule.
The single epididymal tubule is sewn to the
inner lumen of the vas deferens using
microscopic sutures to create a water-tight
closure, similar to vasovasostomy.
inner lumen of the vas deferens using
microscopic sutures to create a water-tight
closure, similar to vasovasostomy.
Additional fine sutures are placed in the
outer layer of the epididymis to secure the
vas deferens in place and to release tension
off of the fine inner sutures.
outer layer of the epididymis to secure the
vas deferens in place and to release tension
off of the fine inner sutures.
Who should perform my vasectomy reversal?
The leading reproductive society, ASRM, has issued practice guidelines stating that:
"Since it is seldom possible to determine pre-operatively if epididymovasostomy will be required in a man undergoing
vasectomy reversal, only surgeons skilled in both epididymovasostomy and vasovasostomy should perform vasectomy
reversal"
It was also stated in the practice committee guidelines that the success and pregnancy rates of men undergoing
micro-surgical (24 times magnification) vasectomy reversal was much higher than in men undergoing the macro-surgical
technique (2.5 times magnification, Loupe assisted).
Choosing a doctor who is a fellowship trained microsurgeon will guarantee that your surgeon meets the guidelines
established by the leading reproductive society in this country. Many urologists offer vasectomy reversal services, but only
1-2% of urologists hold the distinction of being fellowship trained and capable of assuring their patients that they meet the
guidelines set forth by the leading reproductive society in this country.
Some urologists will try to compensate for the lack of this advanced training by offering their patients seasonal specials,
vacation packages or even a money back guarantee along with their vasectomy reversal. These are gimmicks! Most
respectable physicians do not ethically participate in such business practices. These specials are designed to lure
unsuspecting patients into a sub-optimal situation for a vasectomy reversal. It is important to remember that the ultimate goal
of your process and journey is to have a natural pregnancy after your vasectomy and not receive a free vacation or cut-rate
procedure. Additionally, most of these money back guarantees are designed to only give you back a small portion of your
investment and not the entire amount. Read the fine print and you will see that it really isn't a true money back guarantee!
Instead of offering gimmicks or vacation packages, we provide the highest quality service. We are so proud of our technique
and quality of vasectomy reversal that every patient receives high resolution photographs of the critical steps of their reverse
vasectomy procedure. We stand behind the quality of our work by providing you proof of the high quality of the procedure with
actual photos from the surgery. Without these photos, patients are left wondering what happened on the inside and
oftentimes only can evaluate the quality of the incision, which has no relevance to the success of the reverse vasectomy
procedure.
This is why the California Vasectomy and Reversal Center is the leading vasectomy and vasectomy reversal center in
Northern California. We provide our patients with the latest techniques and most sophisticated equipment when it comes to
their vasectomy or reverse vasectomy procedure. We are conveniently located to all major metropolitan areas of San Jose,
San Francisco, Oakland, Sacramento, Santa Cruz, Monterey, Fresno, Stockton, Santa Rosa, and Modesto. Our patients come
from virtually every corner of California, Nevada, Oregon and Hawaii. Patients from Reno, Las Vegas, Portland, Bakersfield,
Los Angeles, San Diego, Orange County, Riverside, Palm Springs, San Luis Obispo, Visalia and Santa Barbara have all had
successful reverse vasectomy procedures performed at our center.
"Since it is seldom possible to determine pre-operatively if epididymovasostomy will be required in a man undergoing
vasectomy reversal, only surgeons skilled in both epididymovasostomy and vasovasostomy should perform vasectomy
reversal"
It was also stated in the practice committee guidelines that the success and pregnancy rates of men undergoing
micro-surgical (24 times magnification) vasectomy reversal was much higher than in men undergoing the macro-surgical
technique (2.5 times magnification, Loupe assisted).
Choosing a doctor who is a fellowship trained microsurgeon will guarantee that your surgeon meets the guidelines
established by the leading reproductive society in this country. Many urologists offer vasectomy reversal services, but only
1-2% of urologists hold the distinction of being fellowship trained and capable of assuring their patients that they meet the
guidelines set forth by the leading reproductive society in this country.
Some urologists will try to compensate for the lack of this advanced training by offering their patients seasonal specials,
vacation packages or even a money back guarantee along with their vasectomy reversal. These are gimmicks! Most
respectable physicians do not ethically participate in such business practices. These specials are designed to lure
unsuspecting patients into a sub-optimal situation for a vasectomy reversal. It is important to remember that the ultimate goal
of your process and journey is to have a natural pregnancy after your vasectomy and not receive a free vacation or cut-rate
procedure. Additionally, most of these money back guarantees are designed to only give you back a small portion of your
investment and not the entire amount. Read the fine print and you will see that it really isn't a true money back guarantee!
Instead of offering gimmicks or vacation packages, we provide the highest quality service. We are so proud of our technique
and quality of vasectomy reversal that every patient receives high resolution photographs of the critical steps of their reverse
vasectomy procedure. We stand behind the quality of our work by providing you proof of the high quality of the procedure with
actual photos from the surgery. Without these photos, patients are left wondering what happened on the inside and
oftentimes only can evaluate the quality of the incision, which has no relevance to the success of the reverse vasectomy
procedure.
This is why the California Vasectomy and Reversal Center is the leading vasectomy and vasectomy reversal center in
Northern California. We provide our patients with the latest techniques and most sophisticated equipment when it comes to
their vasectomy or reverse vasectomy procedure. We are conveniently located to all major metropolitan areas of San Jose,
San Francisco, Oakland, Sacramento, Santa Cruz, Monterey, Fresno, Stockton, Santa Rosa, and Modesto. Our patients come
from virtually every corner of California, Nevada, Oregon and Hawaii. Patients from Reno, Las Vegas, Portland, Bakersfield,
Los Angeles, San Diego, Orange County, Riverside, Palm Springs, San Luis Obispo, Visalia and Santa Barbara have all had
successful reverse vasectomy procedures performed at our center.
Additional resources to learn
about Vasectomy Reversal
and IVF:
about Vasectomy Reversal
and IVF:
Related Articles:
More Photos of Actual Vasectomy Reversal and Reverse Vasectomy Procedures performed at the
California Vasectomy & Reversal Center
California Vasectomy & Reversal Center
Microdot Technique Vasovasostomy
The Microdot method for performing vasectomy reversal is a
variation of the standard multi-layer reverse vasectomy procedure.
Similar 10-0 Nylon and 9-0 Nylon sutures to microsurgical
vasovasostomy are used to re-approximate both layers of the vas
deferens.
variation of the standard multi-layer reverse vasectomy procedure.
Similar 10-0 Nylon and 9-0 Nylon sutures to microsurgical
vasovasostomy are used to re-approximate both layers of the vas
deferens.
The microdot technique allows for easy placement of the mucosal
10-0 Nylon sutures. The microdots guarantee even placement of
the mucosal sutures. Re-alignment of the vas deferens is
performed during the reverse vasectomy procedure to ensure
patency of the lumen of the vas deferens and to prevent long-term
scarring of the vasectomy reversal procedure.
10-0 Nylon sutures. The microdots guarantee even placement of
the mucosal sutures. Re-alignment of the vas deferens is
performed during the reverse vasectomy procedure to ensure
patency of the lumen of the vas deferens and to prevent long-term
scarring of the vasectomy reversal procedure.
Once the inner luminal sutures are tied, the knots are cut precisely.
Because of the very small size of the vas deferens lumen, any
redundant suture material can obstruct the flow of sperm along the
vas deferens. Likewise, sperm leakage outside of the lumen can
cause obstruction of the vas deferens. A water tight closure of the
vas deferens mucosa prevents sperm from leaking out of the vas
deferens after the procedure.
Because of the very small size of the vas deferens lumen, any
redundant suture material can obstruct the flow of sperm along the
vas deferens. Likewise, sperm leakage outside of the lumen can
cause obstruction of the vas deferens. A water tight closure of the
vas deferens mucosa prevents sperm from leaking out of the vas
deferens after the procedure.
The outer serosal sutures are equally important in the reverse
vasectomy procedure. These sutures relieve tension off of the
finer inner luminal sutures and prevent the ends of the vas
deferens from separating after the reverse vasectomy procedure.
Liberal placement of these outer serosal micro-sutures needs to
be done under a microscope as well to ensure that the ends of the
vas deferens are precisely approximated.
vasectomy procedure. These sutures relieve tension off of the
finer inner luminal sutures and prevent the ends of the vas
deferens from separating after the reverse vasectomy procedure.
Liberal placement of these outer serosal micro-sutures needs to
be done under a microscope as well to ensure that the ends of the
vas deferens are precisely approximated.
Epididymovasostomy (LIVE - Longitudinal Intussuception VasoEpididymostomy Technique)
In those cases where sperm are NOT identified in the testicular
vas deferens, an epididymovasostomy or "bypass" operation is
required. The typical appearance of the epididymis many years
after the vasectomy procedure.
vas deferens, an epididymovasostomy or "bypass" operation is
required. The typical appearance of the epididymis many years
after the vasectomy procedure.
A single tubule from the epididymis is isolated for the reverse
vasectomy procedure. This procedure can only be accomplished
under the highest magnification and the patient laying completely
still under a general anesthetic. Two microsurgical 10-0 Nylon
sutures are passed through the single epididymal tubule along the
longitudinal axis of the epididymal tubule, prior to opening the
tubule.
vasectomy procedure. This procedure can only be accomplished
under the highest magnification and the patient laying completely
still under a general anesthetic. Two microsurgical 10-0 Nylon
sutures are passed through the single epididymal tubule along the
longitudinal axis of the epididymal tubule, prior to opening the
tubule.
The abdominal end of the vas deferens is re-approximated to the
serosal edge of the tunic of the epididymis. The attachment of the
vas deferens to the tunic of the epididymis secures the vas
deferens and allows for accurate placement of the inner mucosal
sutures.
serosal edge of the tunic of the epididymis. The attachment of the
vas deferens to the tunic of the epididymis secures the vas
deferens and allows for accurate placement of the inner mucosal
sutures.
The microsurgical 10-0 Nylon sutures are passed through the
mucosa of the vas deferens in their corresponding locations on the
mucosa of the vas deferens.
mucosa of the vas deferens in their corresponding locations on the
mucosa of the vas deferens.
The 10-0 Nylon sutures are tied creating a water-tight closure
between the epididymal tubule and the mucosa of the vas deferens.
The single epididymal tubule is pulled (intussucepted) into the
lumen of the vas deferens.
between the epididymal tubule and the mucosa of the vas deferens.
The single epididymal tubule is pulled (intussucepted) into the
lumen of the vas deferens.
Additional microsurgical sutures are placed between the tunic of
the epididymis and the outer (serosal) edge of the vas deferens.
The additional microsutures on the outer layer of the vas deferens
relieve the tension off of the important inner luminal sutures.
the epididymis and the outer (serosal) edge of the vas deferens.
The additional microsutures on the outer layer of the vas deferens
relieve the tension off of the important inner luminal sutures.
The final appearance of the vas deferens attached to the
epididymis at slightly lower magnification. The "bypass" procedure
restores continuity of sperm flowing through the vas deferens when
an obstruction or "blockage" is identified at some part of the
epididymis.
epididymis at slightly lower magnification. The "bypass" procedure
restores continuity of sperm flowing through the vas deferens when
an obstruction or "blockage" is identified at some part of the
epididymis.
Dr Karpman's article on
Vasectomy Reversal from
M.D. News
Vasectomy Reversal from
M.D. News
Video of Dr Karpman
performing a
microsurgical vasectomy
reversal (vasovasostomy).
Click on the image below.
performing a
microsurgical vasectomy
reversal (vasovasostomy).
Click on the image below.
Vasectomy Reversal Recovery, Healing and Pictures of Incisions
Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like
after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are
Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like
after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are
notgetting on a plane for 3-4 hours or sitting in the car for an equal amount of time was not a problem as soon as the day
after performed. The amount of time required for surgery and the need for general anesthesia should make patients think
that surgery.
Your restrictions for activity after a vasectomy reversal are designed more for the actual healing process that is on-going
inside the scrotum, than the actual discomfort a patient feels. The tiny microscopic sutures are all that is holding everything
together after the vasectomy reversal and it is imperative that these sutures are not disrupted while allowing the surgical site
to heal. There is no good medical justification to tell patients to "take it easy" for 2, 3, 4, or 6 weeks. These restrictions are
quite arbitrary and usually based on a vasectomy reversal specialist's own experience with the healing process. We feel that
patients are able to resume all of their physical activities 2-3 weeks after surgery based on our surgical technique at the
California Vasectomy & Reversal Center.
after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are
Patients always wonder what the recovery process is after a vasectomy reversal and what their incisions should look like
after surgery. Fortunately, vasectomy reversal is not a very extensive operation regardless of which of the two surgeries are
notgetting on a plane for 3-4 hours or sitting in the car for an equal amount of time was not a problem as soon as the day
after performed. The amount of time required for surgery and the need for general anesthesia should make patients think
that surgery.
Your restrictions for activity after a vasectomy reversal are designed more for the actual healing process that is on-going
inside the scrotum, than the actual discomfort a patient feels. The tiny microscopic sutures are all that is holding everything
together after the vasectomy reversal and it is imperative that these sutures are not disrupted while allowing the surgical site
to heal. There is no good medical justification to tell patients to "take it easy" for 2, 3, 4, or 6 weeks. These restrictions are
quite arbitrary and usually based on a vasectomy reversal specialist's own experience with the healing process. We feel that
patients are able to resume all of their physical activities 2-3 weeks after surgery based on our surgical technique at the
California Vasectomy & Reversal Center.
The typical appearance of the scrotum 1 week after vasectomy reversal
surgery. The vasectomy reversal recovery shows minimal if any swelling
and bruising in the scrotum. The scrotal rugae or "wrinkles" are apparent
and indicative of resolution.
surgery. The vasectomy reversal recovery shows minimal if any swelling
and bruising in the scrotum. The scrotal rugae or "wrinkles" are apparent
and indicative of resolution.
Close inspection of the right wound
reveals some scab formation on the
incision line. The scab can liquefy and
cause some staining on the scrotal
support, gauze or underpants.
reveals some scab formation on the
incision line. The scab can liquefy and
cause some staining on the scrotal
support, gauze or underpants.
The left side has virtually no swelling or
bruising. The incisions are both
approximately one inch in length.
Compared to the previous vasectomy
incisions/scars, the wounds are bigger.
Both incisions are in the spectrum of
normal healing 1 week after the
vasectomy reversal.
bruising. The incisions are both
approximately one inch in length.
Compared to the previous vasectomy
incisions/scars, the wounds are bigger.
Both incisions are in the spectrum of
normal healing 1 week after the
vasectomy reversal.
Video of Dr Karpman
performing a
microsurgical vasectomy
reversal
(epididymovasostomy).
Click on the image below.
performing a
microsurgical vasectomy
reversal
(epididymovasostomy).
Click on the image below.
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Microsurgical
Vasectomy
Reversal
Vasectomy
Reversal