Mayo Clinic: Men’s Health Center

Complications and Risks

Almost all vasectomies can be reversed. However, this doesn't guarantee success in conceiving a child. Vasectomy reversal can be attempted even if several years have passed since the original vasectomy — but the longer it has been, the less likely it is that the reversal will work.

Vasectomy reversal rarely leads to serious complications. Risks include:

  • Bleeding within the scrotum. This can lead to a collection of blood (hematoma) that causes painful swelling. You can reduce the risk of hematoma by following your doctor's instructions to rest, use scrotal support and apply ice packs after surgery. Ask your doctor if you need to avoid aspirin or other types of blood-thinning medication before and after surgery.

  • Infection at the surgery site. Although very uncommon, infections are a risk with any surgery and may require treatment with antibiotics.

  • Chronic pain. Persistent pain after vasectomy reversal is uncommon, but if it does occur may require another procedure to undo the vasectomy reversal.


When considering vasectomy reversal, here are a few things to think about:

  • Vasectomy reversal may be expensive, and your insurance might not cover it. Find out about costs ahead of time.

  • Vasectomy reversals are generally most successful when they're done by a surgeon who is trained in and uses microsurgical techniques, including those that make use of a surgical microscope.

  • The procedure is most successful when performed by a surgeon who does the procedure regularly and who has done the procedure many times.

  • About 30% of the time the procedure requires a more complex type of repair, known as a vasoepididymostomy on at least one side. Make sure that your surgeon is able to perform this procedure if it's required.


When choosing a doctor, don't be afraid to ask questions about how many vasectomy reversals the doctor has done, the type of techniques used and how often the vasectomy reversals have resulted in pregnancy. Also ask about the risks and potential complications of the procedure.

We hope that you will choose Mayo Clinic for your vasectomy reversal; if you choose to have your procedure done elsewhere please do your research ahead of time since this is a huge emotional and financial investment for your future. Please watch our video below for the questions that you should be asking your surgeon before undergoing a vasectomy reversal.



Reasons to trust Mayo Clinic with your care include:

  • Experience. Over the years, Mayo Clinic doctors have helped thousands of people begin or expand their families.

  • Nationally recognized expertise. Mayo Clinic in Rochester, Minnesota, is ranked No. 1 among the Best Hospitals for urology by U.S. News & World Report. Mayo Clinic reproductive endocrinologists male fertility experts are fellowship trained and are leaders in their field. They will directly work with you to improve your chances for fertility and successful conception — whether by medication, surgery, in vitro fertilization (IVF) or another method.

  • Advanced technology. At Mayo Clinic, male infertility is treated by a urologist with training in both traditional microsurgical and robot-assisted infertility techniques. Procedures performed include vasectomy reversal, varicocelectomy, microscopic testicular sperm extraction (microTESE), testicular sperm extraction (TESE), microepididymal sperm aspiration (MESA), testicular biopsy, vasography and transrectal ultrasonography with seminal vesiculography, among others.


Mayo Clinic in Rochester, Minn., is ranked No. 1 for urology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Phoenix/Scottsdale, Ariz., and Mayo Clinic in Jacksonville, Fla., are ranked among the Best Hospitals in the nation for urology by U.S. News & World Report. Mayo Clinic also ranks among the Best Children's Hospitals for urology.

What to Expect From your Visit

Before the Procedure

Before vasectomy reversal surgery, we will:

  • Take your history using an online questionnaire. If anything comes up on your questionnaire that may affect your ability to have the procedure or father children, we may recommend additional testing.

  • Check to see whether you can produce healthy sperm. We will ask you to perform some laboratory testing to make sure that the testicle is still performing a normal level of testosterone. These labs should be done in the morning between 6-10 AM for them to be accurate, you do not need to be fasting.

  • Confirm that your partner is capable of having a child. If your partner has had any fertility problems, or if your partner has never had a child or is older than age 40, we would strongly suggest that she be evaluated by a gynecologist prior to your procedure.


We perform this procedure in our procedure suite where we will use an anesthetic that relaxes you but doesn't put you to sleep, as well as a local anesthetic. You can also elect to have this procedure done under general anesthesia in an operating room. Regardless of where you have it done, it is done on an outpatient basis — without an overnight stay.

Vasectomy reversal is a highly specialized procedure and considerably more difficult than a vasectomy. It should only be performed using microsurgery, in which a surgeon uses a powerful surgical microscope to magnify the vas deferens as much as 40 times its size. This type of surgery requires specialized skills and expertise.

Doctors performing this surgery usually will reattach the vas deferens in one of two ways:

  • Vasovasostomy (vas-o-vay-ZOS-tuh-me). With this procedure, the surgeon sews back together the severed ends of each tube that carries sperm (vas deferens).

  • Vasoepididymostomy (vas-o-ep-ih-did-ih-MOS-tuh-me). This surgery attaches the vas deferens directly to the small organ at the back of each testicle that holds sperm (epididymis). A vasoepididymostomy is more complicated than a vasovasostomy and is generally chosen if a vasovasostomy can't be done or isn't likely to work.


The decision to perform a vasovasostomy versus a vasoepididymostomy depends on whether sperm are seen when fluid from the vas deferens is analyzed at the time of surgery.

You probably won't know ahead of time which procedure is needed. In most cases, the surgeon decides during the operation which technique will work best. Sometimes a combination of the two surgical techniques is needed — a vasovasostomy on one side and a vasoepididymostomy on the other. The longer it has been since your vasectomy, the more likely you are to need a vasoepididymostomy on one or both sides. Recovery is the same for either procedure, but if you have a vasoepididymostomy done, you may notice that testicle rides higher than it did before the procedure because we will need to bypass a larger segment of the vas deferens.

During the Procedure

During surgery, your doctor will make a small cut (incision) on your scrotum. This will expose the tube that carries sperm (vas deferens) and release it from surrounding tissues.

Next, the doctor will cut open the vas deferens and examine the fluid inside. When sperm are present in the fluid, the ends of the vas deferens can be connected to re-establish the passageway for sperm.

If the fluid contains no sperm, scar tissue may be blocking sperm flow. In this case, your doctor may choose to perform a vasoepididymostomy.

Robot-assisted surgery has been used for vasectomy reversal, but usually is required only in select cases.

After the Procedure

Immediately after surgery, your doctor will cover the incisions with bandages. You'll put on tightfitting undergarments, such as an athletic supporter, and apply ice for 24 to 48 hours to reduce swelling.

You may be sore for several days. You can remove your bandage within 24 hours, and resume showing. Any stitches should dissolve in seven to 10 days.

After you return home, take it easy and try to limit activities that might cause the testicles to move around excessively. As the anesthetic wears off, you may have some pain and swelling. For most men, the pain isn't severe and gets better after a few days to a week.

You may resume your normal activities as follows:

  • Wear an athletic supporter for several weeks at all times, except when showering. After that, you'll need to continue to wear one when you exercise.

  • You can resume showering within 24 hours, but avoid soaking the incision in water such as tub bathing or swimming until the skin in completely healed (usually 2 weeks).

  • Limit any activities that may pull on the testicles or scrotum, such as jogging, sporting activities, biking or heavy lifting, for at least four to six weeks after surgery. This is VERY important since the sutures we are using are finer than an eyelash. You don't want to risk pulling the sutures apart by being physically active too soon. Walking and stairs are fine.

  • If you have a desk job, you'll probably be able to return to work a few days after surgery. If you perform physical labor or have a job that requires much walking or driving, talk to your doctor about when it's safe to go back to work.

  • You may start ejaculating at 2 weeks, and resume having sexual intercourse at 4 weeks.


What to Expect From your Visit

Vasectomy reversal is surgery to undo a vasectomy. It reconnects each tube (vas deferens) that carries sperm from a testicle into the semen. After a successful vasectomy reversal, sperm are again present in the semen, and you may be able to get your partner pregnant.

Pregnancy rates after vasectomy reversal will range from about 30 percent to over 90 percent, depending on the type of procedure. Many factors affect whether a reversal is successful in achieving pregnancy, including time since a vasectomy, partner age, surgeon experience and training, and whether or not you had fertility issues before your vasectomy.

Please take a moment to view the following video which will go over what a vasectomy reversal is, how it's performed, and what to expect in terms of recovery:



Success Rates

Given the complexity of couples' fertility, success rates with vasectomy reversals are difficult to define. In addition, the most important measure of success — a healthy baby — is not commonly reported in studies. The most important predictors of success are time since vasectomy (with the highest success rates for men who had a vasectomy done less than 10 years ago), and surgeon experience.

Success rates for vasectomy reversal (defined as the ability to get sperm back in the ejaculate) range from 70-95% depending on what kind of connection is made at the time of your reversal. Upon completing our questionnaire, you will be give a predicted success rates based on your responses. It's important to know that over time a percentage of men with initially successful reversals will experience a failure with few or no sperm in the ejaculate. It's not clear why this happens, but it may occur even several months after an initially successful procedure.



Freezing sperm

Although it's usually not required or recommended, you may choose to have sperm frozen (cryopreservation) in case your vasectomy reversal doesn't work. If you're not able to father a child through sexual intercourse, you may still be able to have children through assisted reproductive technology such as in vitro fertilization. You cannot use the sperm for intrauterine insemination because the concentration of sperm will not be high enough.

The decision of whether to freeze sperm at the time of vasectomy reversal is based on a few considerations. Freezing sperm requires additional upfront costs, including an estimated $1,000 for retrieval plus $250 to $500 for annual storage fees. The advantage of freezing at the time of surgery is that no additional procedures would be required if the vasectomy reversal isn't successful. The disadvantage is that freezing sperm is unnecessary in the majority of cases.

If you decide against freezing sperm at the time of your vasectomy reversal, and if your vasectomy reversal is unsuccessful, sperm may be retrieved at a later time, directly from the testicles. This requires a minimal office-based procedure. Annual storage costs of $250 to $500 still apply.

Results

We will ask you to perform a semen analysis at 6 weeks. If you had a simple connection (vasovasostomy) done, it can take up to 6 months for sperm to show up in your semen. If you had a complex connection (vasoepididymostomy) done on at least one side it can take up to 12 months for sperm to show up in your semen. If you do not have sperm at 6 weeks, you will be offered a repeat semen analysis in 3 months and a course of steroids because inflammation may be blocking the vas deferens. The semen analysis may be performed in a lab close to your home where they do this kind of test. Unless you get your partner pregnant, checking your semen for sperm is the only way to tell if your vasectomy reversal was a success.

When a vasectomy reversal is successful, sperm may appear in the semen within a few weeks, but it can sometimes take a year or more. The likelihood of achieving pregnancy depends on various factors, including the number and quality of sperm present and the female partner's age.

Alternatives to Vasectomy Reversal

If you've had a vasectomy but would like to have children, you may also undergo a procedure called testicular sperm extraction (or TESE) to get sperm directly from the testicle. This sperm will need to be used for in-vitro fertilization, a process where mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus.

If The Vasectomy Reversal Doesn't Work

Vasectomy reversals sometimes fail if there is an underlying issue with the testicle that cannot be recognized during surgery or if a blockage develops sometime after surgery. Some men have a second-attempt vasectomy reversal surgery if the procedure doesn't work the first time.

You may also be able to father a child through in vitro fertilization by using frozen sperm. Sperm may be retrieved directly from the testicle or epididymis either at the time of the reversal surgery or at a later date. Doctors don't usually recommend freezing sperm at the time of reversal surgery, as it may be an unnecessary extra procedure.

Please watch the following video about alternatives to vasectomy reversal and what your options are if a vasectomy reversal doesn't work:

 



Costs and Insurance

At Mayo Clinic in Rochester, Minnesota, options for vasectomy reversal include:

  • Option 1: Microscopic vasectomy reversal in the operating room under anesthesia. Cost is $16,000.

  • Option 2: Microscopic vasectomy reversal in the clinic using local anesthesia and light sedation (preferred option). Cost is $6,000.

  • Option 3: Robot-assisted vasectomy reversal. Performed only in select cases. Cost varies depending on whether your insurance will cover any part of the procedure.


Freezing sperm (cryopreservation) at the time of the vasectomy reversal costs about $1,000. Fees for long-term storage also apply and range from $250 to $500 a year.

Procedure Costs and Insurance

In general, the decision to have the vasectomy reversal in the office or operating room will depend on cost and comfort. The procedure done in the operating room (Option 1) is more expensive, as it requires the assistance of additional personnel and an anesthesiologist. You will be asleep for the entire surgery.

The office-based procedure (Option 2) is less expensive, as it does not require the use of general anesthesia. With this approach, you will be given a medicine that will lightly sedate you (you will still be awake during the procedure), and local numbing medicine will be applied to the scrotum. The numbing medicine may sting for a few seconds. Once it has been applied, you should be comfortable through the remainder of the procedure. During the surgery, which may last two to four hours, you will lie flat and be asked to move as little as possible — something that should also factor into your decision.

The surgical procedure performed is the same with either option, including the technique, use of the operating microscope and fine suture. The outcomes also are similar.

Robot-assisted vasectomy reversal (Option 3) is typically performed only when the vas deferens has become blocked at the level of the inguinal canal. This most often occurs after a hernia repair, although it is rare.

Insurance

Insurance companies rarely cover male infertility procedures. This means that you may need to pay all of the costs associated with the surgery. To help reduce the chance for unexpected costs, Mayo Clinic has fixed prices. The price applies even if the surgery is more challenging or if a more complex procedure is required on one or both sides.

Costs

Because of limited operating room time and the costs incurred by Mayo Clinic with the procedures, the full amount of the procedure must be paid prior to scheduling. If the procedure is canceled for any reason, the portion of your payment that has not been used toward existing balances at Mayo Clinic will be refunded in full with no cancellation fees.

POSTOPERATIVE INSTRUCTION FOR VASECTOMY REVERSAL

WOUND CARE:
Ok to shower 24 hours after the procedure. Pat incision dry after bathing.
No soaking in water (bathing, hot tubs, swimming pool) for 1 week or until skin has healed closed.
Do not apply Neosporin, ointments, or creams to the skin until specifically instructed by your doctor. 
It’s normal for the incision to bleed or ooze blood-tinged fluid for the first week. It’s ok to apply a dressing or band-aid to keep it from getting on your clothing, otherwise keep the incision open to air.
All sutures are dissolvable, but it can take up to 2 months for the suture to completely dissolve. It is normal to feel firm knots under the skin until the suture completely dissolves.
It is ok if the skin opens up slightly along the edges, it will heal closed because there are more sutures in the deeper layers of the scrotum. 
Please send us a message and photo using your patient portal if any of the following occurs:
Your incision is red, warm to touch, or draining foul-smelling fluid. 
You experience any fevers >100.4°F, significant nausea/vomiting, significantly worsening pain, or if the scrotum is getting progressively larger.

ACTIVITY RESTRICTIONS:
No strenuous physical activity including heavy lifting greater than 10 lbs., squatting, or jogging for 6-8 weeks. 
It is ok to ejaculate at 2 weeks, and ok to start having intercourse at 4 weeks.

PAIN MANAGEMENT: 
You will be prescribed Meloxicam, a strong form of ibuprofen (Advil/Motrin) that is an anti-inflammatory medication, which helps with healing. Take one tablet daily until you have finished the prescription. 
Take Meloxicam with food, and do not take additional ibuprofen while on it to avoid stomach upset.
You can use acetaminophen (Tylenol Extra Strength) one to two tablets every six hours for pain. 
Don’t consume >3000mg of Tylenol or acetaminophen-containing products in a 24-hour period. 
If you’re still in pain, you can take the narcotic pain medication that you were prescribed (Oxycodone/Percocet). 
You cannot drive or drink alcohol while taking narcotics (Oxycodone/Percocet), and these medications cause constipation, as well as nausea/vomiting (particularly on an empty stomach).

FOLLOW-UP: 

We will not schedule a follow up appointment, but can see you back at any time if you have any concerns. 

If you would like to schedule a follow up, send us a message through your patient portal, or call (507) 538-5363.

You will be given a paper order for a semen analysis, that can be performed at any lab close to home in 6 weeks, after you have ejaculated at least 20 times. Abstain from ejaculating for 3-7 days prior to assure an accurate result. Please let us know once you have done a semen analysis, so we can go over the results with you.  

Click here to access videos on optimizing your fertility and how to interpret a semen analysis.

If you have any questions relating to your surgery you can contact Dr. Helo’s service in the following ways:

Please set up your patient portal at https://www.mayoclinichealthsystem.org/patient-online-services. You will need your birthdate and Mayo Clinic number to set it up. This is the fastest way to communicate with our team, and you can send us photos securely using an app on your phone if you have any concerns about the wound. 

Alternatively, to contact Dr. Helo’s nurses, call the Urology Appointment Office at (507) 538-5363 to leave a message during normal business hours.

After hours or with emergency concerns please call (507)284-2511 and ask to speak with the resident on call for Dr. Helo’s Urology service.

 

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