After vasectomy, the vas ends can be sutured back together and sperm restored to the semen. This doesn’t always work, so vasectomy should not be considered a reversible form of birth control. However, within the first 3 years of vasectomy, reversal restores sperm to the semen in over 97% of cases! Even when the interval between vasectomy and reversal is 15 years or more, the sperm recovery rate remains about 70%. More details about the biologic response to vasectomy and various approaches to vasectomy reversal are provided in our Vasectomy Reversal 101 page.
Technique for Reversal
Vasectomy Reversal takes about 3 to 5 hours. It is performed under local anesthesia similar to the anesthesia used for vasectomy but with a longer-acting drug. Continuity of both vas tubes can be restored through a single 1/2-inch incision. Magnification is accomplished with either a surgical microscope and optical loupes, the high-power glasses used by gem-cutters and by cardiac surgeons when bypassing the small coronary blood vessels. A small soft drain covered with a gauze pad is removed in the office the next day, and the small incision will seal by itself within another day or two.
Downtime after Reversal
I usually perform one to two vasectomy reversals per week on Tuesday and Thursday mornings. Patients may return to nonstrenuous work on the following Monday, but should avoid sports and lifting more than 20 pounds for an additional week or two. Detailed instructions for before and after the reversal are available here as a PDF file.
Every doctor must follow his or her heart and feel good about the recipients of his or her elective services. We live in a world of 7.8 billion humans, increasing by 81 million per year. Florida has 21 million, rising at a rate of 1000 persons per day. The results are ever more crowded beaches, parks, and roads; and daily loss to “development” of hundreds of acres that other species call home. Just 20 years from now, when your children are still younger than you are now, Florida’s population will be up another 7 million to 28 million. Will it be better? Are we leaving our children with a Florida as nice as the one we inherited? What greater gift to future generations than to limit their numbers by limiting our own rate of procreation?
While acknowledging the joys of parenthood (my wife and I had 2), we also respect its demands. Many of us feel an overabundance of love toward our own children. But love is cheap – college is expensive. And parental time and emotional support are more important still. Additional children impose more stress that drives couples apart more often than it brings them together. One question to ask is whether a couple who already have multiple children simply want to procreate more, or whether they feel a need to bestow their love on more children. If the latter is the case, adoption of one of thousands of children in foster care (and yearning for a loving home) would be a more noble alternative.
I simply do not feel comfortable from an ethical standpoint providing reversals for couples with 3 or more children (his, hers, ours). There are always exceptions and special circumstances, and I am happy to speak with any couple by phone before making an appointment. But for now, my staff has been instructed not to offer consultation visits to couples with 3 or more children until I have spoken with them by phone.
Fees for Vasectomy Reversal
The fee for office-based reversal procedures is $5900 (after a $100 consultation fee). We are often told that these fees are less than charges elsewhere. There are a number of reasons for this:
Since vasectomy reversal is performed in the office, there are no facility fees.
Because it is done under local anesthesia, there are no fees for an anesthesiologist or nurse anesthetist.
We believe strongly that vasectomy is an excellent method of long-term pregnancy prevention, one that prevents unintended pregnancy far more effectively than any other form of contraception. Many men who are considering vasectomy might be discouraged from undergoing a vasectomy were it not for the availability of vasectomy reversal at a price that is within the financial grasp of the average vasectomy candidate. If you are one of the few for whom vasectomy reversal does not succeed, it will be difficult enough, without a $8000-$12,000 bill!
The rationale for our vasectomy and reversal fees is quite simple: a reversal takes ten times longer than a vasectomy, so we charge 10 times as much. If the patient opts for an office-based vas-to-vas (VV) connections, and if lower end findings are so unfavorable that upstream secondary obstruction is likely (correctable by OR-based VE under general anesthesia at a later date), the fee for that “exploration” on each side is only $475, or half of the reversal deposit. This is the Approach Number 3 described in our Vasectomy Reversal 101 page. In other words, if the lower end fluid on the first side evaluated is very poor (thick fluid with no sperm), a connection is not performed and the fee for that side is $475. Then the other side is evaluated, because the two sides can be very different. If the lower end fluid on the second side is very poor, a connection is not performed and the fee for that side is only $475. By that time, the patient has already paid us $950 as a deposit, so he owes us nothing. If the lower end fluid on the second side is favorable (contains sperm), a connection is performed and the fee for that side is half of the reversal fee, which is 1/2 of $5900 = $2950.
A deposit of $950 and a signed reversal deposit agreement (initially completed and mailed to you by our staff) are due within 10 calendar days of scheduling the reversal. If not received within 10 days of scheduling, the chosen reversal date will be offered to other candidates. For cancellation or postponement more than 28 days prior to the reversal, $850 will be refunded or credited. Within 28 calendar days of the reversal date, the deposit is refundable only for M.D.-documented illness of the patient, not a family member. The balance is due on the day of the reversal. A payment plan is not offered by our office, but we accept VISA & MasterCard whom candidates can repay at whatever pace they choose. According to the Federal Tax Code, the expenses of attaining medical treatment to correct a functional impairment (in this case sterility) are tax-deductible once the total medical expenses for the tax year (including what is spent for health insurance) exceeds 7.5% of adjusted gross income. This includes the reversal fee, airfare, mileage expenses at $0.23 per mile (2015 allowance rate for medical expenses), and lodging expenses up to $50 per night, so keep all of your receipts for tax time. We are usually booked six to twelve months in advance, but cancellations do occur and we can often move a patient’s scheduled procedure to an earlier date. We do NOT accept CareCredit for reversal consultations or procedures.
Out of Towners….
Our office is about 25 minutes from Tampa International Airport. After reading this page, click on our Information for Patients from Out of Town. Patients arriving by air must arrive in Tampa at least one day before the reversal and are free to fly home two days after the reversal. Any hotel within 30 minutes of the office would be fine. A deposit of $950 (refundable only for M.D.-documented illness of the patient, not a family member) is due within 10 days of scheduling the reversal, but will be returned if the consult examination reveals technical challenges too great to proceed in the office (this has occurred only twice in over 1600 reversal candidates). Patients who live over 90 minutes away by car should stay in a local hotel on the night of the reversal but may drive home after an office visit next day.
Nationwide vasectomy reversal success statistics are readily available. The most commonly cited article is the report of the Vasovasostomy Study Group which appeared in the Journal of Urology in March, 1991 (J Urol 145:505-511, March,1991; we’ll mail you the abstract or you can review or copy the article at your local hospital medical library). Our office success rates compare favorably with these statistics and our updated results (kept on an AccessÂ® database) are immediately available on request. The single most important parameter determining success is the number of years since vasectomy. Within the first 3 years after vasectomy, reversal results in sperm recovery in over 97% of cases. From 3 to 8 years, about 91%; from 9 to 14 years, about 82%; and beyond 14 years, about 69%. Overall 85%, considering all patients who seek vasectomy reversal. Click here to see a recent sperm recovery results graph. Pregnancy rates (without fertility assistance) also drop slowly with time (from about 86% in the 3-year group to 35% in the >15-years group), but we have had patients cause pregnancies after intervals as long as 30 years! Click here to see a recent pregnancy results graph. As with any surgery, success does not always occur and guarantees are fraught with problems of interpretation, so we do not offer them. We are fully aware that other web sites claim that loupe magnification is inferior to magnification using a microscope. I used a microscope for years during vasectomy reversals at a local surgery center, and in my experience, the microscope provided no advantage over quality loupe magnification in most cases. All of our results are entered onto a database which is updated every 2-4 months and available on request and via the links in the last paragraph.
Success rates may be better when vasectomy reversal is performed under general anesthesia, in an operating room, and with use of an operating microscope so that the surgeon can immediately perform a VE when lower end fluid findings suggest additional blockage upstream from the vasectomy site. Data should be made available by all offices performing vasectomy reversal so that candidates can draw fair comparisons. If any other office can provide accurate data showing results superior to those above, then only the candidate can decide whether the percentage points of greater success is worth the cost differential. Some offices stress a need for immediate vasoepididymostomy (VE) when no sperm is seen in the fluid which exudes from the freshened testicular ends of the vasectomy sites or when the fluid is thick and creamy. VE requires delivery of the testes from the scrotum, which we feel is too involved for an office setting and should be done in a surgical facility. We have analyzed our findings to learn that when sperm are absent from thin fluid on both sides at the time of reversal, sperm recovery in the semen is still 53%. When the fluid is thick and creamy, chances of sperm return to the semen are so minimal that we do not proceed with vas-to-vas connections (or charge a full fee), but the fluid is thick on both sides in only 5% of patients. Most patients thereby avoid the fees for a surgical facility and still get accurate vas-to-vas connections. My technique of office-based vasectomy reversal (Approach Number 3 in our Vasectomy Reversal 101 page) does not create enough scar tissue that VE at a later date would be more difficult. Again, only the candidate can decide whether availability of immediate VE is worth the cost differential of the surgeons who perform reversals in more formal (and expensive) operating room settings.
Every doctor has success stories and testimonials from patients who think that he or she is wonderful. But offering the names of only those patients whose procedures have been successful doesn’t allow the reversal candidate an unbiased spectrum of opinions about a surgeon or the reversal process.
In April 1999, we began to ask every reversal patient for permission to release his first name and phone number to reversal candidates who would like to learn more about the reversal process here in our office. We asked this permission at the time of each reversal, even before we knew if the reversal had restored sperm to the semen. As of January 2014, 792 reversal patients were listed by state and telephone area code. But this became a bit unwieldy, it was time-consuming to maintain, and some of the phone numbers went out of service as people moved or changed listings without notifying us. If you feel that you would like to speak with a former patient with an interval between vasectomy and reversal similar to yours, we can arrange that.
Please request more information on our Visitor Page, if desired. You may also call 813-536-1430 during working hours (M-F 9-4 ET). After hours, please leave a message and we will return your call on the next business day. I answer queries posted on our Visitor Page from home and can usually respond within 24 hours.