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Is A Vasectomy Reversal Right For You?

Of the approximately 500,000 men who request vasectomies each year, it is understood that about 5% of them will change their minds at some point in time. Whether that decision is due to remarriage, a female partner’s fertility struggles, improved lifestyle circumstances that allow for more children, or other reasons such as treatment for post-vasectomy pain syndrome, the surgical technique of vasectomy reversal, clinically known as “vasovasostomy,” allows men to re-establish their fertility and successfully father children again.

At the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles, under the pioneering leadership of Dr. Philip E. Werthman, vasectomy reversals are performed on an outpatient basis with over 99% success for men who have sperm present at the time of surgery.

While we are quite proud of our success rates and the beautiful babies born with the help of Dr. Werthman’s expert care, we want to make sure that those interested vasectomy reversal are:

  • Careful in their consideration of the surgeons who perform vasectomy reversals.
  • Well-informed about all aspects of the vasectomy reversal procedure.
  • Aware of the pitfalls to avoid.
  • Educated about the common myths and misconceptions that can accompany the vasectomy reversal topic.

A Vasectomy Reversal at CMRM

Our Approach: Over the course of 20 years in practice, Dr. Werthman has streamlined and refined the vasectomy reversal process. Our operating room team has been working with Dr. Werthman for years. These are expert professionals who are prepared for every operating room scenario that presents itself when it comes to vasectomy reversals.

Initial Consultation

An initial evaluation is required for each patient treated by Dr. Werthman at his office in Los Angeles or Santa Barbara. With patient convenience in mind, especially for those who travel from out of the area to see us, we can easily schedule the initial consultation for the day before the vasectomy reversal procedure. This allows patients to take less time away from work and other life obligations.

About the Center

At CMRM, patient care, comfort and convenience are among our most important goals. To achieve them, we perform all vasectomy reversals on an outpatient basis at SPECIALTY SURGERY CENTER in Beverly Hills. This surgery center is equipped with the latest and most advanced, state-of-the-art equipment including new operating microscopes – critical in performing successful micro-surgical vasectomy reversals.

About the Procedure

We produced this detailed and informative video as a visual resource for patients, the public and male fertility health professionals. Using the most advanced computer imaging technology, here you will see an animated depiction of how a vasectomy and vasectomy reversal are performed at CMRM.

Center for Male Reproductive Medicine and Vasectomy Reversal

Two-Layer Microsurgical Vasovasostomy

This is Dr. Werthman’s method of choice when it is determined that the patient’s vasal fluid contains live sperm and no blockage or obstruction is present. During this procedure, Dr. Werthman uses a high-powered microscope is to aid in the reconnection of both ends of the vas deferens. An important factor in the success of this procedure is the creation of a “seamless” closure. This is where the expertise of a true microsurgeon is critical. Dr. Werthman prefers a two -layer closure with the meticulous placement of microsurgical sutures along the reconnection site so that a precise, water-tight closure is achieved, allowing sperm to flow unobstructed through the vas deferens. A typical vasovasostomy takes about 1.5 hours to complete and is best performed under general anesthesia although it can be performed with local anesthesia and intravenous sedation for those patients requesting it.

The Mini-Incision Microsurgical Vasoepididymostomy

A technically more demanding procedure than vasovasostomy, this type of procedure is reserved for men who have an epididymal obstruction and is performed when a vasovasostomy won’t work because sperm flow is blocked, or for those who have experienced previous failed attempts at surgical reconstruction of the vas deferens. This procedure attaches the vas deferens directly to the epididymis, above the point where the blockage has occurred. Advances in microsurgical techniques have increased the ease and precision with which a surgeon is able to perform this delicate procedure and in cases that warrant it, Dr. Werthman prefers and has perfected this less-invasive approach, resulting in a faster recovery and less post-operative pain for his patients. A typical vasoepididymostomy takes about two hours to complete and is most often performed under general anesthesia.

About Anesthesia

Dr. Werthman prefers performing vasectomy reversal procedures under general anesthesia for several reasons:

  • From a surgical perspective, microsurgical vasectomy reversals are highly technical procedures that require such precision on the part of the surgeon that the patient needs to remain absolutely still.
  • From a patient comfort perspective, our anesthesiologists are so experienced in administering anesthesia that their techniques allow patients to awaken immediately after the procedure, and without the nausea, grogginess or heavily-sedated feelings some patients can experience at the hands of less-skilled anesthesia specialists. Our patients are typically able to feel better faster, allowing them to go home as soon as possible.

About the Microscope

CMRM is one of only a handful of centers in the nation using the Zeiss OPMI surgical microscope during the performance of vasectomy reversals.

This is the latest technology in microscopic visualization – providing Dr. Werthman with an optical advantage and precision in performing each procedure. While this technology is a considerable financial investment (over $80,000), we believe it is absolutely crucial for the best service to our patients.

Vasectomy Reversal Preparations

Patients undergoing vasectomy reversal should not eat or drink anything after midnight the night before and are asked to arrive one hour before surgery. The surgery itself takes between one and a half to two hours to perform, with patients able to leave about an hour after the procedure is complete. Aspirin and ibuprofen should be discontinued 10 days prior to any procedure as these medications may cause thinning of the blood and can lead to an increased risk of bleeding during or after surgery.

Click Here to View the Post-Op Instructions

Top 5 Vasectomy Reversal Myths and Facts

Myth #1: After a vasectomy, men stop producing sperm.

Fact: No matter how long it has been since a man’s vasectomy, he continues to make sperm unless other factors prevent sperm production. These can include an injury to the testicles, exposure to certain toxins or chemicals and other serious medical problems. Unless one of these situations has occurred, it is not medically necessary or recommended to investigate sperm production prior to a vasectomy reversal.

Myth #2: Vasectomy reversals don’t work on vasectomies that are more than 10 years old.

Fact: This is a common myth that is often told to patients by gynecologists, reproductive endocrinologists and urologists who don’t perform vasectomy reversals. This misinformation is based on very old study data, before significant advances in vasectomy reversal procedures were made. The most recent study to look at vasectomy reversal success rates 15 or more years after a vasectomy (published in the March 2002 edition of Fertility and Sterility) concluded the following pregnancy rates depending on the age of the vasectomy – 15-19 years: 49% success rate; 20-25 years: 39% success rate; 25+ years: 25% success rate. Dr. Werthman holds the record-breaking distinction of helping a man become a father 57 years after his vasectomy.

Myth #3: Even when sperm are present after a vasectomy reversal, anti-sperm antibodies will prevent the female partner from getting pregnant.

Fact: Most men do not have antibodies present on their sperm after they have had a vasectomy reversal and thus, the vast majority of couples do not have problems conceiving after a vasectomy reversal for this reason. While antibodies may cause problems for some patients, it is unusual that they are primarily responsible for most cases of post-vasectomy reversal infertility.

Myth #4: Men shouldn’t undergo vasectomy reversals if their female partner is over 37 years old.

Fact: While it is true that a woman’s fertility begins to decline more rapidly when she is in her thirties, women are able to conceive healthy children well into their forties today. For men who have undergone a vasectomy reversal, the pregnancy rates for their female partners ages 36-40 and 40+ are 32% and 28% respectively. Of the men whom Dr. Werthman has performed a successful vasectomy reversal on, the oldest female partner at the time of conception was 47 and the oldest woman to deliver a baby at the time when the reversal was performed was 44.

Myth #5: In-vitro fertilization is a better option than vasectomy reversal.

Fact: Both vasectomy reversal and in-vitro fertilization (IVF) with sperm harvesting and intracytoplasmic sperm injection (ICSI) generally yield positive results for patients. In fact, the overall delivery rates for babies born as a result of IVF or vasectomy reversal (taking into account all patients and female ages) are almost identical at 40% for IVF and 43% for reversal.

At CMRM in Los Angeles, we think it is important to provide couples with all of their options, allowing them to choose what is best for themselves, their families and unique circumstances.  Many couples who first see female fertility specialists prior to finding us often tell us that they were falsely told by the specialist not to consider a vasectomy reversal because it wouldn’t work.

The female patient is then steered into an IVF cycle based on incorrect information. While there is nothing wrong with choosing IVF as an option to restore fertility, the decision to do so should be made only because each patient/couple had the opportunity to evaluate accurate information and make an informed decision. Dr. Werthman has performed vasectomy reversals on countless men whose wives first went through IVF and failed.

The majority of these couples tell us they would have chosen a vasectomy reversal first if they were given the choice. This isn’t to say that a vasectomy reversal works 100% of the time or that it is a better option than IVF. Simply put, it’s a decision that is best left to the couple considering their options.

There are pros and cons to vasectomy reversal and to IVF. Here are some to consider:

Vasectomy Reversal Pros

  • When successful, vasectomy reversal can lead to natural conception, which is typically a first choice for most couples.
  • Vasectomy reversal is significantly less expensive than IVF. Reversal is roughly one half the price of a single cycle of IVF treatment when all expenses are combined. One study showed that the total costs to deliver a child conceived via IVF were three times higher than those associated with a child born from a vasectomy reversal procedure.

Vasectomy Reversal Cons

  • Some men simply don’t want to have a reversal.
  • Vasectomy reversals aren’t always successful.
  • It can take a fair amount of time to conceive a child naturally after a vasectomy reversal with the average being about 12 months. Many patients report pregnancy much sooner than one year.

IVF Cons

  • IVF is expensive, with most patients requiring more than one cycle in order to conceive.
  • Many women have significant side effects to the hormone injections and medications required for IVF to be successful.
  • Many couples react negatively to having what some refer to as a “test-tube baby,” unless it is their last hope of having a child.
  • There is a very high chance of having multiple births with IVF that can compromise the health of the baby and the mother, complicating pregnancy and classifying it as “high-risk”.

IVF Pros

  • When it works, IVF offers the fastest way to get pregnant in any given month.
  • IVF is an excellent alternative when vasectomy reversal has failed, isn’t surgically possible or there is a female infertility factor as well as male factor problems.
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