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TREATMENTS AND SURGERIES

Vasovasostomy (Vasectomy Reversal)

Vasovasostomy (vasectomy reversal) by micro-incision under a high resolution microscope

Approximately 2% to 6% of men who’ve had a vasectomy eventually wish to regain their fertility. Although a vasectomy has long been considered an irreversible form of contraception, this is no longer the case.

If a man wishes to have children with his partner following a vasectomy, he has two options:

  • A vasovasostomy (vasectomy reversal)
  • Testicular sperm extraction in conjunction with intracytoplasmic sperm injection

Generally, a vasectomy reversal is the preferred option. Unlike artificial fertilization techniques, it has a high success rate and carries a low risk of complications.

The wait time for a vasovasostomy procedure at Dr. Marois’ clinics is generally a few weeks, depending on the day of the week the patient schedules the appointment.

Prior to the vasectomy reversal, an initial consultation at which both partners are present is conducted.

The procedure itself is performed at a second appointment.

Please note that vasovasostomies are done in an unaffiliated private clinic and can’t be reimbursed through the Regie de l’assurance maladie du Québec (RAMQ).

Please note that vasovasostomies are performed exclusively in a non-participating private clinic to the RAMQ. They are not reimbursable by the RAMQ.

Is a vasectomy reversible?
The desired outcome of a vasectomy is to prevent sperm from passing through the vas deferens, which are ducts in the testicles that carry the sperm to the ejaculatory ducts. During the procedure, each duct is cut and tied. As a result, the ejaculate no longer contains any sperm and the unused sperm gradually degenerate and die away. A vasectomy reversal procedure is relatively simple, quick and carries a low risk of complications.

During a vasovasostomy the severed segments of the vas deferens are reconnected. Sometimes, the procedure is not possible for anatomical reasons. In such cases, the vas deferens can instead be connected directly to the epididymis (a tube at the back of the testicles that stores the sperm produced by the testicles). This operation is called a vasoepididymostomy and is more technically complex than a vasovasostomy.
What’s the success rate for a standard vasectomy reversal?
  • It’s important to understand that a vasectomy is meant to be irreversible, so there’s no guarantee that a patient’s vasectomy reversal will be successful. In fact, it’s largely a matter of chance.

  • Various factors influence the probability of achieving a pregnancy after a vasectomy reversal. One of the most important factors is the reproductive potential of the man’s partner. Woman under 30 are generally more fertile than older women. Among couples trying to have a baby following a vasectomy reversal, pregnancy occurs 14% of the time when the woman is over 40, 56% of the time when the woman is aged 25 to 39 and 67% of the time when the woman is aged 20 to 24.

  • The most important factor for men is the time between the vasectomy and the vasectomy reversal.

  • The success rate is based on the patency rate. This refers to the percentage of men who have sperm in their ejaculate following the procedure. The patency rate after a vasectomy reversal is about 75% to 85%.

  • If complications from the vasectomy resulted in a significant amount of scar tissue, it can reduce the chances of the vasectomy reversal succeeding. Trauma or infection of the scrotum can also reduce the success rate.

  • In some cases, the patient isn’t able to produce sperm following the surgery. Alternatively, he may produce what are known as antisperm antibodies, which can make it harder for a couple to have a baby.

  • Note, also, that a vasoepididymostomy has a much lower success rate than a vasovasostomy (around 30% to 45%).

  • Finally, the surgeon’s degree of experience is essential to the success of the operation : this directly relates to the number of vasovasostomies a surgeon performs per year.
What are the chances of pregnancy after a vasectomy reversal?
According to statistics from the American Society of Reproductive Medicine, the chances of having a baby after a vasovasostomy are very favourable when the operation is done within three years following the vasectomy. The patency rate is 95% and the pregnancy success rate is 75%.

When the interval between the procedures surpasses 15 years, the patency rate is 70% and the pregnancy success rate is 30%. This lower success rate is primarily due to the fact that, as time passes, the narrow, coiled tube of the epididymis becomes increasingly at risk of incurring damage. This damage is mainly the result of pressure resulting from the constant buildup of fluids and sperm produced in the testes. Although this doesn’t always cause visible damage, scar tissue may form at the site of the epididymal rupture and present an additional obstacle in the path of the sperm.

Another statistic from a study in the Canadian Urological Association Journal (November 2007, Vol. 1, No. 4, pp. 388-393) evaluating the success factors for a vasovasostomy clearly demonstrated a progressive decrease in the patency rate and the pregnancy success rate relative to the interval of time between the vasectomy and the vasovasostomy.
Does the age of the patient influence the success rate of the vasectomy reversal?
The age of the patient has little bearing on the success rate of the vasectomy reversal. Conversely, the age and reproductive potential of his partner has a major impact on whether or not the procedure results in pregnancy.
What are the possible complications after a vasectomy reversal?
- Minor risk of an infection requiring antibiotic treatment
- Edema (swelling)
- Ecchymosis (bruised scrotum)
- Minor risk of hematoma (accumulation of blood in scrotum)
- Scrotal pain
- Minor risk of spermatocele (cyst in the epididymis)
- Secondary obstruction (stenosis), resulting in azoospermia

There is no influence on the patient’s sexuality.
How long does it take for a couple to achieve pregnancy following a vasectomy reversal?
On average, it takes 12 months for the patient’s partner to become pregnant following the vasectomy reversal. However, couples in their twenties may be able to achieve pregnancy within a few months. In some cases, it can take up to two years for the patient to regain fertility.

However, it’s important to note that it may be more difficult to get a partner pregnant after a vasovasostomy than it was in the time prior to the vasectomy. Specifically, this is the case when (a) fibrosis in the vas deferens or epididymis is extensive, (b) the quality of patient’s sperm has degraded, or (c) antisperm antibodies are present in the patient’s ejaculate. As a general rule, a man’s reproductive potential after a vasovasostomy is weaker than it was prior to the vasectomy.
What can you do to improve semen quality after a vasectomy reversal?
First and foremost, maintain a healthy lifestyle. Obesity is damaging to the overall health of men and women alike. In addition, alcohol abuse, inadequate nutrition and smoking can all have harmful effects on sperm production. Keep in mind that dieting and refraining from drinking and smoking is easier to achieve when one's partner adopts the same resolutions.

Try to steer clear of medications that can degrade semen quality, such as H1 antagonists (used as treatment for gastric ulcers, among other conditions), antibiotics of the macrolide and nitrofuran family, anti-epileptics (valproate), anti-retrovirals (Salazopyrin), anabolic steroids, ketoconazole (Nizoral) and colchicine. Furthermore, most testosterone supplements should be given a miss.

If possible, you should also avoid periods of abstinence. Numerous studies indicate that the sperm become less fertile when the man has not engaged in sex for more than three days.

Another thing to remember is to not allow the testicles to have repeated and prolonged exposure to high temperatures. Testicles are meant to have a temperature of around 35°C; higher temperatures can degrade semen quality. This fact is especially relevant to cooks, bakers, metalworkers, truck drivers and other individuals whose work exposes them to heat. Note also that a high fever can cause a significant and prolonged drop in sperm production (for about two to three months).

Avoid hot baths, tight-fitting underwear and pants, and placing your computer on your lap.

Don’t expose the perineum or testicles to microtrauma: avoid activities such as mountain biking, ATV riding and horseback riding.

Consider taking multivitamins. Certain products have been shown to increase the reproductive potential of men with abnormal sperm. Products with antioxidant properties, such as vitamin C, vitamin E, zinc, selenium and folic acid can improve semen quality. Taking a vitamin supplement that includes all these ingredients is generally a good idea.

One good option is PROfortil™, a multivitamin containing18 vitamins and minerals that work together to improve semen quality. It’s frequently used in fertility clinics. Moreover, five European studies have demonstrated its benefits. Notably, in a controlled study of 205 patients, it was shown to produce benefits across all the major parameters of semen quality: ejaculate volume, sperm count, motility and morphology. Furthermore, after only three months of taking PROfortil™, 26% of men got their partner pregnant. This drug can only be obtained online — for example, through the Canadian website, conceptionplus.ca.

In addition, there are medications that improve semen quality. Clomid (whose generic name is clomiphene citrate) is the most commonly used fertility drug among women; however, it also stimulates sperm production in men with low sperm motility, low sperm count and overall poor semen quality. Specifically, clomid blocks the effect of estrogen on the pituitary gland, resulting in an increase in levels of follicle stimulating hormone (FSH) and luteinizing hormone (LH). Higher levels of these hormones increase testosterone production, which, in turn, can increase sperm count and overall semen quality. Clomid comes in tablet form and the patient takes it orally every day, generally with an initial dose of 25 mg, or half of a 50 mg tablet.

Dr. Marois closely monitors his patients’ hormone levels to ensure that they remain within the ideal target range, as too much testosterone can decrease sperm count. It can take three to six months before sperm production is improved. Sperm analysis tests are necessary during this period. Once sperm production reaches normal levels, the treatment can be suspended.
What anesthetic is used during a vasectomy reversal?
  • In a hospital setting, surgery is often done under general or spinal anesthesia, as the patient must be motionless during the operation.

  • In Dr. Marois’ clinics, the procedure is performed using a local anesthetic, namely, a bilateral spermatic cord block. This is similar to the anesthetic used for vasectomies, but more effective. It’s administered with an injector that distributes the high-pressure anesthetic liquid through the skin. The patient feels a pinching sensation, similar to being struck by an elastic band. Thanks to the anesthetic, the tiny injection to the skin and subcutaneous tissue in the scrotum isn’t felt during the vasovasostomy.

  • The anesthetic only affects the area around the injection.

  • For a more effective anesthesia and more comfortable vasectomy reversal, a spermatic cord block is administered on both the left and right side. This eliminates pain inside the scrotum. We wait 12 minutes before beginning the procedure. This is the moment when the anesthetic is at its most effective.
What can patients expect to happen during a vasovasostomy?
  • For optimal comfort, the patient is laid on his back on a gel mattress. A protective screen is placed below his head to shield his view and make the operation less stressful for him. Sterile sheets are placed on the patient and on the surgical microscope.

  • Two incisions are made in the scrotum, on either side. The vas deferens is accessed with an incision of several millimetres (similar to the Chinese technique used for the vasectomy). This exposes the two ends of the vas deferens and allows their reattachment. The scar tissue on both ends of the vas deferens is removed. The surgeon proceeds with the operation if the vas deferens is in sufficiently good condition to allow satisfactory sperm flow.

  • Next, the permeability of the epididymis is verified by extracting a liquid sample and examining it under a microscope.

  • Sometimes, the vas deferens is too scarred to allow adequate sperm flow. In such circumstances, a vasoepididymostomy is required in place of the vasovasostomy.

  • The vasectomy reversal is performed with a high-resolution surgical microscope.

  • Each vas deferens is stitched together with fine sutures, hardly visible to the naked eye. Due to its complexity, the procedure can take up to one hour per side (or two to two-and-a-half hours in total).
How much does a vasectomy reversal cost?
Note that this surgery requires an initial consultation. The fee for this appointment isn’t included in the price of the procedure itself.

After the consultation, a surgery can be scheduled for some time within the next two weeks.

All vasectomy reversal surgeries are performed at our Montreal clinic.

The fee for a bilateral vasovasostomy is $4,420. This a two-and-a-half-hour surgery that takes place in a minor surgery room, with the assistance of one or two nurses. It’s a microsurgery that uses very small sutures and is carried out using a high-precision surgical microscope. Local anesthesia is administered using a bilateral spermatic block.

Included in the price of the procedure are a telephone follow-up appointment conducted by a nurse and all needed post-operative visits (for the two months following the surgery) in the event of complications. Also included are updates with a nurse regarding the semen analysis, one at three months and one at six months after the operation.

Contact us for more information or to schedule an adult circumcision at a private clinic in Montreal, Laval, on the South Shore or in Quebec City.

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Dr. Marois is a urologist who is not a member of the Régie d’Assurance Maladie du Québec (RAMQ). As such, the clinic can not claim the RAMQ for the payment of his services. If you consult Dr Marois, you must pay for the services rendered.

Cancellation of appointment:

To ensure the smooth running of the clinic and a minimum of courtesy towards other patients and our staff, we ask you to notify us 48 hours in advance for the cancellation of a consultation, 5 working days in advance for a surgery at the office and 21 working days in advance for a major surgery. If these deadlines are not respected, a cancellation fee of 50% of the service will be charged.

Change of appointment:

We understand that events occur, so we ask you to provide us with at least a 24-hour notice for any change in their appointment; we will be happy to accommodate you, the best we can. However, if you fail to inform us within this timeframe or do not show up, we will charge a $ 100 fee.

Thank you for your understanding.

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