A Second Chance: Vasectomy Reversals

They’re expensive and complicated, but vasectomy reversals may be worth it for men who want a second lease on fatherhood.

Medically Reviewed by Louise Chang, MD on June 13, 2007
From the WebMD Archives

For most men who get a vasectomy, the thought of a needing a vasectomy reversal later is the last thing on their mind. Gene McCroskey was just 23 when he had his vasectomy. He had already fathered a boy and a girl, timed just as he wanted. “His wife had endured two difficult pregnancies. Why, he figured, would he want additional children?

Thirty years later, it was time for a new fairy tale. McCroskey had divorced the mother of his children and met a new woman who wanted children of her own. McCroskey decided to try to get his vasectomy reversed. But “the doctors in Phoenix wanted $8,000 to $12,000 for the operation,” McCroskey’s current wife, Michelle, tells WebMD. “And when they found out he was over 20 years out [from his vasectomy], they didn’t even want to try.”

A Tucson-based urologist, Sheldon Marks, MD, took on McCroskey’s case. Today, McCroskey is the proud, 62-year-old father of Jessica, 8, and Kaitlin, 9. “It’s really exciting to see them discover things and figure things out,” he says. Marks is a partner at the International Center for Vasectomy Reversal and also a urology expert on WebMD.

Vasectomies are commonly considered a permanent form of birth control. Reversals are expensive and complicated surgical procedures, and success is not guaranteed. But many doctors report very high success rates from vasectomy reversals. And specialists in the procedure reject the notion -- widely held even in the medical community -- that the procedure is rarely successful in men who had their vasectomy more than 10 years earlier.

“If you don’t think you have a chance at a reversal, you do,” says Rick Bellah, whose vasectomy was reversed by Marks a whopping 42 years after the original procedure. Bellah and his wife, Eloi, now have a 3-year-old girl, who has a 50-year-old half-sibling.

A Big Decision

Of the half-million men who have a vasectomy each year, an estimated 2% to 6% later decide to have a vasectomy reversal, according to Cleveland Clinic. A common situation involves a divorced man whose new wife has never had children, says Ira D. Sharlip, MD, a urologist at the University of California, San Francisco, and a spokesman for the American Urology Association.

A vasectomy prevents the release of sperm when a man ejaculates. During a vasectomy, the vas deferens -- the tube that carries sperm from the testicle -- is cut or clamped. After a vasectomy, the man still ejaculates, but the semen contains no sperm. In a vasectomy reversal, the vas deferens is sewn back together or attached directly to the testicle so sperm can once again enter the semen.

Vasectomies are relatively simple procedures that are nearly 100% effective. By contrast, a vasectomy reversal requires use of surgical microscopes and microscopic sutures. And vasectomy reversals usually aren’t covered by insurance. The cost can vary strongly depending on the surgeon, but Marks estimates that it ranges between $8,000 and $20,000.

Before conducting the procedure, Marks consults with the man’s female partner to try to increase the chances that she is fertile. If the woman is over 35 or has menstrual irregularities, he suggests that she visit a reproductive endocrinologist to investigate fertility issues. “There’s nothing worse than investing financially and emotionally [in a reversal] and finding out that there’s no way the female partner can conceive,” Marks tells WebMD.

In Marks’s surgical suite, the reversal procedure typically takes about three hours. McCroskey remembers making jokes throughout the procedure as he felt the effects of laughing gas. The aftermath was somewhat more painful -- McCroskey’s privates were packed in ice for much of the time. “I remember thinking, vasectomy’s got nothing on this,” he says.

A Tale of 2 Procedures

The success rate of vasectomy reversals is generally related to the length of time that has elapsed since the vasectomy performed. That’s because men who had vasectomies a long time ago are more likely to require a more complex and challenging form of reversal procedure.

In the most common form of reversal, the surgeon simply sews together the severed ends of the vas deferens. But in some cases, blockages have formed in the vas deferens or the tube between the vas and the testicle, known as the epididymis. In that case, the vas deferens must be directly connected to the epididymis. This procedure is known as a vasoepididymostomy, or “VE.”

The chances that a blockage has formed -- and that a VE is necessary -- increase with time. Craig Niederberger, MD, chief of urology at the University of Illinois at Chicago, estimates (based on existing studies) that the chances of needing a VE in both vas deferens tubes increase to 20% for a patient who had a vasectomy more than a decade ago.

And the success rate of a VE is lower. Niederberger, for example, reports that more than 90% of patients in his clinic who undergo ordinary reversals succeed in producing sperm. By contrast, 71% of his VE patients succeed in producing sperm.

But success in producing sperm does not guarantee that a man will get his partner pregnant. The pregnancy rate for Niederberger’s patients, for example, is about two-thirds for patients undergoing ordinary reversals and about 50% for VE patients. This is most often due to fertility problems in the woman, Niederberger says.

Unfortunately, there’s no way of knowing until a patient is on the operating table whether he will need a simple reversal or the more complex VE. That’s why many urologists say it’s important to find a doctor who has a lot of experience in vasectomy reversals.

Taking the Plunge

“Every single urologist” has been trained to perform vasectomy reversals, contends Marks. “But this is a very delicate, technically complex surgery that requires constant practice to get the optimal result. If you’re only doing it a few times, there’s no way you’ll be able to get the same results as full-time doctors.”

Marks suggests that patients seek out a reversal specialist. He contends that some general urologists who merely dabble in reversals may be unwilling or unable to perform the more complicated VE procedure.

But it’s not enough to know that a surgeon has performed a lot of reversals, Sharlip cautions. You should also gauge the surgeon’s reputation among nurses, gynecologists, or fertility specialists who know him or her. Your rapport with the surgeon is another factor to consider, Sharlip says.

A vasectomy reversal isn’t always the best way for men who have had vasectomies to father a child. For couples in which the female partner is older or has fertility problems, in vitro fertilization is another option.

The bottom line, urologists say, is that most men who have had vasectomies have a good chance at becoming fathers again. And for many of these men, a new shot at fatherhood is like discovering a fountain of youth.

“It’s amazing to have these miniature versions of yourself and to watch them grow,” says Luther Armstrong, 51, who fathered two more children after getting his reversal nine years ago. “It brings a smile to your face.”

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SOURCES: Sheldon Marks, MD, International Center for Vasectomy Reversal, Tucson, Ariz. Craig Niederberger, MD, FACS, director of urology, University of Illinois, Chicago. Ira D. Sharlip, MD, clinical professor of urology, University of California, San Francisco. Rick Bellah, Kona, Hawaii. Luther Armstrong, Redlands, Calif. Gene McCroskey, Phoenix. Michelle McCroskey, Phoenix.

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