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DR. JEAN-PHILIPPE BERCIER BSC, MD, CCFP

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Introduction

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Preparation

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Operation

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Recovery

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1 – Introduction

As vasectomy becomes an increasingly popular means of birth control, the frequency of vasectomy reversal—the recovery of sperm in the semen—is also increasing. Vasovasostomy is an effective and safe procedure that restores sperm to allow ejaculation.

Fifteen per cent of healthy American couples are infertile for a variety of reasons, representing an 85% chance of conception in any healthy couple. After a vasectomy reversal, the chances of pregnancy are less than this 85% figure. The duration of time since the original vasectomy and the technique used to perform said vasectomy are factors that affect the chances of a pregnancy after vasectomy reversal.

The testes can still produce sperm after vasectomy. However, sperm cannot exit as usual, since the vas tubes have been blocked. On each side, sperm can still enter the epididymis—the long-coiled tube behind the testis where sperm normally become mature—and the lowermost portion of the vas tube. Two possible reasons can explain why the fine tubes of the epididymis may become blocked after vasectomy.

In the epididymis, white blood cells in normal testicular circulation ingest and recycle the trapped sperm. This increased white blood cell activity is defined as chronic inflammation. Inflammations can lead to scarring; scarring in a thin tube like the epididymis can cause obstruction. For example, liver inflammation (hepatitis) can cause liver scarring (cirrhosis); joint inflammation (arthritis) can cause scarring with stiffness and decreased range of motion. The longer inflammation lasts , the greater the likelihood of scarring and obstruction that may occur in the epididymis or any other organ.

The epididymis may be obstructed after vasectomy because of upstream pressure from the vasectomy site, causing a “blowout” in the thin tubes of the epididymis and resulting in sperm leakage, local inflammation, and blockage.

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Irrespective of obstruction cause, the likelihood for obstruction is roughly proportional to the number of years that passed since the vasectomy. For instance, after a one- to three-year interval, the epididymis is rarely blocked. However, after a 20-year interval, the likelihood of secondary obstruction may increase to 40%. Fixing the vas where it was divided at the time of the vasectomy (vasovasostomy or VV) will not correct the secondary obstruction upstream in the epididymis. This requires a more elaborate procedure called vasoepididymostomy  (VE), in which the portion of the upper vas tube is connected to the portion of the epididymis.

Vasovasostomy (VV) and vasoepididymostomy (VE) are not the same operation. Because VV reconnects the vas where it was severed at the time of vasectomy, it is considered a true “reverse vasectomy.” VV can often be performed by lifting the vas tubes out of the scrotum through a small incision, just as they were lifted out at the time of the vasectomy. The vasectomy site will be either a gap or a nodule (lump); either way, both ends of the vasectomy site will be freshened and sutured. The left and right sides can usually be repaired in turn through the same ½- to 1-inch vertical incision in the centre of the scrotum, all under local anesthesia in a doctor’s office. With the help of magnification using optical loupes or a microscope, 8–12 sutures are used on each side. The operation takes three to four hours.

VE serves different purposes.

Firstly, since the epididymis is attached to the testes, VE requires delivery of the testes. In other words, the testes must be taken out of the scrotum while the connection between the epididymis and vas is made. This procedure requires a larger incision larger than that of VV.

Secondly, the portion of the vas between the vasectomy site and the epididymis is not used, so the gap that must be bridged is longer. The upper section of the vas must be “mobilized” to provide the required length. To carry out this procedure, surgeons must usually make two incisions on the left and right, which can be extended toward each groin to allow the higher portions of the vas to be dissected and loosened.

Finally, the epididymal tubes are smaller than the vas tubes. A microscope must be used because the connection between the vas and epididymis in VE is often weaker than the connection between vas and vas in VV; the success rate of VE is not as high as the success rate of VV. A VE is more technically demanding than a VV; some surgeons who excel at VVs may not perform VEs as frequently to be comfortable with them.

What group of men need a VE?  It is confirmed that the likelihood of a secondary obstruction in the epididymis is greater when the year interval between vasectomy and reversal is longer. But some men have secondary obstruction after only two years, and some do not have it after 30 years. Wouldn’t it be nice if we could determine with certainty what group of men need a VE before surgery? Unfortunately, we cannot. Physical exams, ultrasound, CT or MRI would not help, either.

But physical exams may provide a few clues.

An enlarged, firm, and tender epididymis is more likely to be obstructed than a small, soft, and non-tender epididymis.

A nodule (lump) at the vasectomy site may be “sperm granuloma,” a place where sperm leaking from the lower end of the severed vas are being recycled. If the inflammation needed to recycle sperm is taking place at the vasectomy site, the inflammation is downstream, thereby sparing the epididymis and reducing inner pressure. That said, a vasectomy site lump has a positive effect. Not all lumps, however, are granulomas. Some of these lumps are simply suture knots or clips used during the vasectomy.

Some surgeons believe that high vasectomy sites—sites away from the testes— are a good sign, as more vas on the testis side absorbs the back pressure.

Operative findings are also useful.  When the vasectomy site is investigated and the lower end is freshened, the fluid that may drain from the lower end is a key clue. If the fluid contains sperm, the likelihood of an upstream obstruction is low and the likelihood of sperm reappearance in the semen after VV is high. In contrast, if the fluid contains no sperm, especially if it is thick or creamy and packed with white blood cells (pus cells), the likelihood of an upstream obstruction is high and the likelihood of sperm reappearance in the semen after VV is low. No fluid at all is a relatively poor sign, and watery fluid, even though devoid of sperm, is a relatively good sign.

To solve the dilemma, there are three approaches to vasectomy reversal.

Surgeons may perform a bilateral VV through a single incision in the office or in a facility, regardless of the lower end fluid findings, because (a) most patients have good lower end fluid findings and do not need a VE; (b) some patients appreciate the return of sperm to the semen to cause a pregnancy even when lower end findings are adverse; and (c) VVs are technically less demanding and more likely to remain open than VEs.

Surgeons may perform all reversals under general anesthesia through two incisions in an operating room with a lab ready to accept sperm for storage. By delivering the testes, surgeons can work with excellent exposure and go right to a VE on one or both sides they feel would be better served with VE to increase fertility.

Despite these first two approaches, problems arise.

In the case of the first approach, the procedure fails when epididymal obstruction is observed on both sides (on average, this occurs about 17% of the time) and the full-fee patient procedure has not yielded any benefits. If patients choose to undergo a subsequent VE, the VV would have caused some scarring and loss of upper end length during the trimming and suturing process, making the subsequent VE more challenging. The chances of success are less.

With respect to the second approach, all patients pay the operating room and anesthesia costs even though most patients would have achieved success in an office environment. When even the most liberal criteria for performing a VE instead of VV are used, per a recent study, 75% of men in an operating room had a VV on both sides, while 8% had a VV on only one side. Since similarities between VV techniques used in the office and operating room are noticeable, the patients in this study may have enjoyed a return of sperm to the semen at a lower cost—a major consideration for an operation that is not covered by most insurance carriers.

The second approach has yet another problem: after the larger bilateral incisions, patient recovery may be longer than a single smaller incision. These patients may require more recovery time before returning to work. But because scrotal wounds heal quickly, recovery should not be a major obstacle.

The final approach addresses the problems in the first and second approaches. The solution? Patients undergo their procedure in the office.

This step explores one vas on the testis side of the vasectomy site with a small midline incision. This lower end is opened; the fluid, evaluated. If findings are favourable, VV is carried out. If findings are unfavorable because of an absence of fluid or thick fluid with no sperm, no connection is made; the patient is charged an exploration fee lower than a VV fee. The upper end is left unharmed and scarring is minimal. The patient can undergo a VE and sperm harvesting in an operating room at a later date. If the lower end fluid findings are equivocal (watery or thin fluid but no sperm), the patient and doctor can decide whether to proceed with VV The same step is repeated on the other side. Regardless of the interval between vasectomy and reversal, most patients will have favourable findings on both sides, will have a VV on both sides, and will experience a return of sperm to the semen.

The third approach is the most sensible for men whose intervals are short (less than 10 years) and physical findings are favourable. Why spend thousands of dollars on operating room and anesthesia costs when the likelihood of success with an office procedure is great? The second approach may be reasonable when the interval is longer.

Success rates

American vasectomy reversal success statistics are readily available. The most cited article is the report from the Vasovasostomy Study Group that appeared in the Journal of Urology in March 1991 (J Urol 145:505-511, March 1991).  Our technical success rates compare favourably with these statistics.

The single most important parameter determining success is the number of years since vasectomy. Within the first three years, we have seen reversal results in sperm recovery in over 97% of cases; three to eight years, about 91%; 9 to 14 years, about 82%; beyond 14 years, about 69%. Overall, this percentage sits at 85% when we consider all patients who seek vasectomy reversal.

In addition, no standards for reporting pregnancy rates are set. Some offices will report a pregnancy failure in a couple only if pregnancy has not occurred within two years of the reversal.

In our office, however, we report a pregnancy failure within one year.  Pregnancy rates will “look” even better for those offices that do not include couples as pregnancy failures until three years after the reversal, and so on.

Payment

Insurance companies do not generally cover vasectomy reversal. Consult your insurance company to find out if your vasectomy reversal will be covered.

Dr. Bercier will not charge fees for the initial consultation if we receive a doctor’s referral and it takes place in Ottawa or Hawkesbury. In this consultation, Dr. Bercier meets with and examines the patient, provides further details, and answers any questions. A ten business days period is required to cancel or postpone the consultation.  Otherwise, a $80 fee will be charged to your credit card.

The vasovasostomy procedure costs $5,000, including all follow-up visits. Since an entire day is dedicated to one procedure, a $1,000 deposit is required seven days prior to the procedure. The remaining balance is due on the day of the procedure.

Why does your procedure cost less than other local reversal clinics?

Since vasectomy reversal is performed in the office, facility fees are not charged. And, because vasectomy is done with local anesthesia, patients need not pay anesthesiologist or nurse anesthetist fees.

READ OUR REVIEWS

Colin LumsdenColin Lumsden
20:45 21 Mar 24
Great experience, on time, ready, clear and the receptionist was outstanding. The "blue balls" upon exit was a great touch to add an element of fun to the experience. Highly recommend Dr. Bercier and team!
Corey LecoursCorey Lecours
19:53 21 Mar 24
Great care from the staff
vinetusvinetus
19:38 21 Mar 24
terry luterry lu
23:50 20 Mar 24
I would highly recommend Dr Bercier. They are very well organized there and I was in and out in 15 to 20 mins.
Kevin AmesburyKevin Amesbury
20:20 20 Mar 24
Great service, quick turnaround and excellent communication. I recommend this clinic to everyone I know. Truly a cut above the rest!
Dave TurnbullDave Turnbull
21:26 07 Mar 24
Fast, efficient, business friendly, professional, and painless. Great work. Just follow their instructions regarding before and after procedure and all will be fine. That's how I see it.
Chris ClairmontChris Clairmont
21:50 06 Mar 24
I was very hesitant to book and honestly a little frightened. Upon showing up it was very thorough , very fast and felt absolutely nothing . Leave your pride at the door , and get it on the way out . I had over thought the process , and it was really done before I knew it .I did feel the after care amount of 170$ was quite steep as I feel most of which should be covered under ohip , 50$ for the glue he used? , 12$ for 2 condoms ? Was made mandatory to pay before but on the after care sheet was stated as an option .all in all , I am happy it’s done . And anyone looking to book , know it was a real easy , painless procedure .
Francois DubeFrancois Dube
21:05 06 Mar 24
My appointment was at 10:20, I got there a 10 and at 10:22 I was in my car riding back home. Professional, quick and effective procedure. Did not feel a thing while the doc was performing the vasectomy. 100% recommend this place.
Create , incredible... Make easy service ! The Doctor was relax and very professional! The attitude and the overall atmosphere was very noice and casual
Andre ComtoisAndre Comtois
16:37 06 Feb 24
This clinic is great. They've really perfected the craft. In and out, takes longer to sign in than it does to get the procedure done. Procedure was painless. And I left with no risidual pain either. A big thank you to Dr. Bercier and his team.Note - As part of your mental prep for this procedure, make sure you know what music you want to have playing while it happens. Or else you may end up hearing The Dixie Chicks when you really don't want to hear them.
The best!!!! If I could do the operation again, I would do it again without hesitation! Dr Bercier is the doctor of the situation, my Doctor, our Doctor quite simply! In addition, its painless technique is positioned from afar, in the allegorical floats, in front of the parade, whatever. 🙌🙌🙌🙌Dr Bercier, THANK YOU
My vasectomy with Dr. Dumais went very well. I was worried, but she told me to settle down and not to worry. Well, without other options, I settle into my greatest vulnerability. No discomfort or pain felt. According to some reviews, the post-op kit contains unnecessary items. This is not the case. I try to add a photo of the work, but it doesn’t work :/ Thank you Dre Dumais
Vasovasostomy by Dr. Bercier. Efficient, professional and dedicated. Strongly recommended!
Mike VetteseMike Vettese
02:13 12 Oct 23
The staff and Dr Bercier have created a very calm experience. In and on within 15 mins and the actual procedure was seriously 2 mins. Best in the biz!
Maxx LMaxx L
00:12 06 Oct 23
Amazing. In and out in 20 minutes. Healing is going very well. Hardly feel a thing. In all honesty it's pretty nice to get a few days just to relax. Keep it up!
Rob CarterRob Carter
21:19 02 Aug 23
Had my vasectomy performed by Dr Dumais, who has taken over for Dr Weiss who has since retired. She was absolutely excellent. Great bedside manner, clear explanations of what was happening and any potential discomfort that might be felt during each step. Entire procedure from freezing to finish took under 10 minutes.Before beginning Dr Bercier confirmed my age (31), that I had no children, and that I was 100% certain I never wanted to have any (and that my partner felt the same way). She reiterated that while surgical reversal is sometimes possible, the procedure should be considered permanent.Nurses/office staff were friendly and efficient. Got up from the table a bit too quick and ended up sitting down in the chair and fainting. They were right on top of things and immediately went into their usual routine for when those things happen. We had a little chuckle about it, and at no point did it feel weird or judgemental which I very much appreciated.A couple of other notes based on some things mentioned in a few other reviews here:- Total out of pocket fees are $170, consisting of a $20 deposit and $150 on the day of the procedure. Those costs are detailed in the attached photo of the “Pre and Post Vasectomy Kit”. As detailed on the page patients can choose to pay only for the specific items/services they want, and they also give you a week post-procedure to request a refund and pay only for the needed items. This information is not provided anywhere before going in, so most will just pay the $170 and be done with it. While some of these costs are certainly quite highly inflated, they do help make up for the fairly minimal compensation the clinic receives from OHIP for each procedure.- Website is a bit of a mess, although most of the important bits are easy to find (and all the most important info is attached to the emails you’ll get). Specifically one thing they have changed is that you do *not* need to travel to the office to pick up your vasectomy package before the procedure! You are given it after your appointment just before leaving.- To the few complaining about pain/discomfort lasting more than the first week and “not being made aware of the risks”… did you not bother to fully read through the documentation available both on the website as well as repeatedly sent to you in the emails? All of the risks and rates of various complications are explicitly laid out in advance. Every body is different, and there is a small chance of a variety of complications. Choosing to ignore the provided information and then complaining that you wouldn’t have gone through with it if you knew is just ridiculous.One last recommendation for the doctors here: I highly recommend investing the few thousand dollars towards having a professional web design company re-build you a new website from the ground up. The current site is a mess, particularly on modern phones, and this is something that will radically improve the patient experience.Edit 2023/10/24: Wow, the new website is looking great!
Gaignun KukaiGaignun Kukai
03:43 18 Jul 23
Dr. Valerie Dumois did my vasectomy, and she was really quite kind willing to answer questions. It was for the most part painless and the pain you feel is minimal. Reception was also pretty great they answered all my questions to male sire I heal properly. Was great meeting them all and doing it the modern way or a scalpel and needle is definitely in every males favour. Thank you so much for being such great people
Garlic Jr.Garlic Jr.
18:19 06 Jul 23
Half an hour to my appointment they told me to wait outside(35 degrees celcius) until exactly my appointment. Dr. Bercier if you can call him a doctor had the most rude and disrespectful attitude I've had from a doctor. I asked him three questions to which he said he didn't care. During the procedure I simply asked how long does it take and he replied with "How long do you think it takes? Did you see me with the other patients?" I think his attitude was racially motivated because I'm not French. Don't come here! Go somewhere else!
BongoBongo
19:58 19 Jun 23
Great clinic, 5 stars all around. Leading up to the appointment they provide you with fantastic information that explains everything in detail. Great communication, super organized, friendly and professional. Everyone from reception, to the nurse, to the doctor - all were pleasant, efficient, and professional. It was a huge piece of mind. The doctor played my choice of music during the procedure. It was practically painless, with only minor discomfort for a brief moment, and it was quick. I am now recovering comfortably with very detailed instructions about how to enhance my recovery. Thank you Dr. Weiss and Dr. Bercier! Highly recommend.
Louis KearnsLouis Kearns
16:14 28 Apr 23
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