Restore Your Path to Parenthood With a Vasectomy Reversal at The Bercier Clinic
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.
Consultation
What is a vasectomy reversal?
A vasectomy reversal is a microsurgical procedure that reconnects the vas deferens, the small tubes that carry sperm from the testicles.
After a vasectomy, the testicles continue to produce sperm, but sperm can no longer travel through the vas deferens and enter the semen. A vasectomy reversal aims to restore this pathway and allow sperm to return to the semen, creating the possibility of a natural pregnancy.
Vasovasostomy (VV) and vasoepididymostomy (VE)
There are two main types of vasectomy reversal.
A vasovasostomy (VV) reconnects the two ends of the vas deferens at the site of the previous vasectomy. This is the procedure performed by Dr. Bercier.
A vasoepididymostomy (VE) is a more complex microsurgical operation that connects the vas deferens directly to the epididymis, a very small and delicate structure located behind the testicle. A VE may be required when a secondary blockage has developed in the epididymis.
Compared with a vasovasostomy, a VE is a more technically complex and extensive procedure. It is most commonly performed in a hospital operating room under general anesthesia, requires larger surgical exposure, and generally takes longer to complete. Because it is a more extensive operation and usually requires general anesthesia, there is also a greater potential for surgical and anesthetic complications, and recovery may be longer.
The likelihood of a secondary blockage generally increases with the number of years since the vasectomy. As a practical estimate, the risk of having a blockage on both sides increases by approximately 2% for every year following vasectomy. For example, a man whose vasectomy was performed 5 years ago may have approximately a 10% chance of requiring a bilateral VE, while this likelihood may be approximately 20% after 10 years and 40% after 20 years.
These percentages are estimates and cannot predict the findings in an individual patient. Some men develop an epididymal obstruction only a few years after vasectomy, while others may have no obstruction decades later.
Unfortunately, no physical examination, ultrasound, CT scan, or MRI can determine with certainty before surgery whether a VE will be required.
A true microsurgical technique
Dr. Bercier performs vasovasostomy using a high-magnification surgical operating microscope specifically designed for microsurgery.
Under the microscope, the very small opening of the vas deferens and its individual tissue layers can be clearly visualized. The vas is then meticulously reconstructed using extremely fine microsurgical sutures in multiple layers.
This high level of magnification and precision allows the same fundamental microsurgical principles used in an operating-room setting to be applied to the reconstruction of the vas deferens.
The procedure is performed under local anesthesia and takes approximately two hours on average.
How do we know if a vasovasostomy can be performed?
During surgery, the vas deferens is examined at the site of the previous vasectomy. The fluid coming from the testicular end of the vas is carefully evaluated under magnification for the presence of sperm cells or sperm parts.
Finding sperm is a very favourable sign. In our practice, when sperm cells are identified during surgery and a microsurgical vasovasostomy is performed, sperm returns to the semen in more than 95% of patients.
When no sperm cells or sperm parts are identified at all, the situation is much less predictable. This finding may indicate a secondary blockage in the epididymis, in which case a vasoepididymostomy may provide a better chance of success.
Published studies have reported sperm return rates as high as approximately 60% following vasovasostomy even when no sperm or sperm parts were identified during surgery. In our own practice, however, the sperm return rate in this specific situation has been approximately 5%.
Because the procedure is performed under local anesthesia, the patient is awake and able to communicate with Dr. Bercier during the surgery. If no sperm cells or sperm parts are identified, the findings and their implications are explained to the patient at that time.
The patient can then decide whether to proceed with the vasovasostomy despite the lower and less predictable chance of success, or to stop the procedure and consider a vasoepididymostomy performed in a hospital operating room at a later date.
If the patient chooses not to proceed with the vasovasostomy, the total procedure fee is reduced by $1,000 for each side that is not reconstructed.
This approach allows the decision to be individualized based on the actual surgical findings, the patient’s preferences, and the likelihood of a successful reconstruction.
Our success rates and how they compare with published studies
The success of a vasectomy reversal can be measured in two different ways: the return of sperm to the semen, known as the patency rate, and the achievement of a pregnancy. These are not the same outcome.
Our clinical results compare favourably with those reported in some of the largest and most frequently cited studies of microsurgical vasectomy reversal.
The landmark Vasovasostomy Study Group evaluated 1,469 microsurgical vasectomy reversals. When the vasectomy had been performed less than three years earlier, sperm returned to the semen in 97% of patients and 76% of couples achieved a pregnancy. For vasectomies performed three to eight years earlier, the reported rates were 88% for sperm return and 53% for pregnancy.
Reviews and more recent clinical studies that include patients with varying intervals since vasectomy and a mixture of vasovasostomy and vasoepididymostomy procedures generally report overall sperm-return rates of approximately 85% to 90% and pregnancy rates of approximately 45% to 50%.
In our practice, when sperm cells are identified during surgery and a microsurgical vasovasostomy is performed, our overall rate of sperm returning to the semen is greater than 95%.
Our pregnancy results within the first year following surgery are:
- 70% when the vasectomy was performed within the previous five years
- 87.5% when the vasectomy was performed within the previous five years and there are no known female fertility issues
- 40% when the vasectomy was performed between five and ten years earlier
These results compare favourably with the larger published studies.
It is important to understand that the return of sperm to the semen does not guarantee pregnancy. Pregnancy rates are influenced by the age and fertility of both partners, the number of years since vasectomy, the type of reconstruction required, the duration of follow-up, and the use of subsequent fertility treatments.
Our pregnancy rates reflect pregnancies documented within one year of the reversal. The eventual pregnancy rate may therefore be higher if couples are followed for longer, as some couples may naturally conceive more than one year after surgery. Pregnancy rates may also be influenced by subsequent fertility treatments.
Individual results vary, and pregnancy cannot be guaranteed. These factors will be discussed during your consultation.
Risks and complications
As with any surgical procedure, complications are possible, although serious complications are uncommon.
Potential complications include infection, bleeding or scrotal hematoma, and persistent scrotal discomfort or pain.
Dr. Bercier will review the risks of the procedure with you and answer your questions before surgery.
Consultation and payment
Vasectomy reversal is generally not covered by provincial health insurance or private insurance plans. Patients are encouraged to contact their insurance provider if they have questions about possible coverage.
There is no fee for the initial consultation with Dr. Bercier when a physician’s referral is received and the consultation takes place in Ottawa or Hawkesbury.
If the consultation takes place at one of our private clinics in Montreal or Gatineau, or if no physician’s referral is provided, the consultation fee is $300.
During the consultation, Dr. Bercier will review your medical and vasectomy history, perform an examination, discuss your likelihood of success, explain the procedure, and answer your questions.
The cost of a vasovasostomy ranges from $6,000 to $7,500, including follow-up visits when required. The fee is based on the desired booking timeframe:
- $6,000 – Regular booking: the usual waiting time is approximately 6 to 8 months.
- $7,500 – Earlier booking: the procedure can generally be scheduled within a few weeks to 4 months.
Because an entire half-day is reserved for each vasectomy reversal, a $2,000 deposit is required to secure the surgery date.
The deposit is refundable if the procedure is cancelled or the surgery date is changed more than four weeks before the scheduled procedure. If a cancellation or modification is made within four weeks of the surgery, the deposit is non-refundable.
The remaining balance is due on the day of surgery.
If, during the procedure, no sperm cells or sperm parts are identified and the patient chooses not to proceed with the vasovasostomy, the total procedure fee is reduced by $1,000 for each side that is not reconstructed.
Why is the cost lower than at some other vasectomy reversal clinics?
Dr. Bercier performs microsurgical vasovasostomy in a specialized office setting under local anesthesia.
The procedure is performed using a high-magnification surgical operating microscope and microsurgical technique. However, because a hospital operating room and general anesthesia are not routinely required, patients do not have to pay additional operating-room, facility, or anesthesiology fees.
This allows the procedure to be offered at a lower cost while maintaining the magnification, precision, and microsurgical principles required for vas deferens reconstruction.
Preparing for the Procedure
Eating and drinking
The vasectomy reversal is performed under local anesthesia, which means you will remain awake and will not be put to sleep. No fasting or special laboratory testing is normally required.
Have a substantial breakfast on the morning of your procedure. However, limit how much fluid you drink.
You will be asked to empty your bladder immediately before the procedure. Since the surgery takes approximately two hours, you will not be able to urinate during that time. Drinking too much beforehand may cause your bladder to become uncomfortably full.
Shaving and showering
The day before the procedure, use a disposable BIC-type razor to completely remove the hair down to the skin from the following areas:
- The entire scrotum
- Above and around the penis
- The inner groin on both sides
- The front of the left thigh
Please shave carefully to avoid cuts or irritation.
Shower and wash your hair before leaving home on the day of the procedure. You will not be permitted to shower for two days following the surgery.
Transportation and accompanying person
You must arrange for someone to drive you home or back to your hotel after the procedure. You will not be permitted to drive yourself.
Your driver does not need to remain at the clinic during the surgery but should be available to pick you up approximately two hours after the procedure begins.
Your partner or another support person is welcome to remain in the procedure room and sit near your head during the surgery.
Operation
During the procedure
The vasectomy reversal is performed in our office under local anesthesia. You will remain awake during the procedure.
Your partner or another support person is welcome to remain beside your head during the procedure to keep you company.
If you attend the procedure alone, we can also provide an Apple Vision Pro virtual reality headset for your comfort and entertainment. You can use it to watch movies or television shows during the procedure through our streaming services, including Prime Video, Disney+, and Crave. The headset and access to these streaming services are provided by our clinic, so you do not need your own subscription.
Discomfort is generally no greater than what most patients experience during a vasectomy, although the reversal takes considerably longer. Most patients are very comfortable, and many fall asleep at some point during the procedure.
Because you will be lying on your back for approximately two hours, some patients may experience temporary back stiffness or fatigue.
Microsurgical reconstruction
Each vas deferens is repaired separately through a small paramedian scrotal dissection approximately one centimetre in length.
Using a high-magnification surgical operating microscope, the ends of the vas deferens are precisely aligned and reconstructed. Between 6 and 20 extremely fine microsurgical sutures are generally used on each side in a multilayer repair.
Once the reconstruction is complete, Tisseel, a fibrin sealant, is applied around the reconnected vas deferens. This provides additional support and sealing around the microsurgical reconstruction.
The entire procedure takes approximately two hours on average.
Closing the surgical sites
At the end of the procedure, the small surgical sites are closed with absorbable sutures and surgical skin adhesive. The sutures dissolve on their own over the following two to three weeks and usually do not need to be removed.
A routine follow-up appointment is generally not required. However, our clinic remains available if you have concerns or questions following the procedure.
Recovery
Immediately after the procedure
After lying down for approximately two hours during the procedure, you will likely be happy to get up and move around. However, we ask that you return directly home or to your hotel and minimize your activity.
Spend the remainder of the day resting in bed or on a sofa. Reading, watching television, or other quiet activities are encouraged.
If you travel home or to your hotel by car, another responsible adult must drive. During the car ride, recline the passenger seat and remain lying back as much as safely possible rather than sitting fully upright.
You may eat normally after the procedure.
Scrotal support and ice
The scrotal support provided by our clinic should be worn at all times for the first 48 to 72 hours following surgery.
We recommend applying ice to the front of the scrotum, over the scrotal support, for the first 72 hours. Apply the ice for approximately 20 to 30 minutes at a time, followed by a break of 10 to 60 minutes before reapplying it.
Two to three days after the procedure, you may switch to a traditional athletic supporter or jock strap. Lower the support for urination, bowel movements, and showering.
Continue wearing scrotal support for approximately four weeks.
Medications
Complete the antibiotics prescribed by Dr. Bercier.
Prednisone is prescribed to all of our vasectomy reversal patients starting on the day of the procedure. The goal is to reduce postoperative inflammation and potentially decrease scarring around the microsurgical reconstruction.
The prescribed regimen is:
- Prednisone 5 mg once daily for 7 days
- No prednisone for the following 7 days
- This 7-day on, 7-day off schedule is repeated for a total of 6 months
Please take the prednisone exactly as prescribed and complete the full six-month course unless Dr. Bercier advises you otherwise.
If you continue to experience discomfort despite ice and your prescribed medications, you may take acetaminophen (Tylenol).
Do not take aspirin or anti-inflammatory medications such as ibuprofen (Advil or Motrin) or naproxen (Aleve) unless specifically instructed by Dr. Bercier.
Wound care and showering
Extra gauze will be provided. If the gauze becomes soiled or excessively moist, it can be changed through the opening of the scrotal support or by temporarily lowering the support.
You may remove the scrotal support and gauze and take a shower two to three days after the procedure. Gently wash the scrotum with soap and water, pat the area dry, and reapply the scrotal support.
If skin glue was used, do not apply hydrogen peroxide, creams, ointments, or other products to the surgical sites unless instructed by our clinic.
Some bruising or skin discolouration around the surgical sites is normal. The discolouration may occasionally extend partially along the penis.
The surgical sites and absorbable sutures may take two to three weeks to fully heal. The sutures usually dissolve on their own and do not need to be removed.
A routine follow-up appointment is generally not required when skin glue has been used and recovery is progressing normally. However, our clinic remains available if you have concerns or questions.
Returning to work and physical activity
Your return to activity should occur in three phases over the first eight weeks following the reversal.
First 48 to 72 hours: rest and remain horizontal
For the first 48 to 72 hours, avoid physical activity and spend as much time as possible in a horizontal position, either lying on your back or on your side. By remaining horizontal, your scrotum naturally stays closer to the level of your heart, which helps reduce scrotal venous pressure, swelling, and bleeding.
Only get up when necessary, such as to use the bathroom or for other essential needs.
After 48 to 72 hours until two weeks: light daily activities only
After the first 48 to 72 hours, you may begin standing, walking around the house, and gradually resuming light daily activities.
Sedentary or desk work may be resumed as your comfort allows.
During the first two weeks, avoid physical exercise, lifting, strenuous household work, and activities involving significant bending, twisting, or abdominal straining.
Two to eight weeks: progressive return to physical activity
Beginning two weeks after the reversal, you may progressively return to your usual routine and physical activities.
Increase the intensity of your activities gradually over the following six weeks. More demanding activities should be reintroduced later in the recovery period.
Activities that place significant strain or tension on the groin and scrotum should generally be left until closer to the end of the eight-week recovery period. These include heavy weight lifting, strenuous lower-body training, cycling, horseback riding, contact sports, and other high-intensity physical activities.
By approximately eight weeks after the reversal, most patients can return to their usual level of physical activity, provided their recovery is progressing normally.
Ejaculation and sexual activity
Ejaculation should resume three weeks after the procedure.
You may notice a small amount of blood in the semen when ejaculation resumes. This can occur after the procedure and is generally not a cause for concern.
After the initial three-week healing period, we recommend ejaculation approximately every 48 hours.
Semen analysis and the risk of late scarring
A semen analysis should be performed approximately one month after the reversal.
Additional semen analyses are recommended approximately three to four months after surgery, six months after surgery, and one year after surgery.
Even after sperm initially returns to the semen, scar tissue can occasionally develop at the site of the microsurgical reconstruction and cause a later obstruction. Published studies have reported a risk of late obstruction or secondary azoospermia ranging from approximately 5% to 33%, depending on the patient population, type of reconstruction, and definition used.
For this reason, continued semen analysis is recommended even after an initially favourable result.
In selected situations, sperm banking may also be discussed as a way of preserving sperm for future use. If natural pregnancy does not occur, other reproductive options, including intrauterine insemination (IUI) or other fertility treatments, may be considered.
Optimizing your chances of pregnancy
A successful vasectomy reversal is only one part of achieving a pregnancy. The health and fertility of both partners are important.
We recommend that both partners maintain a healthy lifestyle, including:
- Eating a balanced diet
- Exercising regularly
- Maintaining a healthy weight
- Getting adequate sleep
- Avoiding smoking
- Limiting excessive alcohol consumption
- Avoiding recreational drugs
Avoid prolonged or excessive heat exposure to the scrotum while trying to conceive. This includes hot tubs, saunas, and prolonged hot baths.
After the initial three-week healing period, continue ejaculating approximately every 48 hours.
We recommend monitoring the female partner’s ovulation using a menstrual cycle tracking application and/or a urine ovulation predictor kit to help identify the predicted day of ovulation as accurately as possible.
For the best chance of conception, we recommend following this intercourse schedule based on the predicted day of ovulation:
- 6 days before ovulation: intercourse
- 4 days before ovulation: intercourse
- 2 days before ovulation: intercourse
- Day of ovulation: intercourse
- 1 day after ovulation: intercourse
The predicted day of ovulation is the most important day in this schedule, and intercourse on that day is strongly encouraged.
These recommendations are intended to help optimize the chances of natural conception following a successful vasectomy reversal.
Why Choose The Bercier Clinic for Your Vasectomy Reversal?
At the Bercier Clinic, our focus is on providing personalized care in a welcoming environment. Our advanced surgical techniques, paired with cost-effective procedures performed under local anesthesia, minimize recovery time while maximizing success rates. We are committed to making vasectomy reversal accessible and effective for families. Book an appointment for a consultation now.
(613) 249-7287
