A vasectomy is often approached as a permanent birth control solution, and most of the time, it is. But what happens if circumstances change and a man ultimately regrets his decision to get snipped? To learn more and get some answers about vasectomy reversals, we spoke to Dr. Premal Patel, a urologist who specializes in male infertility, microsurgery and sexual medicine at the University of Manitoba.
In basic terms, how does a vasectomy work?
“The basic idea of a vasectomy is to stop the flow of sperm from the testicle,” Dr. Patel explains. “The vas, which transports sperm from the testicle, is blocked to stop this.”
“It does take time for the system to clear out, which is why the doctor performing the procedure requires the patient to perform a semen study to confirm there is no sperm present—or very low quantities of non-moving sperm—at around 2 to 3 months from the procedure.”
This means providing a sperm sample and waiting for lab results to confirm that the procedure was a success—and until then, using another method of birth control. “It is important to know that a vasectomy does not cause immediate sterility, and you can get someone pregnant!”
How common are vasectomies?
Roughly 55,000 vasectomies are performed in Canada each year, and Dr. Patel notes that 7.4 per cent of sexually active women cite vasectomy as their current form of contraception. “In Canada, vasectomy is more common than tubal ligation,” he says. “Overall, vasectomy is less invasive, easier on the patient and more cost effective than tubal ligation.”
What is the average success rate with vasectomies?
There’s a reason so many men choose to go under the knife—it works! “A vasectomy is over 99 per cent successful,” Dr. Patels says. “The chance of a pregnancy after a successful vasectomy is approximately 0.1%.”
How often do men ask for a reversal, and what might their reasons be?
“Approximately 5 per cent of men who undergo a vasectomy end up undergoing a vasectomy reversal,” Dr. Patel says. Common reasons for getting a reversal include a change in partner, deciding to have more children with the same partner, or a man previously thinking he didn’t want children and then changing his mind. Less commonly, some men request a reversal due to post-vasectomy pain (this is rare, Dr. Patel asserts) or the failure of prior vasectomy reversal (quite uncommon, according to Dr. Patel).
Is the cost of a reversal procedure covered by provincial health care?
“A vasectomy reversal is not covered by any provincial health care plan,” Dr. Patel notes. “The price can vary, but ranges from $6,000 to $8,000.”
Are vasectomy reversals typically successful? Does the timing matter?
Vasectomy reversals have a very high success rate, but timing does play a role—and, it also depends on what sort of procedure is needed. “At the time of [reversal] surgery, the surgeon looks to see if the tube is still open and sperm is passing through it. If there is sperm and he re-connects the tubes, the chance of the reversal working is more than 95 per cent,” Dr. Patel says.
“If there is no sperm, a different complex bypass is required which does drop the success rate to roughly approximately 65 per cent,” Dr. Patel explains. This more complex bypass procedure, called a vasoepididymostomy, is more common if the vasectomy happened more than 10 years ago. “The key factor is looking to see if sperm is present or not at the time of surgery.”
If a vasectomy reversal doesn't work, are there other options?
Absolutely, says Dr. Patel. If sperm does not return to the ejaculate because the reversal has failed, the presence of sperm declines over time due to scar tissue forming or there ends up being a fertility issue with the female partner, there are still options.
“In situations where a vasectomy fails, a person can undergo a repeat vasectomy or alternatively, sperm extraction and in-vitro fertilization,” Dr. Patel says. “Patients can also freeze sperm at the time of surgery as back-up.”
Should a couple get a vasectomy reversal or undergo a sperm extraction and IVF?
“This is probably the most common question I get,” says Dr. Patel. When he meets with a couple seeking fertility options after having a vasectomy, he starts by asking some key questions. On the male side, he asks about prior fertility history (children, pregnancies with same partner or previous partner), how much time has passed since the vasectomy, if he takes testosterone (this can stop sperm production) or other medications, and if there have been prior surgeries. On the female side, he asks about their fertility history (children, pregnancies with the same partner or a previous partner) and their age. “As women get older, their reproductive potential decreases substantially.”
Dr. Patel also asks the couple how and when they wish to conceive, as successful vasectomy reversals typically take 3 to 6 months to take effect (longer if the more complex procedure is required). Cost and personal preference may also play a role. “Overall, when it comes to cost and success rate, vasectomy reversal tends to be the cheaper option. It also has the same success rate as IVF if the vasectomy was less than 10 years ago and if the female partner is less than 40.”
The bottom line? A vasectomy provides exceptional birth control, but it doesn’t have to be forever.
