Services - Vasectomy Reversal
Vasectomy Reversal
In our hands, vasectomy reversal procedures are an effective way to restore fertility for men that have previously undergone a vasectomy.
Why choose our services?
Our results are our top priority, no compromises.
Dr. Flannigan spent an additional 2 years of training with the world’s best in New York, and uses the most effective microsurgical techniques published.
We track our outcomes and know our results. Dr. Flannigan’s technique combined with his surgical experience translates to success rates of up to 97.3% for all vasectomy reversals irregardless of the type of connection needed and are among the top in the world.
Our Vasectomy Reversal Success Rates
In our experience, 24% of patients will require a more technically demanding type of connection to successfully reverse a vasectomy called a vasoepididymostomy (VE). General urologists and other surgeons are not trained in this technique, while sub specialized surgeons such as Dr. Flannigan are specifically trained in this reconstruction. Dr. Flannigan’s results are aligned with the top centres around the world.
We are committed to your success in growing your family at the time of surgery and beyond your surgical date.
*As of May 2023. Includes all primary consecutive vasectomy reversals performed with one sperm test within 6 months of the surgery and at least 6 months of follow up testing. Includes all vasovasostomies, vasoepididymostomies, and mixed techniques.
All Vasectomy Reversals
- Any Sperm
- > 2 Million Moving Sperm
What are the costs associated with vasectomy reversals at Flannigan Fertility?
Initial consultation: $195
Vasectomy reversal surgery: $7995
Follow up: No charge for 3 post-operative follow ups.
($100 per follow up afterwards)
Financing the procedure is available through Beautifi
3 Easy Steps:
1
Apply Online
Simply visit the website to learn more and apply online.
2
Get Approved
Receive a call from a Beautifi loan specialist to confirm your financing details.
3
Get Ready For Your Procedure
You are ready to go. Beautifi will pay Flannigan Fertility directly.
Below are frequently asked questions about financing with Beautifi:
Beautifi pays Flannigan Fertility directly. They ensure the fixed monthly payments are affordable and within your budget.
Apply online and get-prequalified in minutes. Beautifi can approve your loan and finance your procedure in less than 24hrs.
No. There is no risk or obligation when applying for a loan with Beautifi.
Your rate is based on monthly income and credit history, as well as the loan amount and term length. Rates start as low as 8.95%
Yes. You can repay part or all of your loan at any time, with absolutely no pre-payment penalty of fees.
You can choose to finance all or just a portion of your procedure.
How do Vasectomy Reversals Compare with IVF?
There are 3 fertility options for men wanting to father a child following a vasectomy.
1. Vasectomy Reversal
2. Vasectomy reversal + sperm retrieval
3. Sperm retrieval + In Vitro Fertilization (IVF)
The bottom line, is that both options are potentially effective and come down to different pros and cons for most couples. If there is female fertility troubles, IVF may be a better option. Vasectomy reversals offer the chance to have children naturally. In otherwise healthy couples, wanting one or more children, vasectomy reversals are typically the most cost effective option. Success rates are comparable but typically favour vasectomy reversals in most scenarios.
For couples where the female partner is aged 30-35, the pregnancy rate for vasectomy reversal in one study was 78.4%, while the pregnancy rate for a single cycle of IVF was 56.6% and the cumulative IVF pregnancy rate (1-4 cycles of IVF) was 69.4%. For couples with female age over 40, the vasectomy reversal pregnancy rate was 42%, while the single IVF cycle pregnancy rate was 19-27%, and cumulative IVF pregnancy rates (1-4 cycles of IVF) were 34%. Overall, for most couples, vasectomy reversals are cost effective, and hold high chance of success in our hands.
Time since vasectomy?
Historically, many believed that vasectomies performed many years ago, >15 years for instance, were not amenable to microsurgical reconstruction. However, we now understand that a secondary blockage of the ‘epididymis’ may occur in cases with increased time since vasectomy. A conventional vasectomy reversal (vasovasostomy; VV) will not work in this scenario; however, intra operative diagnosis by the surgeon, and a special reconstruction to the epididymal tubules (vasoepididymostomy; VE) can be successful, providing men with a high chance of sperm returning to their semen post-operatively. General urologists and other surgeons are not trained in this technique, which is why choosing a sub specialized male reproductive microsurgeon can make a significant difference for your success.
Our outcomes irregardless of time since vasectomy reversal (1 to 26 years):
Our Success Rate
- Any Sperm
- > 2 Million Moving Sperm
*As of May 2023. Includes all primary consecutive vasectomy reversals performed with one sperm test within 6 months of the surgery and at least 6 months of follow up testing. Includes all vasovasostomies, vasoepididymostomies, and mixed techniques.*
How to Book a Consultation & Procedure?
The first step in moving towards regaining your fertility is to reach out through our website contact section where you will contact Dr. Flannigan directly, and request a consultation. We know that timeliness is a priority, and aim to offer you an appointment within 1 week of reaching out.
At the time of consultation, we will discuss your fertility options, review the procedure, answer your questions, and look to book your procedure if it’s the right fit for you and your partner.
Vasectomy Reversal Frequently Asked Questions
The chance of getting pregnant after vasectomy reversal is dependent upon the success of the vasectomy reversal and the fertility potential of both couples. Female age and reproductive health is an important variable and the chance of pregnancy for women, aged 30 to 39 following vasectomy reversal is 78% and the chance of pregnancy for women 40 to 44 is approximately 42% according to the medical literature. Pregnancy rates for individual couples will vary depending upon their reproductive health, and circumstances.
Reference: Hinz S, Rais-Bahrami S, Kempkensteffen C, et al: Fertility Rates following Vasectomy Reversal: Importance of Age of the Female Partner. Urol. Int. 2008; 81: 416–420
Vasectomy Reversals are surgical procedures that reestablishes a connection within the vas deferens to transport sperm between the testicle and the ejaculate. This involves one of two types of connections. Most commonly, a microsurgical reconnnection of the vas deferens tubes on either side of the vasectomy site is performed using a high-powered operating microscope. Sometimes a more specialized procedure is necessary when a second blockage site is present related to the vasectomy; here, the vas deferens tube is connected to a smaller epididymal tubule upstream to the second blockage using a high-powered operating microscope. This technique is called vasoepididymostomy or VE.
Yes. Nearly 5 to 10% of individuals that have undergone a vasectomy will pursue a vasectomy reversal at some point in their lives afterwards.
The chance of having any sperm in the semen is over 97% and the chance of having greater than 2 million moving sperm is approximately 91% in our hands. Specifically, vasovasostomy success rates are over 98% chance of having any sperm detected in the semen following surgery and 93% chance of having at least 2 million moving sperm. Vasoepididymostomy success rates for achieving greater than 2 million moving sperm is 71% in our hands.
Reference: This data is based upon Dr. Flannigan‘s personal practice as of May 2023. This includes all primary vasectomy reversals performed in his practice with his hitch-microsurgical microdot technique, whom performed at least 6 months of follow up testing.
Typically, vasectomy reversal surgeries are more cost-effective fertility options for most couples. However, it is important to have a detailed conversation with your fertility expert to ensure this is the case in your specific situation.
Reference: Witherspoon & Flannigan. Fertility treatment options after vasectomy. BCMJ 2021. 63(2):62-66. https://bcmj.org/articles/fertility-treatment-options-after-vasectomy
Considerations Prior To Surgery
Yes. At the time of vasectomy reversal, we can take a small biopsy approximately the size of a pencil eraser head, and have it transported back to an IVF fertility Centre for cryopreservation (freezing). This needs to be arranged in advance of the surgery so that additional bloodwork can be performed and the logistics arranged. This typically adds a cost of $1700-$2500.
Yes. Sperm retrieval for patients with a previous vasectomy can be performed in an office setting with local anesthetic (freezing) using either a needle (called PESA) or performing a small testicular biopsy (called TESE).
The total cost is approximately $2500 to extract sperm after a vasectomy in an office setting using a PESA or TESE technique.
Most individuals tolerate vasectomy reversal surgery very well. It’s common to have some swelling, bruising and some discomfort after the procedure. The risk of significant swelling of the scrotum called a scrotal hematoma is less than 5%. The risk of infection is estimated to be between 1-3%. The risk of a late failure is estimated to be 5-13%. Other less common risks may include injury to the spermatic cord, epididymis, testicle, or prolonged discomfort.
Yes. Alternative options using the individual’s sperm would include a sperm retrieval paired with IVF-ICSI i.e., in vitro fertilization – intracytoplasmic sperm injection. This would involve sperm retrieval under local freezing, similar to going to the dentist. The sperm can be retrieved either with a needle in a procedure termed PESA, or through a small testicular biopsy in a procedure called TESE. The sperm is then cryopreserved (frozen) at the IVF Centre and can be used for IVF-ICSI with your partner’s eggs. Dr. Flannigan works with all of the local IVF centres and can help coordinate this process as well.
Alternatives not using your sperm include donor sperm and adoption.
Reference: Witherspoon & Flannigan. Fertility treatment options after vasectomy. BCMJ 2021. 63(2):62-66. https://bcmj.org/articles/fertility-treatment-options-after-vasectomy
Referral for a female, fertility evaluation can always be considered. Dr. Flannigan will perform screening questions regarding your partner’s overall health, reproductive history, and any potential risk factors for female infertility that could impact their chance of a natural pregnancy. However, for a female age 35 and older is typically recommended to have a female, fertility evaluation with one of the female fertility Centres that Dr. Flannigan collaborates with. This will typically involve a history, physical exam, series of blood tests and potentially a pelvic x-ray to assess for tubal patency.
For most individuals who are healthy, no additional bloodwork or investigations are necessary. However, if there’s a history of testosterone therapy, gym anabolic steroids then we will require blood work to perform hormonal evaluations. If it’s been greater than 10 years since vasectomy, then we may consider performing some bloodwork for hormonal assessment depending upon the individual scenario.
No. Ultimately, we must test the fluid within the vas deferens tube coming from the testicle to determine whether we should perform a VV or a VE type of connection. We look at this fluid from the tube using a microscope, and if there are sperm or sperm parts – that confirms the tubes are likely open and we can perform a VV. However, if we do not see any sperm or sperm parts, this indicates a secondary blockage in the epididymis, and we have to continue searching systematically throughout the epididymis until we find sperm, which indicates we are above the secondary blockage, and can perform the VE type connection above the site of blockage.
Increasing time since vasectomy leads to a higher chance of a secondary blockage and requirement for a VE type of connection. In our hands, the chance of having greater than 2 million moving sperm with a VE is 71% (80% chance of seeing any sperm in semen post operatively) compared to 93% with a VV (98.7% chance of any sperm after VV – which is how many surgeons report their results online or in publications). So, therefore, the greater the time since vasectomy does increase the chance of needing a VE; however, the chance of success with a VV, or with the respective VE does not change with time since vasectomy. In our practice, we have performed vasectomy reversals between less than one year and 26 years since initial vasectomy, with success.
The ultimate answer is yes. We would not recommend performing the vasectomy reversal while you’re actively on testosterone therapy or if you have used testosterone very recently within three months. In this scenario, we typically recommend one of two options.
The first option is to stop the testosterone therapy and Dr. Flannigan will monitor recovery of your hormone profile until we’ve had normalization of the hormones related to sperm production for a minimum of three months.
The other option is stopping testosterone therapy and initiating off-label hormone medications, such as hCG injections, and/or clomiphene citrate. These can help encourage your body‘s natural physiology to produce testosterone within the Testis. Testosterone therapy suppresses the testicle’s ability to produce testosterone and sperm; therefore, recovering the ability to produce testosterone within the testicle is really important because it is essential for sperm production. We need testicular testosterone production for sperm production to be active at the time of vasectomy reversal for the best outcomes, because we use the presence of sperm or sperm parts in the fluid coming from the testicle diagnostically to help guide which type of connection that would be best for you between a VV and a VE. Dr. Flannigan can work with you throughout this process to optimize it.
FAQ Regarding Vasectomy Reversal Procedure
When performing vasectomy reversal’s, we can either perform a standard connection where we connect the two ends of the vas deferens tube on either side of the vasectomy (termed vasovasostomy or VV); or, if there is a secondary blockage that we diagnose at the time of the surgery, to get around this problem, we connect the vas deferens tube to one of the small epididymal tubules above the second site of blockage. This technique is called a vasoepididymostomy or VE.
Yes. When it is indicated, the preference is to perform a VV, as in our experience were able to achieve any sperm and 98% of cases and over 2 million moving sperm in over 93% of cases. However, if there’s a secondary blockage, this technique will not work and we will have to perform a VE. In this case, the chance of having greater than 2 million moving sperm in our hands is approximately 71%.
Dr. Flannigan uses the techniques that have been described with the highest published success rates. Specifically, he uses a modified multi-layer, microdot VV technique, using a high-powered microscope where he adds additional ‘hitch’ stitches to relieve tension on the connection. This involves use of 10-0 sized microsutures that are small than the hair on your head (70-100 microns in diameter) on the inner layer and 9-0 sized microsutures on the outer layers. For VE procedures, Dr. Flannigan uses the LIVE or Longitudinal Intussusception Vasoepididymostomy technique, using 10-0 and 9-0 microsutures and a high-powered operating microscope.
In nearly all circumstances, we can connect the ends of the tube and perform a vasectomy reversal. In rare occasions, if an extremely large gap is present, it may be challenging to make the connection tension free which is important for success.
Post-Operative
If you work from home, most people after surgery can begin resuming work in approximately one week after surgery. If you work in the office, it would be reasonable to get back to the office in one to two weeks. If your job involves physical labor, it may be best to wait 2 to 3 weeks.
You can begin walking around your home later the day of surgery. Progressing to lifting small items around the home is typically reasonable after a few days following surgery. Activities such as long walks would be reasonable after 10 to 14 days. Isolated resistance training in the gym can likely resume around three weeks following surgery and progressing to more moderate to vigourous exercise 4 to 6 weeks afterwards. Activities such as cycling are likely best to wait for approximately one month.
Most people do quite well after surgery. It is reasonable to expect, some mild sharp or aching pain to the incision sites and the testes. Most people will be able to tolerate this with use of Tylenol or ibuprofen.
Unless there’s a medical reason that you’re not able to take Tylenol or ibuprofen, we typically recommend starting with Tylenol as prescribed on the bottle or the first 24 to 72 hours. If you need additional pain control adding ibuprofen can be safely combined with Tylenol and can add additional help. Dr. Flannigan will often prescribe either Tylenol #3 (with codeine) or Tramacet (Tramadol + Tylenol) at the time of surgery that can be filled if regular Tylenol and ibuprofen are not working well enough. Both of these medication‘s contain Tylenol and therefore can only be used if substituted for regular Tylenol (i.e. one or the other), but can still be combined with ibuprofen.
Yes, there will be stitches on both sides of the scrotum. These are dissolvable and will typically fall out within 4 to 6 weeks. After three weeks, you can gently pull out the ends of the stitches; when the stitches are ready, they’ll come out.
We recommend waiting to shower for 48 hours after surgery. Once you initially begin showering, we still recommend keeping direct water off of the incisions for the first week until the skin edges are completely sealed.
We typically recommend waiting 2 to 3 weeks before going into bodies of water. The reason behind this is to reduce the risk of infection.
Following surgery, you’ll typically have a gauze wrap around the scrotum to provide support and compression. Under the gauze, there will be a square dressing over each incision. There may be some blood spotting, and this is within the normal range and should not be concerning. You can remove this dressing two days after surgery if it stays on; however, the gauze wrap often falls off prior to this, and that’s not a problem. If the dressing does come off, feel free to wear supportive underwear that provides some extra compression and keeps the testes elevated. You could consider using a female pad to line your underwear in case there’s any spotting of blood mainly to protect staining your underwear. There may be some dried blood or scab to the incision site that evolves over the first few weeks. It is very common to have some signs of bruising or some swelling.
If you’re experiencing unexpected symptoms, feel free to contact Dr. Flannigan who can help navigate these. If you’re experiencing significant scrotal swelling where the scrotum is expanding beyond the size of an orange or grapefruit, please contact Dr. Flannigan or if it is changing over the course of the day, we recommend going to the local emergency department and letting the treating physician know that Dr. Flannigan performed the surgery and can contact Dr. Flannigan. If you experience increasing pain 1 to 2 weeks after surgery, redness to the incisions, or any fevers or chills, this could be a sign of an infection and again you should contact Dr. Flannigan or see your local physician.
If your vasectomy reversal does not work, the options would be to either repeat the vasectomy reversal, or, sperm can be retrieved in an office setting using a needle or small, biopsy, in procedures termed PESA or TESE. This retrieved sperm could then be used for IVF-ICSI. Alternative options would be adoption or donor sperm.
After vasectomy reversal surgery, it’s important to keep the testicles well supported to avoid any tension on the vasectomy reversal connections. This is very important in allowing the connections to heal optimally. Otherwise, it is important to live a healthy lifestyle, avoid heat exposures such as hot tubs, saunas, and steam rooms as well as avoiding recreational drugs and alcohol use less than five servings per week.
Rates of late failure are typically reported to be between 5-13% in the literature. This means that following your vasectomy reversal if it is successful with positive results and sperm seen in the semen analysis, there is a 5-13% chance that some months to years later, the sperm counts drop off to zero or very low numbers not amenable to natural pregnancy. From the literature the median time for this to occur is approximately 9 months if it does happen.
Dr. Flannigan will give you a requisition to do a semen analysis at your local laboratory such as life labs six weeks after surgery. However, if you had bilateral VE type of procedures Dr. Flannigan will typically have you wait for approximately eight weeks.
Once you can begin ejaculating, after four weeks, you technically begin trying to conceive. Once we confirm that the reversal was successful and there is sperm in the ejaculate, the chances of pregnancy will increase as the total number of moving sperm increases.
We recommend timing intercourse with ovulation. Your female partner could use various tools to monitor ovulation such as mobile phone apps, or ovulation detection kits from the pharmacy. It is consensus that you can have intercourse every day or every other day leading into ovulation and at the time of ovulation.
Sperm are believed to be healthy after a vasectomy reversal and capable of creating a pregnancy. The most important variables are the total number of moving sperm in terms of predicting natural pregnancy.
After vasectomy reversal surgery, it is possible to have millions of moving sperm return to semen and achieve a pregnancy soon after surgery. However, in most cases, it takes several months for the total number of moving sperm to increase within the normal range, and most couples will conceive within the first 1.5 years following surgery.
If the vasectomy reversal is successful, the transport of sperm will be reestablished. Sperm will be effectively transported from the Testis to the epididymis, through the vas deferens tube, and into the semen.
No. Vasectomy reversal works on different anatomic structures than those related to generating your erections.
FAQ On The Day Of Surgery
Dr. Flannigan will typically perform vasectomy reversals under a general anesthetic at a surgical center. This means that you will go to sleep for the procedure and wake up when it is completed. Dr. Flannigan will also leave freezing to the surgical site which typically lasts 4 to 6 hours.
Vasectomy Reversal surgery is a day surgery. Meaning, you come and go the same day. In nearly all circumstances, you’ll go home the same day, unless there are unique considerations to your case.
Dr. Flannigan typically performs the vasectomy reversals in 2 to 3 hours.
FAQ What You Should Ask Your Prospective Surgeon
It is important for surgeons offering vasectomy reversals to know their own success rates and outcomes.
It is also important to ask what type of connections they are capable and proficient in performing. The 2023 Canadian Urologic Association Azoospermia i.e. infertility, guidelines recommend that surgeons offering vasectomy reversals should be proficient in offering both regular VV type of connections, and more specialized VE type of connections. This is because the odds of potentially needing to perform a technically challenging VE is approximately 20-30% among all vasectomy reversal cases. If they are not able to successfully perform this VE surgery, that would mean in 20-30% of reversals, a patient would not be receiving the correct procedure with a chance of success.
It is also important to choose a surgeon who has performed specific microsurgical training for vasectomy reversals and performs them regularly for best outcomes.
FAQ Cost & Booking Vasectomy Reversals
Yes. Is important for Dr. Flannigan to have a detailed fertility and medical history. It is also important for Dr. Flannigan to have the opportunity to discuss the details of the procedure, alternative options, expected outcomes, and potential risks to ensure that you are fully informed to make the best decision for you and your partner. The consult also serves as an opportunity for you to ask questions regarding the procedure or follow-up care.
Dr. Flannigan will aim to schedule an initial consult within a week of reaching out through this website.
Dr. Flannigan will typically aim to arrange a surgical date within 4 to 8 weeks.
Unfortunately, the medical services plan (MSP) does not cover vasectomy reversal surgery for fertility or the consults, or follow up care related to private surgeries such as vasectomy reversals.
Dr. Flannigan charges $195 for a consult. Follow up care is no charge.
The total cost including surgical centre fees etc, is $7995 when booked with Flannigan Fertility.
- Initial consultation: $195
- Vasectomy reversal surgery: $7995
- Follow up: No charge for 3 post-operative follow ups. ($100 per follow up afterwards)
- No. Unfortunately, Canadian physicians do not have appropriate medical legal coverage and practice insurance to offer services beyond Canadian citizens and residents.
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