Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS
Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS

Why Do Vasectomy Reversals Fail?

A vasectomy reversal which fails is an extremely disappointing — not to mention a very expensive — experience. Patients are of course anxious to know why the surgery didn’t work — and what to do to prevent such failures, either on their first reversal, or especially when considering a redo after failed reversal.

Microsurgical vasectomy reversal is one of the most challenging operations in all of surgery, because of the extremely small size and delicacy of the structures being reconstructed. This is particularly true when the epididymis needs repair, where the wall of the epididymal tubule is only about 1/4 the diameter of a human hair.

Every surgeon who performs vasectomy reversal has some failures — if you find a surgeon who “guarantees” success, it is best to look elsewhere, as he or she is not being honest. Highly experienced reversal surgeons will, as expected, have the lowest failure rates — but it is important to determine the nature of even a good surgeon’s skills — in particular, their experience and success with epididymal reconstruction (VE), which is far more challenging than uncomplicated vas-to-vas (VV) repairs.

Most well-trained and reasonably experienced reversal surgeons should achieve 90% or better success rates (that is, postoperative sperm counts in the normal range) in uncomplicated vas (VV) repairs. With current techniques, the success rate of epididymal reconstructions should approach 60% — but success rates like these require a great deal of experience with this very difficult repair. Less experienced microsurgical surgeons are generally more likely to achieve only 30% success, or less, on such repairs.

Some surgeons unfortunately seem to blame the patient when the reversal fails, telling them that they formed “scar tissue” which blocked the reconnection. While this is occasionally true, it is much more likely that surgical technique, or failure to perform the correct surgery, are the cause of most reversal failures. Some surgeons promote the use of anti-inflammatory medications and even steroids (such as Prednisone) after surgery, to prevent such “scarring” — despite the fact that there is no medical evidence for their benefit in reducing the failure rate of reversal surgery, and drugs such as Prednisone impair healing and increase the risk of infection, among other complications.

So why do reversal surgeries fail? In Dr. Finnerty’s experience of nearly 40 years of performing microsurgical reversal, they fail for one of the following reasons:

  •  A technically poor repair: All non-microsurgical, and many microsurgical, vas-to-vas repairs, fail because there is poor alignment of the vas, which results in leakage of sperm fluid, inflammation, and scarring. While technical failures can occur even with a very experienced microsurgeon, they are far more likely in less experienced surgeons. Repairs done with non-microsurgical techniques (2-3x loops, using large sutures) cannot be performed with sufficient accuracy to prevent this problem. Epididymal repairs, because of the extremely small size and delicacy of the epididymal tubule, often result in technical failure by less experienced surgeons not comfortable with this demanding procedure.

  •  Inadequate blood supply to the vas: Many vasectomy techniques use cautery (using an electric current to coagulate the ends of the cut vas by heat). While small amounts of cautery pose no problem, extensive cauterization damages the blood supply to a long length of the vas. This damaged tissue may be very subtle and difficult to detect at surgery, and must be removed if proper healing is to occur. This type of failure often results in some sperm being present early after surgery, with failure 3-12 months later.

  •  Failure to recognize and repair epididymal obstruction: This is very common in less experienced microsurgeons who are not comfortable with this very difficult procedure. Many surgeons skilled at repairing the vas with microsurgery are much less comfortable performing epididymal repairs for this reason, and often therefore perform vas-to-vas (VV) repairs when epididymal repair (VE) is a much better option. Note that the presence of a few sperm or sperm parts in the fluid found at surgery does not guarantee that there is no obstruction in the epididymis — a fact which many reversal surgeons do not take into account.

  •  Extremely proximal epididymal obstruction: In some instances, obstruction after vasectomy occurs near or in the efferent ducts, which are delicate tubes which join the testes to the epididymis. In such cases, even expert epididymal repair may fail. Connecting the vas to the efferent ducts can be performed by an experienced surgeon. This repair is extremely challenging from a technical standpoint, and the tubule at this level is far smaller (0.1mm or less) than the more distal epididymis, and therefore these repairs have a substantially higher failure rate even than epididymal reconstruction.

  •  Other infertility problems: In some cases, failure is caused by other fertility issues, such as poor testicular function. Another common potential issue is the use of testosterone replacement therapy, which effectively shuts down sperm production.

The reversal surgery was a great success! We are sorry we didn''t contact you sooner. Thank you again for your willingness to provide such a special service for families.
M.F., California
I am writing to send our heartfelt thanks to you for your expertise. On September 9th, you performed my husband''s procedure. Three weeks later, we conceived our first daughter. She was born exactly 43 weeks post-op. Since then, we have welcomed a son and also another daughter. We''ll always be grateful.
M.H., Vancouver, WA
A little over 5 years ago, my husband and I flew from Chicago to your office to have his vasectomy reversed. We both want you to know how grateful we are -- to you, to your staff, and for your expertise. Since the surgery, we have had Michael (almost 4!) and Mary Jo (10 months) ... We feel it is important for you to know what a difference you made in our lives, and what an awesome grace it was to have you as our surgeon. Words cannot convey how much we appreciate what you have made possible for us -- we will be eternally grateful!
C. & K.P., Chicago
A child is God''s most precious gift. We joyfully announce the birth of our son.
J.C., Idaho
My husband had his vasectomy nearly 13 years before the reversal, which resulted in the birth of our daughter.
R.B., California
My husband had a vasectomy reversal four and one-half years ago performed by Dr. Finnerty. Three and one half years after, we were able to conceive a child. Our daughter is such a constant joy in our lives.
C.J., California
Thank you for helping our dreams come true.
J.W., Atlanta
Easter blessings to you and your family from us. We are having a special celebration and invite you to join us -- we celebrate the life of our new daughter.
C.K., California
We wanted to share our delightful news with you. We were blessed with a beautiful baby daughter in October.
D.W, Oregon
Thank you again for making possible the blessings God had in store for us in the way of children ...
T.P., Minnesota
We have been so excited about our new son and he has been such a joyous addition to our family ... Thank you so much for your devotion and belief in vasectomy reversal, we have been so blessed by our little guy. Of course, he can never take the place of our daughter who died, but he sure brings new joy to us ... Again, thank you for all you did! We have been so blessed....
M.M., Camas, WA
My wife and I would like to give you and your staff a hearty "thank you" for the professionalism and care given us...following my son''s departure to our heavenly Father. Your calming manner and assurance that we had a reasonable chance at reattaching my vas deferens, which might allow us to get pregnant, was at fruition soon after our stay in Tacoma. 14 days following the procedure, my wife ... had become pregnant!. We lost our first son, and Dr. Finnerty, touched by God, enabled us to have another son ...
J.G., Washington
We were very excited to learn just before Christmas that the surgery was a success. We saved the news for out kids until Christmas Eve and what a blessing their reaction was, it couldn''t have been a better Christmas present! We do thank you so much for providing your services at realistic fees, we could never have done it had there not been options other than what we found locally.
T.S., California
Our family now has 7 blessings, 3 of which you had a very special part in. Thank you!
G.S., Alaska
Our child is a true gift from God. God bless you for turning my vasectomy around after 30 years with so much care and love. We will always love you.
J.C., Tennessee