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Last Modified - 12/17/2010.
Vasectomy Reversal and Reverse Vasectomy Procedures
.......because a man can change his mind
Vasectomy reversal is the most cost-effective way to achieve pregnancy after a vasectomy. Whether
a couples desires more children in a relationship or the desire for children in a new relationship,
vasectomy reversal offers the greatest success rates over any other procedure.
Dr Karpman is one of the few urologists in the San Francisco Bay Area and Northern California who
is fellowship trained to perform vasectomy reversal. Only 1-2% of urologists nationwide hold this
distinction in training. His advanced microsurgical training and experience allow him to perform
either vasovasostomy or epididymovasostomy, depending on the findings at the time of surgery.
It is important for your surgeon to be skilled in performing either procedure. Based on several
factors such as the amount of time since your vasectomy and the site of your vasectomy, you may
have already developed a secondary epididymal blockage upstream from the vasectomy site. If this
is the case, then reconnecting the vas deferens at the site of vasectomy will not be successful. In
fact, 40-50% of vasectomy reversal failures are due to this reason. The more technically
challenging epididymovasostomy will be required to bypass the blockage upstream to offer the
greatest chance of success. This determination to perform either vasovasostomy or
epididymovasostomy can only be made at the time of surgery after thorough evaluation of the fluid
for sperm under a microscope from the cut end of the vas deferens.
Your best chance to successfully reverse vasectomy is when it is done correctly the first time. For
this reason, choosing the right microsurgeon is important. Dr Karpman has experience and
success in reversing vasectomies for couples who have even had previous failed vasectomy
reversals (re-do vasectomy reversal) performed by other surgeons.
Dr Karpman performs all of his vasectomy reversals under a powerful operating microscope. This
allows him to precisely visualize the procedure under magnification 25 times the normal image.
The suture that is used for vasectomy reversal is thinner than a human hair. It is important to use
such fine suture when considering that the vas deferens is approximately the diameter of a piece of
spaghetti and must be sewn back together in two layers. Some surgeons prefer to use only loupe
magnification (2.5 times). However, this has been shown to decrease success rates in terms of
return of sperm to the ejaculate and more importantly, pregnancy rates. Dr Karpman's technique of
vasectomy reversal has been published in both national and international journals. (Karpman E et
al, Contemporary Urology; Karpman E et al Canadian Journal of Urology)
Dr Karpman offers all his patients the option of freezing sperm (cryopreservation) at the time of
surgery. Cryopreservation of sperm gives the patient the added security of knowing that the surgery
will be successful. Additional services related to male infertility evaluation are also provided if the
Vasectomy Reversal Procedure in Pictures
Vasectomy Reversal - Vasovasostomy with Micro-Dot Technique
Vasectomy reversal performed by vasovasostomy is done using an operating microscope that provides
magnification 25 times the normal image size. This is important since the size of the vas deferens is about the
same as a piece of spaghetti and should be sewn in two-layers to offer the highest pregnancy rates. Microscopic
suture (10-0 nylon) unseen by the naked eye is used during the vasectomy reversal. It is important to use this fine
suture to prevent leakage of sperm and to minimize obstruction of the lumen of the vas deferens by the suture
itself. The cost of the suture itself is over $900 per vasectomy reversal!
The initial step during a vasectomy reversal is to identify whether
or not there are sperm in the fluid from the cut end of the vas
deferens. If sperm are identified then a vasovasostomy can be
performed successfully using microsurgical technique. If sperm
are not identified then a secondary epididymal obstruction has
developed and re-connecting the vas deferens at the site of
vasectomy will universally be unsuccessful. This occurs 30% of
the time and is dependent on several factors such as the time
since your vasectomy and the site of your vasectomy. If sperm
are not seen then an epididymovasostomy will be required in
order to reverse the vasectomy. (see below)
The microdot technique allows for easy placement of the
mucosal 10-0 Nylon sutures. The microdots guarantee even
placement of the mucosal sutures. Re-alignment of the vas
deferens is performed during the reverse vasectomy procedure
to ensure patency of the lumen of the vas deferens and to
prevent long-term scarring of the vasectomy reversal procedure.
Once the inner luminal sutures are tied, the knots are cut
precisely so as to ensure that none of the suture material
extends into the lumen of the vas deferens. Because of the very
small size of the vas deferens lumen, any redundant suture
material can actually obstruct the flow of sperm along the vas
deferens. Likewise, the finest (10-0 Nylon) non reactive
micro-suture must be used to ensure that the lumen is not
partially blocked by the suture material. A water tight closure of
the vas deferens mucosa prevents sperm from leaking out of the
vas deferens after the procedure.
The outer serosal sutures are equally important in the reverse
vasectomy procedure. These sutures relieve tension off of the
finer inner luminal sutures and prevent the ends of the vas
deferens from separating after the reverse vasectomy procedure.
Liberal placement of these outer serosal micro-sutures needs to
be done under a microscope as well to ensure that the ends of
the vas deferens are precisely approximated.
The Microdot method for performing vasectomy reversal is a
variation of the standard multi-layer reverse vasectomy
procedure. Eight evenly spaced microdots are placed on the
face of the cut ends of the vas deferens using a fine micro-tip
pen. Similar 10-0 Nylon and 9-0 Nylon sutures to microsurgical
vasovasostomy are used to re-approximate both layers of the
Can I talk with Dr Karpman before making an appointment?
Yes. Dr Karpman is available to answer any questions regarding your vasectomy reversal at no obligation, even if you are just
considering the initial phase of the process. You can contact him directly at the office (650-962-4663). If you prefer, you can
also contact him via email (email@example.com) with any questions regarding your vasectomy reversal.
Where is the vasectomy reversal surgery performed?
All surgeries are performed at El Camino Surgery Center located adjacent to El Camino Hospital and across the street from
How long does the vasectomy reversal surgery last?
Usually, it takes approximately 2 1/2 hours to perform the operation. Your actual time at the surgery center will be longer. You
will be evaluated by the nursing staff and an anesthesiologist. They will prepare you for the actual procedure by filling out some
paperwork and placing an I.V. line. You will also spend approximately an hour in the post-operative recovery room. The
nursing staff there will make sure you are comfortable and all of your questions are answered prior to being discharged home
on the same day.
What type of anesthesia will I receive?
We believe that having a vasectomy reversal should be a pain-free experience. You will get general anesthesia and be
completely asleep for the entire procedure. You will receive additional pain medication in the recovery room after surgery
ensuring your comfort.
How soon will I be able to return to work?
It depends on the type of work that you do. Patients with desk jobs usually can return to work in 3-5 days. If your work requires
a great amount of activity then you should take at least 10 days off from work.
What limitations will I have after vasectomy reversal?
You should abstain from sexual intercourse for 14 days. Then, resume your regular routine. Likewise, you should refrain from
exercising or any strenuous activity for 14 days.
When do I need to follow-up?
A routine follow-up appointment should be scheduled 2 weeks after the procedure. If you are from out-of-town, Dr Karpman
can arrange a follow-up with a local doctor.
How soon will I know if my vasectomy reversal is successful?
Your first semen analysis will be performed 6-8 weeks after surgery. This can be done on-site at El Camino Urology or at
another convenient location. If you do have your semen analysis performed elsewhere, a copy of the report should be sent to
Dr Karpman via email or fax.
What if I am flying or driving in from out-of-town?
Our helpful and friendly staff will help you with any arrangements. We are conveniently located near San Francisco and San
Jose International airports. There are abundant hotels in the vicinity. Car rental from the airport is extremely convenient.
Vasectomy Reversal Cost
Dr Karpman offers one flat rate for your vasectomy reversal. Whether a vasovasostomy or the technically more challenging
epididymovasostomy is required, you won't be charged any extra. Dr Karpman will also perform the cryopreservation
procedure at no additional charge. If you choose cryopreservation of sperm, there will be a small additional charge for the
processing and storage of the sperm. Included in the cost of the vasectomy reversal are general anesthesia and surgery
center fees, any post-operative follow-up related to the procedure and a semen analysis performed on-site. We offer a very
competitive rate for vasectomy reversal and our staff can help arrange payment options. Financing is available for the entire
cost of the procedure for as low as 1.9% based on your credit history.
Will my insurance pay for vasectomy reversal?
Insurance companies usually do not cover any of the costs for vasectomy reversal. If you have special circumstances, let us
know, and we will try to accommodate you.
How do I schedule my vasectomy reversal?
You can schedule your procedure by contacting Dr Karpman in our office at (650) 962-4663 or via email
Frequently Asked Questions about Vasectomy Reversal and Reverse Vasectomy Procedure
Vasectomy Reversal - Epididymovasostomy - Longitudinal Intussuception VasoEpididymostomy Technique
Epididymovasostomy is required during vasectomy reversal when there is absent sperm in the vas
deferens. This signifies that a secondary epididymal obstruction has developed upstream from
the vasectomy site. This situattion is encountered in approximately 30% of individuals after a
vasectomy. Epididymovasostomy can only be performed under a powerful operating microscope
and only by specially trained microsurgeons using the finest suture (10-0 nylon).
The epididymis is opened and a single tubule is
isolated to bypass the obstruction that has
The vas deferens is then attached to the epididymis using fine
sutures (9-0 nylon). This attachment brings the vas deferens into
close proximity of the single epididymal tubule.
The microsurgical 10-0 Nylon sutures are passed through the
mucosa of the vas deferens in their corresponding locations on
the mucosa of the vas deferens.
The 10-0 Nylon sutures are tied creating a water-tight closure
between the epididymal tubule and the mucosa of the vas
deferens. The single epididymal tubule is pulled (intussucepted)
into the lumen of the vas deferens.
Additional microsurgical sutures are placed between the tunic of
the epididymis and the outer (serosal) edge of the vas deferens.
The additional microsutures on the outer layer of the vas
deferens relieve the tension off of the important inner luminal
Video of Dr Karpman
performing a microsurgical
vasectomy reversal from
YouTube. Click on the