Top experts can achieve up to a 99.5% vasectomy reversal success rate for vas-to-vas connections using the new Marks Vas Cutting Forceps and a precision multi-layer (3 to 4 layer) microsurgical technique (1). It is important to ask the doctor’s success numbers (% of men with return of motile sperm into the semen) to help each couple find those with the highest success rates. The higher the doctor’s success, the better the chances that each couple will achieve the dream of having children together. After all, isn’t this what the reversal surgery is all about? Be aware that there are many doctors that claim a high success rate but don’t even do follow-up testing, so how do they know their success rates?  Some doctors consider seeing a single sperm in the fluid as success. 

Of course, every doctor that performs vas reversals will have successes and happy couples. As with any technically challenging surgery, the top urologic microsurgery experts usually provide the very highest success rates with the fewest complications, and so give their patients the very highest chances for realizing their goal of restoring his fertility.

It is smart to ask how the doctor came up with his reverse vasectomy success rates. Did the doctor quote the published success of top experts as if these were their own results? Most would agree that though it’s good to know what is possible, it is best to know what that specific doctor is able to achieve for his or her patients. The doctors of ICVR have a published, proven vasectomy reversal success rate of 99.5% for vas-to-vas connections.

Considering what’s at stake and the consequences for choosing a vas reversal surgeon with a lower success rate, isn’t it smart to seek out a vasectomy reversal doctor with the highest vasectomy reversal successes?

Vas reversals in 2024 can cost anywhere in the US from $800 up to $100,000 or more, but usually not for the same procedure and most likely not for the same reverse vasectomy success rates. Though here at ICVR we charge $12,700, most of the top vas reversal experts charge from $8,000 to $15,000. It is smart to research each doctor and ask for the total all inclusive, “out-of-pocket” cost. We often hear from men who come to us for a redo vas reversal after a failed vas reversal elsewhere that receive surprise bills weeks to months later. Also, some doctors charge more if they have to perform a vas-to-epididymal bypass or if they provide sperm banking. 

ICVR has always offered a fixed, no-surprise cost of $12,700 with 6 months of included aftercare and a year of sperm banking at no charge. Whether we do a straightforward, customized, microsurgical 3 to 4-layer vas-to-vas connection or a more challenging precision epididymal bypass that can take an extra hour or two more, our patient’s costs never go up. Use our personalized Vasectomy Reversal Cost Calculator to learn exactly how much your procedure would cost when performed by one of our expert surgeons.

The wide difference in cost of a vas reversal has to do with many factors. Most often big cities and those on the coasts tend to be more expensive. Insiders know that there are many fixed overhead costs that most will not compromise. There are some older vas reversal techniques that are still used by some doctors  that  are quicker or cheaper. Other doctors don’t provide close or even any aftercare. Some charge less but perform multiple vas reversals in a day.

We suggest that it is logical to first identify the doctors that are true world-class experts, respected by their colleagues and that offer the highest 99.5% vasectomy reversal success. Once these best-of-the-best doctors have been found, then it makes sense to compare cost and what is received for the money invested. At our full-time, vas reversal only center, we perform redo vas reversals almost weekly on men who tell us that they regret using cost as a primary reason to choose the doctor that performed their failed first attempt. As the old saying goes, “the quality and results are remembered long after the cost is forgotten.”

What does each patient get for that investment? 

After all, this is really a once in a lifetime investment that when successful will allow you to have your own children together. You will always be able to find cheaper vas reversals. Even if a doctor offers a discounted vasectomy reversal cost, it is smart to find out what is and is not included. Who actually does the surgery? How many vas reversals does that doctor perform in a day? Ask about aftercare – what if there are questions or issues weeks or months later? Many men do not think they will need aftercare, until they do. Will the doctor review follow-up semen analysis results even many months later and make recommendations for care? Does the doctor offer sperm banking or andrology services at no additional cost? Many do not.

Having a top urologic microsurgeon nearby is rarely important. This is a logical question only if each person assumes that all doctors that perform vasectomy reversals offer the same success rate and care. If this were true, then it makes sense to choose a vasectomy reversal doctor nearby based on the convenience of having the surgery just down the street or nearby in town. Unfortunately, this assumption is not accurate for most men as the vasectomy reversal success rates vary widely from doctor to doctor. While some doctors may be happy with a 70%, 80&, and even a 90% success, many top full-time, there vas reversal only centers like ICVR that are able to achieve up to a 99.5 % success for vas-to-vas connections, usually with much fewer complications. With patients from every state in the US and more than 85 countries around the world, more than 7500 thousand couples have done their research and decided to travel to Dr. Marks and Dr. Burrows in Tucson for the very highest chance for success. We suggest couples first find the best doctors that will give them the highest chances to achieve their dream of having a family together and then look at location.

Yes, vas reversals at our surgery center can still have a high success rate even after 10, 15 and 20 or more years from vasectomy. Our research shows that the number of years from vasectomy, called the “obstructive interval,” does not directly influence the vasectomy reversal success rates. The doctors of ICVR published an important paper showing that the need for a vas-to-epididymal bypass procedure (VE) levels off and plateaus at about 20 years from vasectomy, so the chances for success remains about the same for any number of years past the 20 year mark.

Experts know that, in general, the longer the time from vasectomy, the more likely that a deeper epididymal bypass will be needed with a lower success rate (70 to 90% success) than with a straightforward vas-to-vas connection (99.5%) when no epididymal blockage is found. The doctors of ICVR published an important paper showing that the need for a vas-to-epididymal bypass procedure (VE) levels off and plateaus at about 20 years from vasectomy, so the chances for success remains about the same for any number of years past the 20 year mark. Despite what many doctors say, there is NO magic number of years when a vasectomy reversal will or will not be successful! Just the same, we teach that doctors should not be using the number of years since the vasectomy to decide what connection technique is needed. Some men need bypasses at 5 years and others at 25 years do not. We are proud to have the world’s record vas reversal 42 years from vasectomy, now with a daughter who has a daughter of her own!

No, there should not be any significant discomfort during or after a vas reversal. The good news is that in skilled hands, most men feel no pain and are surprised how comfortable they are during and following the vas reversal. When we do our “house calls” the next day, visiting our patients at their hotel, almost all of our vas reversal patients haven’t even taken a single Tylenol afterwards. It has always baffled me why I hear and read about many men who are sent home with prescriptions for lots of narcotics and who have significant pain that can last for days or weeks after vasectomy reversal elsewhere.

There are a number of reasons why we think our patients have no pain. Much of it, I believe, may be that we are not in a hurry or under pressure to get through several vas reversals in a day, nor are we fatigued from earlier microsurgeries as each doctor limits his practice one vasectomy reversal a day. Plus, this one-a-day approach gives us the luxury of time to be especially precise and meticulous throughout and when closing. Plus before we even start, after the sedation kicks in, we instill plenty of short and long acting numbing medicines so the patients never feel any pain.

There are three types of anesthesia used by most doctors for vasectomy reversals. The type of anesthesia each doctor uses depends on many factors, most commonly what technique the doctor learned during their urology residency  years before or during their fellowship training (4).

A. Some doctors prefer to use the oral sedatives “shotgun” approach where each patient is given various sedatives and narcotics to swallow as pills or liquid before the vasectomy reversal begins. Unfortunately, this approach can provide varying and sometimes unpredictable levels of sedation and comfort. In my mind, the doctor will always have to assume and worry that the sedation might be too much or not enough. Plus, how does the doctor adjust the level of sedation during the vas reversal?

B. Each person will may absorb and metabolize these medications differently, which can result in widely inconsistent and variable onset, intensity and duration of the sedation. There is no way to know how each person will absorb and metabolize each of the medications individually and in combination. At the other extreme are doctors that use general anesthesia, which for many surgeries is truly a modern miracle, where the patient is put into a deep sleep by an anesthesiologist. The advantage to this technique is that the men do not feel any pain during the surgery while they are in a deep, drug induced sleep. There are some concerns that some men can have issues with nausea or vomiting when they wake up. My primary concern is that there can be very rare but very serious complications that I have seen from the general anesthesia (5). Anesthesiologists get paid by how many "cases" they do in a day, and the high volume model is not what we do at ICVR.

C. In our practice we have found we can achieve the ideal balance that is perfect for our patients by using mild intravenous sedation with plenty of long-acting and instant onset numbing medication, which gives each patient all the benefits of the mild sedation without issues with general anesthesia and more control, relaxation and comfort than the “handful of pills” approach. With this mild intravenous sedation technique, the patients are so relaxed that they fall asleep, resting comfortably and pain-free throughout and after the vas reversal. This technique is nice because it uses only the minimal amount of medication needed, so there are essentially none of the rare but serious risks that can be seen with deeper general anesthesia (6). Yes, many doctors prefer general anesthesia to provide a stable surgical platform but in our experience with more than 7000 patients, movement during the vasectomy reversal is very rare and has not been a problem.

ICVR’s doctors developed and perfected an advanced “MicroPulse” mild sedation technique so every patient is relaxed and sleeps comfortably and safely throughout the vasectomy reversal, waking up feeling great and pain-free afterwards.

Unfortunately, insurance rarely pays for a vasectomy reversal. Be aware that even if the insurance company tells a patient that a vas reversal is a covered or partially covered outpatient surgery, even by a doctor not contracted in the plan, the insurance company later on can and often will refuse to pay anything for the vas reversal, which means you are responsible for the cost.

Even in those very rare situations where the insurance company does pay, it is often only a small fraction of the doctor’s fee, as the insurance company alone gets to decide what they think is “reasonable and customary.” There are some plans that will cover or reimburse the costs of a vas reversal, so it is always smart to call each person’s specific company to ask and find out for sure.

To make it more affordable to come to ICVR, we have set up Affordable Payment Options >>

Will the VA or military cover the vasectomy reversal costs?

Yes, sometimes the VA will agree to cover the costs, though usually for a reverse vasectomy at a VA hospital. The good news is that some of the top vas reversal experts perform vasectomy reversals at VA hospitals. Unfortunately, there are other VA hospitals where a general urologist who has minimal experience or may have no significant training could be the "designated" reverse vasectomy doctor, so possibly with a much lower success rate. Just as with the VA, active-duty military members can have a highly respected fellowship-trained urologist or a doctor with no training or expertise perform the vas reversal. It is always smart to ask and find out more about the specific doctor that will be doing your reversal early on wherever the vasectomy reversal will be performed. Just because they can do it does not always mean that they should.

In skilled and experienced hands, a correctly performed precision vasectomy reversal usually takes 2 to 2 1/2-hours. There are some doctors that will perform a vasectomy reversal in 45 to 60 minutes, performing up to 5 in a day. We have performed more than 7,500 vasectomy reversals and we simply do not know what these doctors are doing or not doing that allows them to go so fast. I have talked to many respected vas reversal experts who tell me that they wonder if any critical steps are being skipped. They also have concerns about the doctors that routinely take 4 to 6 hours or more to do a routine vasectomy reversal.

The answer should be an ABSOLUTELY YES! Urologists are the only medical specialists trained with 4 years of an intensive urologic residency and training in complex aspects of male reproduction and reconstructive fertility microsurgery. Having this training allows urologists to handle any hormonal or other male fertility questions or issues that often come up before, during or after the vasectomy reversal. I am told by patients that that come to us for a redo reversal because of a failed reversal elsewhere, that many "self-proclaimed" vasectomy reversal doctors are not even urologists.

I have been told that some have not had any significant training in male reproduction or even urologic microsurgery. One patient that came to us following a failed first vasectomy reversal attempt elsewhere told us that the non-urologist doctor he used believed that whatever knowledge or skills they have from other specialties or from watching someone else perform vas reversals combined with a desire or calling qualified them to perform vas reversals. At ICVR, both Dr. Marks and Dr. Burrows are highly trained, experienced senior urologists (board certified) who offer the very highest vasectomy reversal success rates, and so the highest chances for having a baby after a vasectomy! No surprise lack of urologic microsurgery.

(A sneaky way of getting this answer is to ask, “what other surgeries does the doctor do?”) The highest success rates will usually be with urologists where vas reversals are all they do or at least a large part of the surgeries that they perform. Most general urologists rarely perform vasectomy reversals and so their success rates can be much lower than the busy true urologic experts. ICVR has been a full-time, vas reversal only center for decades. The entire staff of senior professionals is here for one goal, one purpose – to give every patient the most successful, customized reverse vasectomy with world-class care.

Almost all of the world’s true experts usually limit their practice to only one vas reversal a day. By limiting ourselves to only one vasectomy reversal a day, each patient can trust that he will get the doctor’s full and undivided attention-to-detail. Every patient knows the surgeon is not pressured to rush to the second or third case that day, nor is he fatigued from earlier vas reversals. ICVR’s doctors each limit their practice to only one vas reversal each day – always have, always will. Because we believe that this is what’s best for each patient.

Top vas reversal experts often perform up to 2 to 5 vasectomy reversals every week. It is rare to find top notch urologists that do only an occasional vas reversal as part of a busy general urology practice. I personally am not a fan of the high volume approach where 10 to 15 or more vas reversals are performed by a doctor every week, sometimes 3 or more a day! Dr. Marks and Dr. Burrows together perform on average 5 to 8 vasectomy reversals every week. Of course, there are others that disagree with this and feel that they get the same results performing multiple vas reversals in a day.

The best answer should be yes, it is smart to seek out a doctor that is considered by his or her colleagues to be a true vasectomy reversal expert. Many doctors only do an occasional vas reversal and are not true experts. Others want their patients to think they are top experts when they may not be. The doctors of ICVR are frequently asked to teach the courses at International Urology and Fertility conferences and meetings. When one of the world's leading experts was asked why he keeps asking Dr. Marks to teach the vasectomy reversal course, he explained "there is no one else in the world that has the same high success and volume.

The doctors of ICVR are true authorities and continue to publish important papers plus we have presented research studies at many international meetings about vasectomy reversals, wrote the certification course on vas reversals as well as authored the only textbook for other doctors to learn advanced vasectomy reversal techniques.

We are just a few of the true experts that continue to be invited to teach the courses at international meetings for more than 15 years to other urologists on how to perform state-of-the-art vas reversals. If a doctor has published a paper, look at the subject matter of the paper. Many times, it has nothing to do with vas reversals or even urology. Of course, just because a doctor published papers does not alone mean that he or she is a skilled microsurgeon, but it is often a good sign.

The answer should be an absolute yes, the doctor should microscopically analyze the vasal fluid to find evidence that the tubes are open or there is epididymal blockage with every vas reversal on each side. Knowing whether sperm are present or absent in the fluid is the only way to know if the deeper system is open and so a vas-to-vas (VV) connection is correct or if there is deeper blockage and so a vas-to-epididymal (VE) bypass is needed.

Many vas reversal doctors still don’t do a microscopic analysis of the vasal fluid, mistakenly believing that the number of years from vasectomy (obstructive interval) or the way the fluid looks (the gross findings) tells them what vas reversal technique they need to do.

I have been told by our patients that some doctors will only perform a vas-to-vas connection on every patient, even when they the findings suggest that there is deeper blockage, believing in the “one size fits all” approach. Microscopically looking at the vasal fluid is not a new idea – urologists have known for more than 30 years to do this, and looking for sperm is what we teach in every course and in the textbook we wrote on reverse vasectomies. Analyzing the vasal fluid for sperm is a critical part of every personalized vasectomy reversal at ICVR to decide what correct procedure is needed for that patient, whether a vas-to-vas or a vas-to-epididymal bypass. Doing the wrong technique guarantees failure on that side.

(or does the doctor use medical students, residents, fellows-in-training or physician extenders to participate in any part of the vasectomy reversal surgery or care?) Most often, the very highest success rates will be when the urologic microsurgeon performs the entire vas reversal himself, from start to finish. ICVR does not allow doctors-in-training to perform or even participate in the reverse vasectomy. At our full time, vas reversal only center, each patient gets the top doctor that was selected to do the entire microsurgery to achieve the very highest success rates with the lowest risks for complications. Why settle for anything less?

Of course, the above thoughts are generally true. There will always be highly trained and well published doctors that may not be microscopically skilled while others with minimal to no training may have excellent outcomes. Just the same, there may be some who are not fully trained urologic microsurgeons and may be technically gifted. The key point is to ask questions so each patient can choose the physician that will give them the highest chances for vas reversal success with the fewest complications and close, attentive aftercare.

The correct answer to that is yes, anti-sperm antibodies are not usually an issue and rarely impact on fertility after vas reversal. Study after research study shows that anti-sperm antibodies after vas reversals are not relevant to male fertility in the vast majority of men and play almost no role in natural conception and pregnancy. Yet many doctors still believe wrong ideas or misinterpret old studies and so incorrectly think that antibodies commonly play a role.

We have heard from many patients that some doctors told them that anti-sperm antibodies always block fertility and so they should not have a vasectomy reversal and instead go directly to IVF. At ICVR, we rarely see any issues from sperm antibodies. We even did our own research and looked at many patients with and without significant antibodies after a vasectomy reversal and found no difference in fertility and pregnancy rates between the two groups. One of our patients even had 100% anti-sperm antibodies after his vas reversal and still fathered several children naturally.

The ideal answer is yes, the surgeon should always use a high-power surgical microscope with 40X power to perform a precision multi-layer (3 to 4 layer) connection. True experts realize that patients will achieve the highest vas reversal success rates, up to 99.5 % for vas-to-vas connections, with the more precise, anatomically correct multi-layer alignment of each of the layers of the vas. This has been studied for decades and should only be done using a high-power surgical microscope. I do not understand why some doctors still use these older, easier and quicker 1- or 2-layer closure vas reversal techniques, often with only magnifying glasses (called Loupes) or basic training microscopes and so probably have lower success rates. Dr. Marks and Dr. Burrows will only perform the more precise multi-layer closure for both the vas-to-vas and the vas-to-epididymal connections using a high-power surgical microscope for every vas reversal.

The most up-to-date technique that we teach in 2024  is to use six stitches of the tiniest 10-0 (the higher the number, the thinner the sutures) Nylon micro sutures with a 70 or 100-micron needle on the innermost layer for every vasectomy reversal. It is critical to use the smallest suture thickness with the smallest needle that will do the job. Larger, thicker sutures and needles may be easier to handle and less expensive but cause more damage to the delicate tissues, with concerns for increased inflammation and so more scarring at the connection sites, with a higher risk of blockage and delayed failure of the vasectomy reversal. I understand that there are doctors that use really thick 8-0 or even 7-0 on the inner layer. ICVR’s doctors will only us the most delicate 10-0 microsutures to give each patient the very highest vas reversal success rates.

The answer should be an absolute yes in 2024 to ensure the highest chances for success. We encourage patients to look for doctors that provide continued, frequent aftercare relating to the vasectomy reversal. Many doctors may think that as soon as the vas reversal is over that they are done, when this is not safe or the standard-of-care in 2024. 

What they don’t understand is that the aftercare is often just as important as the reverse vasectomy and for some, may be more important. In any surgery, aftercare is a critical aspect of the care. How some vas reversal doctors do not provide this essential aftercare makes no sense. The doctors of ICVR understand the importance of vasectomy reversal aftercare.

It is smart to find a doctor where the answer is yes, that they provide  the option for no-cost sperm banking during the reverse vasectomy. It is smart to look for a doctor where each patient has the option to bank sperm at no charge during the vas reversal, if / when the fluid is bankable. ICVR’s onsite andrology lab provides the option for free sperm banking at the time of the reverse vasectomy, just in case, with the first year of storage at no additional cost. This provides an added level of “peace of mind” and can save our patients many thousands of dollars for sperm retrieval, in the rare situation it might be needed.