Reversing Vasectomy Reversal Thinking

Posted on by Paul Turek, MD

Man in his late 40s considers vasectomy reversal.

You had your wings clipped, and now you want more children. What’s a guy to do? Well, that depends on who you ask.  Your choices include vasectomy reversal or sperm retrieval and assisted reproduction (IVF – ICSI). Doctors who perform IVF – ICSI might say that vasectomy reversals don’t work. Doctors who do vasectomy reversals say that they do. Other doctors fall somewhere in the middle and say that “younger” vasectomies are reversible but “older” ones are not. Again, what’s a guy to do?

Facts about Fatherhood after Vasectomy

To get a handle on this, let’s begin with the irrefutable facts of the case:

  • Where does conception occur? Vasectomy reversal allows for conception in the bedroom, whereas it occurs in a fluorescent-lit, laboratory test tube with IVF – ICSI.
  • Who pays? If insurance does not cover either approach, then vasectomy reversal is always cheaper than IVF – ICSI.
  • Who gets procedures? Reversal involves surgery on the man but not the woman. IVF – ICSI involves procedures on both partners. Good to know if you like sharing such things.
  • How quickly can we get pregnant? Time to conception is generally faster with IVF – ICSI than vasectomy reversal. This may not be true if the vasectomy was done less than 10 years ago, when time-to-pregnancy may be similar.
  • What is the risk of twins? The chance of having twins or higher multiples is 1% with vasectomy reversal (i.e. sex) and 20% with IVF – ICSI.
  • What is the risk of birth defects? The chance of having a child with birth defects is higher (3.5-4% vs. 3%) with IVF – ICSI compared to sex. And, there is a bias to the birth defects associated with IVF-ICSI in that they tend to be neurodevelopmental (brain) and heart- or genital-related. (So, lab conception carries different risks than bedroom conception, and that matters to some couples.)

Should I Get an Exam Before Reversing a Long-Term Vasectomy?

Yes. A vasectomy that is over 15 years old does not automatically predict the type of repair required. A preoperative exam lets me (Dr. Paul Turek) assess testicular size, consistency, vasal length and the presence of granulomas or other markers that can hone or refine expectations for reversal success. 

The Problem of the Older Vasectomy

As I appraise patients of these facts in my daily practice, it has occurred to me that the issue of the age of the vasectomy or how “old” it is appears important..  The question I had heard most often — “Are older vasectomies even reversible?” — had surprisingly little data behind it. So I set out to study it directly. My published research speaks to the relative performance of vasectomy reversal and IVF-ICSI with female partners who are less than 38 years old. It also addresses the success of reversals in cases of either older men (>45 years) or older vasectomies (>15 years) or both. 


Probably the biggest issue with the “older” vasectomy is that, just like a tire that is continually being filled, a physiological “blow out” of the system is more likely to be observed at reversal. It’s not dangerous or anything, but it does mean that a more “involved” procedure, termed epididymovasostomy, is needed at reversal to restore connectivity and fertility. And, by the way, the epididymovasostomy is one of the hardest microsurgical procedures to perform well on this good earth. So figuring out how often blow-outs actually occur — and if an individual patient may need this procedure — matters a great deal.


For 25 years, the prevailing thought among surgeons was that the rate of “blow outs” increased linearly as vasectomies age. Published algorithms and nomograms confirmed the thinking that, given enough time, every vasectomy will “blow out” and need an epididymovasostomy instead of a vasovasostomy to restore sperm counts and fertility. And, as epididymovasostomy success rates are not as good as simpler procedures at reversal, this means that vasectomy reversal success rates should indeed fall with vasectomy age.

But what if that isn’t true? What if blow-outs don’t continue rising indefinitely? That is exactly what our research suggested. In our study, the rate of epididymovasostomy increases for the first two decades after vasectomy, then plateaus — meaning many long-standing vasectomies remain far more repairable than previously believed. I guess that I agree with Don Miguel Ruiz when he said: “It is always better to ask than to make an assumption.”

Can We Confirm Whether a “Blow-Out” Has Happened?

Yes. During reversal, the fluid from the testicular side of the vas is examined microscopically. The presence of sperm fragments or specific fluid patterns (based on Silber scoring) indicates whether pressure buildup caused an epididymal obstruction. This determines the correct repair — vasovasostomy or epididymovasostomy — at the moment of surgery.

Schedule a Consultation

If you’re considering fatherhood after vasectomy—whether your vasectomy was one year ago or thirty one—there’s real value in getting answers grounded in data, not assumptions. Schedule a consultation with Dr. Turek in San Francisco or Los Angeles at 1-888-TUREK-MD to review your exact situation, understand your chances, and chart the clearest path back to fertility.