Does carefirst cover vasectomy reversal

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By Health Editorial Staff. Men who have undergone a vasectomy may, at some point in the future, decide to have the procedure reversed.

Although advances in surgical techniques and medical science have made vasectomy reversal possible, this procedure involves delicate microsurgery that is complex and requires the use of general anesthesia. Most insurance plans will not cover these costs, so the financial burden will likely be shifted to the person undergoing the procedure. The out-of-pocket costs associated with a vasectomy reversal may prompt the investigation of other conception methods.

Assisted reproductive technologies ART tend to be more expensive than vasectomy reversals. Such approaches, which include in vitro fertilization, have an overall success rate of about 30 percent.

In comparison, vasectomy reversal success rates range from 40 to 75 percent. See Alternatives to a vasectomy reversal for more information. Before choosing between vasectomy reversal and ART, check with your insurance company to find out what costs, if any, are covered.

The path lumen within the vas deferens is around one-third of a millimeter in diameter. The lumen of the epididymis can be one-third to one-half of this size. Thus, when possible, vasovasostomy is preferred. The decision of whether to perform a vasovasostomy or a vasoepididymostomy depends upon the quality of the fluid from the vas deferens at the time of surgery, patient characteristics such as time since vasectomy greater than 10 years and surgeon experience.

Sometimes the sperm can be blocked in a region separate from the vasectomy site — often in the epididymis after a prolonged time since vasectomy.

In these cases, bypassing the vasectomy site with vasovasostomy will not suffice to allow sperm to reach the ejaculate. Using intraoperative findings, an experienced surgeon will be able to decide the appropriate procedure. Since this decision is made during the surgery, it is important to have a surgeon who is experienced, confident and prepared for either operation.

Using suboptimal magnification equipment can drastically cut the cost of the procedure. However, optimal magnification has been shown to improve outcomes. In addition, when a proper surgical microscope is used, general anesthesia is usually preferred. However, many clinics using lesser magnification will perform the operation under local anesthesia to cut costs. Others cut costs by performing only vasovasostomy to limit the time of the operation, even when vasoepididymostomy would be preferred by an experienced surgeon.

Vasoepididymostomy or epididymovasostomy requires even more experience and surgical precision for optimal results. As mentioned, the decision to perform vasoepididymostomy is made during the operation, so it is imperative that the surgeon is prepared and experienced in this technique. To perform vasoepididymostomy, a single epididymal tubule is carefully dissected and mobilized.

It is then incised in a location upstream from the suspected obstruction. The fluid is checked for sperm and, if none are present, another transection is made closer to the beginning of the epididymal tubules. The anastomosis connection is then performed with two layers of extremely fine suture under the operating microscope. You will be asked not to eat or drink anything the night before surgery, as a measure to decrease the chance of complications with anesthesia.

You will then present to the facility and meet with the anesthesia team and doctor. The procedure is done under general anesthesia, meaning the patient is completely asleep. It is an outpatient surgery, so patients return home or to a nearby hotel without actually being admitted directly to the hospital. This saves considerable expense and makes the overall experience much more pleasant.

Vasovasostomy or epididymovasostomy usually takes approximately 2. Postoperative follow-up includes an evaluation of the healing wound at weeks, although many foreign patients forego this visit for convenience purposes. Semen analysis is usually first checked between two and three months after surgery.

Semen analyses are then obtained for approximately 4 — 6 months, or until the sperm count stabilizes. It can take up to 6 — 12 months for sperm to return to the ejaculate following a vasovasostomy and longer following an epididymovasostomy up to 18 months. However, in the vast majority of patients, sperm will be seen in the ejaculate three months after vasovasostomy. If semen quality is less than expected, anti-inflammatory medications may be prescribed to decrease scar formation that can block the surgery site.

Adoption and the use of donor sperm with assisted reproductive techniques ART are entirely acceptable options. In this case, sperm retrieval might make more sense for the couple than vasectomy reversal. Cryopreservation of sperm sperm banking can be performed at the time of vasectomy reversal.

Sperm can be acquired by testicular sperm extraction TESE in most patients, and from epididymal or vasal fluid in some patients.

Because vasectomy reversals may infrequently scar over time despite good initial results, cryopreservation may also be performed on ejaculated specimens early in the course of recovery.