Vasectomy – The Procedure

Basic Anatomy

Sperms are produced and stored in the testicles. During sexual intercourse at the time of male orgasm, the sperms are rapidly transported from the testicle and are ejaculated. The thin tube that transports the sperm from the testicle is called the vas deferens. Each testicle has only one vas deferens.

During the vasectomy procedure, the vas deferens from each testicle is cut through and one end (abdominal end) tied off. This prevents any future transport of sperms away from the testicle. In other words, sperms are still being produced but they have no way of getting from the testicle to “the outside”, therefore rendering the male infertile (sterile).

The Vasectomy Procedure Step-by-Step

The majority of men who opt to have a vasectomy do so between the ages of 25 and 45 years. These are the years of career building and productivity. With this in mind, I have optimized the circumstances and technique of the operation to ensure a relaxed and stress-free operation day and rapid post-operative recovery.

If you opted to have the vasectomy performed under local anaesthesia, there is no need to be nil by mouth from the previous evening. You need to arrive at my consulting rooms and surgical facility about 90 minutes prior to the scheduled time of your operation. You will be admitted to the ward and then transferred to the fully equipped operating theatre where the vasectomy will be performed as follows:

Step 1: Local anaesthesia – NO NEEDLE

No needle is used to inject local anaestetic into the area that will be operated on. I use the “Madajet Needle-Free Injector” to spray a high pressure jet of long-acting local anaesthetic solution onto the scrotal skin on the exact spot where access to the vas deferens will be obtained.

The mist of anaestetic penetrates into the skin and underlying structures (vas deferens), achieving a complete numbing effect 12 times faster than with the conventional needle-injection anaesthesia technique. Apart from the benefit that patients are not subjected to the pain of a needle puncture in this very sensitive area of the body, another advantage of the “no needle” approach is that there is less trauma to the small nerves and blood vessels lying under the skin and around the vas deferens. Minimizing tissue trauma during an operation facilitates a decrease in post-operative pain, fewer complications and faster recovery.

Step 2: Access to the vas deferens – NO SCALPEL

After making sure that the area has been completely anaesthetized, a small surgical forceps with a very sharp tip is used to puncture the skin overlying the vas deferens.

The opening in the skin is then dilated / opened up a few millimeters to allow a segment of the vas deferens to be pulled through the opening – a special forceps with a ring at the tip is used for this purpose.

Step 3: Removing a segment of vas and tying off one end – OPEN ENDED

With a 3cm piece of vas deferens now pulled through the skin opening, a 1cm segment is removed using a surgical scissors. This leaves 2 open ends of vas deferens:

The abdominal end is closed by tying it with a surgical stitch (called “ligation”). This is to decrease the risk of the 2 ends somehow re-connecting on their own at a later stage. Additionally, I stitch a small piece of muscle tissue that is normally situated next to the vas over the tied off end – this technique (called “fascia interposition”) has been proven to decrease the risk of vasectomy failure even more. Furthermore, the inside (lumen) of the abdominal end of the vas deferens is also thermally disrupted (called “mucosal cautery”) in order to prevent it from ever opening up and re-connecting. Performing these three measures (ligation, fascia interposition, mucosal cautery) ensures a very high success rate.

The testicular end of the vas deferens is not closed with a stitch – it is left open (“Open-ended Vasectomy”). Leaving this piece open has been proven to reduce the risk of “Post Vasectomy Pain Syndrome”, which is a long-term painful and extremely bothersome reality for about 5% of men who are subjected to the traditional method of vasectomy. International research has further showed that open ended vasectomy significantly improves the chances of successfully reversing the vasectomy, should a patient wish to have more children at some stage in the future.

It is important to note that open ended vasectomy (combined with ligation, fascia interposition and mucosal cautery of the abdominal end) is just as effective in establishing male sterility as a vasectomy where both ends of the vas are tied off. So no compromise is made on the efficacy of the vasectomy by leaving one end open – it just has the added advantages mentioned above.

Steps 1 to 3 should take altogether about 25 minutes to complete on both sides (left and right testicles). No stitches are needed to close the “no scalpel” openings in the scrotal skin – a small plaster is simply placed over each wound.

You will then leave the operating theatre and go back to the ward to make sure that you are feeling relaxed and not in pain, after which you’ll be allowed to go home.

  • Good day Dr Zarrabi I hope you are keeping well. It has been 10 months since we did the Varicocele repair and a lot has happened since then and obviously it’s been quite a journey. But needless to say it was not all in vein. Hence my e-mail to you today. If you recall we went back to the Aevitas about August for one last Invitro (6th). The result was that we had a better count and better mobility due to the Varicocele repair as what we ever had before with the previous 5 Invitros. And I am very pleased to announce that E had a successful/positive result and she is 3 and half months pregnant now. We would just like to express our Sincere Gratitude to you and your staff for all your assistance and prayers through the whole process. Kind regards,
    JB, Ermelo
  • We want to thank you and Dr Zarrabi for being kind and gentle…. There is such a huge difference in patient care, follow-ups and bruising between the previous Dr and Dr Zarrabi’s offices. I thank God that we went to your practice and I will let you know if there is a little heart beat inside of me… Lots of Love.
    RL, Rustenburg
  • Good day Dr Zarrabi Trust you well. I just wanted to say thanks very much for your professionalism and great help on my husband’s operation. Today I have a very healthy active 9 month old son thanks to you. At one stage we had just given up because nothing happened but then this miracle came along. Keep up the great work. Thanks and regards,
    KW, Cape Town
  • Dear Dr Zarrabi We have the best, if not surprising news, 'M is PREGNANT!!! She been feeling funny in the latter part of August as I was starting my course of prelox. We are overwhelmed and overjoyed. Thank you, thank you so so much.
    PM, Johannesburg
  • Good morning Gillian I just want to send you this email to say a big thank you for all your assistance in making our trip a success. We are safely back home and everything with M is going great so far. Dr Zarrabi really is the best! I will keep you posted on any further developments. Thank you kindly and have a blessed day.
    NL, Johannesburg
  • Hi Doctor Baby girl YP was born on the 12th of April 2017. You do amazing work and she turns 3 months old tomorrow. See pics attached… Regards
    TN, Johannesburg
  • Dear Dr Zarrabi A and I feel truly blessed to have been able to have this reversal done by Dr Zarrabi. The fact that he is able to even perform an operation of this nature is truly amazing and we are fortunate to have somebody in South Africa that has the skillset to perform Micro surgery reversals. I imagine it must be very rewarding to make such a positive difference in people’s lives. In addition to this we found it to be easy and hassle-free to undergo the surgery in spite of the fact that we live more than 1500 kilometres away. Thank you for the professional, efficient and friendly way that you assisted us throughout this process. I will be sure to let you know as soon as A is pregnant (she may already be). Once again thank you.
    CF, Witbank
  • Good day Dr Zarrabi Thank you so much to You and your Staff. We (my Wife) recently did a blood test; and it came out positive - that she is pregnant. Thank you soo much Dr Zarrabi; thank you for helping us in our journey.
    PF, Johannesburg
  • Thank you so much, doc I truly appreciate all your support and valuable information. I hope your stay in the USA is amazing, you have been the most amazing medical professional i have ever dealt with and I'm extremely grateful that you've helped me all along. Kind regards,
    DK, Cape Town
  • Good day Dr Amir / Gillian and Team I hereby would like to thank you all for the excellent and friendly service we received. Everyone on the doctor’s staff was professional and efficient, they made me feel at ease in a stressful situation. I felt that I made a good choice in coming here and, as a group, each of the staff members cared for me and wanted to help me get better. I was thoroughly impressed with the facilities and services at the hospital. Everyone knew what needed to be done, at what time and did it with a smile and compassion. Any questions that myself or wife had was answered quickly and with a friendly disposition. In closing, I would like to thank you for all that you did even after I was dismissed and had a little complication Dr Zarrabi assisted and was ready to take action. It is professionals as yourself and facilities like your hospital that made me decided to use you from the beginning. Regards,
    JH, Pretoria
  • Dear Dr Zarrabi We are not sure you will remember us, amongst all your clients! D and I came to see you in November 2013 for a vasectomy reversal procedure. You were a little concerned that his vasectomy was 15 years in the past and he was 55 at the time. We visited your practice this month while in Cape Town for the first scan of our expected little one - we wanted to share the good news with you! We did conceive within 3 months of the procedure but had an early miscarriage and what with the ups and downs of life over the last 2 years didn't get this far until now. SO - D is in peak condition and our baby is due on Christmas day this year. Thank you so very much for all the microsurgery and D says please send him 1000 business cards to hand out wherever he goes! We will send you a picture of the three of us for your collection when baby is born. With heartfelt gratitude and deepest thanks.
    SD, Johannesburg
  • Dear Dr Zarrabi We are writing to you to thank you for your amazing care, concern and professionalism. Since meeting you we have has such a wonderful experience working with you. Thank you for everything!! It is greatly appreciated. Wishing you a good evening. With gratitude,
    NC, Johannesburg
  • Hi Amir Hope all's well on your side. I am pleased to announce that L is pregnant - exactly 1 year to the day of the reversal! We had it confirmed with a blood test today. We just thank you for your skill and optimism. Just interested to know... Have we set a new record for length of time between vasectomy and reversal: 18 years ;-) thanks again to you and your team. Cheers D.
    DO, Port Elizabeth
  • Liewe Dr Zarrabi Ons wil u net graag in kennis stel dat die prosedure wat u gedoen het suksesvol was. Ons moes nog gaan vir die sperm analise, maar ons het vroeër uitgevind ons is swanger. Ons is nou 6 weke swanger, en wil u net baie hartlik bedank vir die suksesvolle operasie. Baie Dankie
    GH, Cape Town
  • Hallo Dok, Lyk my jou operasie was ‘n reuse sukses. My vrou is nou 11 weke swanger. Dit het ons dus so 1 jaar en 3 maande geneem om swanger te raak. Groete,
    JD, Pretoria
  • Hi Amir Weereens baie dankie vir jou hulp! Dit was n great ervaring! Baie profesioneel! World Class!! Groete
    JS, Cape Town
  • Dear Dr. Zarrabi, Hope you are well. I just want to say thank you for a fantastic service and care I received. It was nice to chat with you first and it made me feel like I am in the right hands. The staff in the clinic were also great. Warm and kind and understanding. A service that stands out compared to other clinics or hospitals where nobody comes to check on you and you never see anybody around.  
    OF, Hermanus
  • Hallo Dokter Zarrabi Ekt gister met my sussie en swear ‘n koffietjie gedrink en hierdie ‘great’ storie gehoor van hoe u hulle hanteer en versorg het. (eintlik gebless het!) My mond het oopgehang, want mens hoor dit min. Dankie Dokter, ek eer en respekteer jou daarvoor. Alle sukses met jou praktyk en drome vorentoe. Vriendelike groete  
    BB, Johannesburg
  • Hello Dr. Zarrabi, It has been a hectic couple of months. I have great news, M is 11 weeks pregnant and to top it off I didn’t even go for the sperm test. We found out the week that the test was scheduled. Thank you! You have worked miracles we never in our wildest dreams thought that it would happen so soon. We will keep you updated as the pregnancy progresses and might even come introduce the little one next time we are in Cape Town. Regards
    LB, Botswana 
    (Vasectomy 8 years previously)
  • Dear Dr Zarrabi, Many thanks to you and the gift that you have given to me. I really wish that I were in Cape Town to celebrate with you. Thanks once again for your great skill and miraculous hands.  
    PN, Durban
    (Vasectomy 14 years ago, 2 cycles IVF / ICSI unsuccessful)
  • Hi Doc, Just a quick email to share our wonderful news - we are pregnant!!! We can't thank you enough for all you have done, and not giving up when most doctors probably would have just shrugged their shoulders. I know you were a tool in the Great Healer's hands, but nonetheless, a BIG thank you!! Can't wait to send our updated family picture. Have a wonderful, blessed day!  
    MH, Swakopmund
  • Dear all, After much soul searching, S and I decided to reverse his vasectomy and try naturally before resorting to other options. S had his vasectomy reversal done by Dr Amir Zarrabi. We never got to do the 6 month sperm test as I had fallen pregnant. The pregnancy was uneventful and our son was delivered at 39 weeks.  
    GL, Cape Town
    (Vasectomy 13 years ago, 4 cycles IVF / ICSI unsuccessful)
  • Hi Dr, Thank you so much for this report!! I am in tears right now, I did not even realize how much I was stressing about this until I got your e-mail!! You really have made this year the best one ever and we will highly recommend you to anyone we can. Your support and complete handling of our case including your after service has been so amazing! We are both so grateful to you. Kind regards,
    MS, Plettenberg Bay
    (Vasectomy 17 years ago, 3 cycles IUI with donor sperm unsuccessful)
  • Dear Dr Zarrabi This letter is long overdue…but for a very happy reason. My wife and I would like to express our heartfelt appreciation for the efforts you made and the application of your considerable skill in reversing my previous vasectomy done 13 years ago. Before proceeding with the surgery you fully explained what we could expect in terms of a timeline, and we complied with all the steps along the post-surgical way. As per your instruction we were supposed to have a sperm analysis done 3 months after the operation but when my wife missed her date we knew something was going on and I didn’t even have to go for the sperm test. We were ecstatic to learn that the surgery was successful and that I was once again delivering viable “swimmers”! We are now 12 weeks pregnant and all thanks goes to you. Doctor we are so blessed to came across your information on the website just when we were at our lowest. We have been through ICSI twice, as we thought it would have a better chance of success. With even everything as normal and positive as could be both sessions was unsuccessful. It costed us a fortune and we didn’t realize that if we did our homework properly the first time, we could had our baby in our arms right now. That is why we are extremely thankful that you have done such a great job. We never doubted you once…we just knew this was it. Words are a poor conveyance of the gratitude we feel, but please accept them with the knowledge that you have made us very happy as a result of your outstanding skill and diligence. Warmest regards,  
    GH, Cape Town
    (Vasectomy 13 years ago, 2 cycles IVF / ICSI unsuccessful)
  • Hi Doctor Amir, We hope that you and your family had a wonderful Christmas and new year. We have some wonderful news, D is pregnant!! This miracle was conceived naturally!! She is just over five weeks today and we are both over the moon. We would like to thank you again for all that you have done for us to make this miracle happen! We will keep you updated. Kind regards,
    CD, Phalaborwa
    (Vasectomy 10 years previously)
  • Dear Dr Zarrabi, As you can see from the attached pics, our 2015 started off extremely well, all thanks to you... KL was delivered via c-section at 08:31am on Friday the 2nd Jan 2015. Weighing 3.22kg and measuring 51cm. She is gorgeous! I'd like to extend a very big thank you to you and your staff for making our dream come true. A is thrilled to be a big sister. Take care and best regards,
    MD, Namibia
    (Vasectomy 8 years previously)
  • Good day Dr Zarrabi We are happy to announce the birth of our baby girl TH. She was born on the 4th of February 2015 weighing 3.350kg. This was a miracle to us. We would like to thank you for making our dream come true by resulting in a successful vasectomy reversal on my husband G in October 2013. Thank you so much doctor!
    SH, Cape Town
    (Vasectomy 13 years previously)