VASECTOMY REVERSAL

For those who do not fully understand what a vasectomy is it is a small operations which stops a man's sperm reaching the semen and is therefore considered a permanent form of contraception. A vasectomy takes around 30 minutes under local anaesthetic and involves cutting or sealing the tube that takes the sperm to the penis.

Vasectomy is quite reliable, only about 1 in 1000 operations are not successful.

Vasectomy reversals are only aprox. 50% successful. Research into this operation shows that the sperm count risers slowly with a plateau occurring by 9 months; and there is a direct relationship between the time since the vasectomy and the success rate following reversal.

Up to three years between the vasectomy and the reversal, the success rate is the highest at around 70% after this time it begins to reduce eventually down to 20% after aprox. 14 years.

Couples must therefore realise that the chances of producing a pregnancy (in the 6-10 men who produce sperm) are around 50% but considerably less if the interval since the vasectomy is 8 years or more.

The more successful vasectomy reversals use a meticulous technique compared to the macroscopic technique (microscopic surgery), although other techniques have varying success rates. One of the major problems of vasectomy itself is the production of antibodies against the mans own sperm. What does this actually mean – well there is a barrier between sperm cells and blood system, and this prevents the blood system recognising the sperm cells and “tagging” as “self”. When the blood system comes into contact with the sperm cells for the first time due to damage, infection and or surgery (to mention a few), antibodies are made against the sperm cells as the body my think they are foreign entities. These anti-sperm antibodies develop in 60 – 70% of men following vasectomy, and the antibodies themselves can prevent fertilisation and pregnancy.

Apart from the problem of antibodies there can be others preventing successful reversal. A number of these are due to various types of blockages that occur in the reproductive tract (vas deferens) or in the epididymis. Depending on the cause of the blockage, further surgery to relieve the block can be performed in some cases, but if this arises, one can imagine, restoration of a good sperm count takes considerably longer.

Other complications however rare could be infection through this very delicate operation.

Couples should be well informed to ascertain their realistic chances of success both by their clinician and the counselling. This will include detailed considerations of the female partners ability to become pregnant, taking into consideration her age and other factors.

For example: if there is a reduced success rate of the sperm to fertilise the female egg then the female partner is in her late 30's or early 40's and her reproduction efficiency is also significantly decreased. These two factors together would make the chances of conception highly inefficient. However other more efficient ways possibly, IVF with ICSI could be used with greater success in having that much wanted baby, again the emotional cost alone for this procedure must be taken into consideration.

The only option available if the reversal is unsuccessful is donated sperm, again professional support is available to all those contemplating any of the treatment procedures discussed above.