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Dr Margaret answers e-mailers' embarrassing problems in this biweekly problem page. Vasectomy reversal Dear Dr Margaret My partner had a vasectomy 2 years ago and now regrets it. He’s considering having a vasectomy reversal done. Will it be successful? There is a very good chance that the reversal operation will be successful, partly because the vasectomy was done fairly recently. As you probably know, the vas deferens is the tube that carries the sperm from the testicles towards the penis. There is one each side, and they are cut during a vasectomy. During the reversal operation, the surgeon sews the cut ends together, keeping the channel open. This is tricky, because they are tiny - the channel inside the tubes is about 1 mm across. During the operation the surgeon will use a magnifier. Some surgeons are using a special microscope and incredibly fine stitches. Using this technique (microsurgery), they sew the insides of the ends of the tubes together with one row of stitches, and the outside of the tubes with another row. I think this is amazing, when you consider the inside of the tube is the size of a pinhead. The more recent the vasectomy, the more likely that reversal will work. In a large American study of vasectomy reversal, the pregnancy rates were 76% for those, like your partner, whose vasectomy was less than 3 years previously. The pregnancy rates were not as good if the vasectomy was longer ago - 53% for 3-8 years previously, 44% for 9 - 14 years previously and 30% for vasectomy more than 15 years previously. In this study, the reversals were done by microsurgery. Don’t expect to become pregnant immediately after he has had the operation - it can take several months for the sperm to become optimal. There are several reasons why a reversal may not be successful. One of the most common is a blockage where the tubes are joined, or a blockage may have occurred previously in the tubes further back towards the testicle. Another reason is that so-called ‘anti-sperm’ antibodies may have formed after the vasectomy. Sperm continue to be produced after a vasectomy, and some may leak out from the cut end of the tube, and enter the surrounding tissue. The body perceives these as invaders, and makes antibodies to attack them. This happens to some extent in 60% of men after vasectomy. If very large amounts of antibodies are present, all the sperm he makes may be damaged, so the man becomes infertile even though the vasectomy has been reversed, but this is uncommon. If you want to know more about vasectomy, look at www.engenderhealth.org/wh/fp/cvas2.html and www.plannedparenthood.org/BIRTH-CONTROL/allaboutvas.htm. A good information sheet on vasectomy reversal is also available from Claremont Hospital, Sheffield S10 5UB, UK. Tel: 01142 632103
Sources Belker AM et al. Results of 1469 microsurgical vasectomy reversals by the vasovasectomy study group. Journal of Urology 1991;145:505-11. Vasectomy and vasovasostomy (vasectomy reversal). Nidus Well-Connected Report #37 September 30 2001. www.well-connected.com. Any
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