Most common reasons to “regret” a vasectomy.

From Family Practice Notebook

Risk factors: Regretting Vasectomy

  1. Age under 30 years (12.5 times more likely to request vasectomy reversal)
  2. Few children (but men with no children are less likely to request reversal)
  3. Relationship not stable
  4. Religious affiliation prohibiting vasectomy
  5. Pressure from partner to have procedure
  6. vasectomy performed during time of personal crisis
  7. Lack of discussion with partner regarding vasectomy
  8. Hope vasectomy will solve sexual and marital problems
  9. High interest regarding reversibility issues
    1. Vasectomy Reversal
    2. Sperm banking

In my experience the male does not regret having a vasectomy-he wants to have it reversed because something has changed in his life.

The most common reason for a reversal is divorce and remarrying a younger female with no children. The second most common reason is that a couple with children desire more.

Vasectomy Reversal-What a Woman Wants to Know.

From Vasectomy.com

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The decision to reverse a vasectomy should be considered carefully by each couple. As a woman, you may have special concerns that are difficult to express.

Vasectomy reversal (and the microsurgery involved) raises questions for both men and women. Although men need to be forthcoming about any questions, concerns and fears they share with their physician, it is just as important for women to be informed and reassured about the procedure. You may be surprised to know that many women share the apprehensions about reversal surgery that you may have.

Candid questions, correct information, and the assurance of an experienced urologist are the keys to feeling more comfortable and sure about the decision you and your spouse have made to have a vasectomy reversal. Make a list of the questions that concern you most before meeting with your doctor.

Here are some of the questions women commonly ask:

“This is my first marriage– and his second. Will my spouse’s older age affect the health of his sperm or our babies born after his reversal?”

Generally speaking, a man who has healthy sperm can reasonably expect to father a healthy child. A man’s age does not affect fetal development the way a woman’s does. But time does have an impact on successful conception.

The longer the amount of time between a man’s vasectomy and his reversal, the less potent he may become. This is why: After a vasectomy, unreleased sperm collect in the testicles before being absorbed by the body. The body responds to the unspent sperm with a reaction that can affect, to some degree, sperm quality and health. Over time, this reaction can gradually reduce the mans sperm count, and impair sperm motility.

A successful reversal that results in pregnancy is proof that the man has a healthy, adequate sperm count. The course of pregnancy that follows a vasectomy reversal should be as normal as any other pregnancy. A vasectomy reversal merely restores sperm to the seminal fluid. It should not affect the health of an unborn baby in any way, no matter how old the man is at the time of his reversal.

“Will a vasectomy reversal affect a man’s ejaculation?”

Sperm is only a tiny portion of the seminal fluid that is released at ejaculation. Just as a vasectomy does not change the volume, color, or consistency of the ejaculate, neither does a vasectomy reversal. Sperm are impossible to detect in seminal fluid without the use of a microscope. The quality, intensity and duration of a mans orgasm and ejaculate will not change after a reversal.

“How long will it be until my spouse and I can resume sex?”

Physicians usually advise that it is best to wait three or four weeks following the reversal procedure before returning to sexual activity. It will take additional time before sperm returns to the ejaculate.

“Does the vasectomy reversal procedure leave scars?”

Despite the greater complexity and time involved in a vasectomy reversal procedure, there is usually no lasting or noticeable difference to the feel or appearance of the scrotum.

“How soon can I expect to get pregnant?”

If reversal is successful and healthy sperm rejoin the seminal fluid, it may take 12 months, on average, to achieve pregnancy. The range, from reversal to conception, is between one and 82 months. Most couples achieve pregnancy within a year.

“Can I and should I be examined and tested for fertility first, before we decide on a reversal?”

Since many couples consider reversal surgery a costly matter, women often do choose to consult with their own physicians or fertility specialists first, to determine whether there is any question or doubt about the woman’s ability to conceive and complete a healthy pregnancy.

“How long will my husband be in pain, and what can I do to help?”

You can expect your husband to experience some degree of discomfort and swelling in the first three to five days following reversal surgery. A gradually decreasing ache in the scrotal region will follow and may last for three to four weeks. His attention to doctors orders during the recovery process, lots of ice and rest, and your tender loving care will be the best medicine for your husband.

“Does a vasectomy reversal make you more, or less, susceptible to sexually transmitted diseases?”

Vasectomy and vasectomy reversal surgery do not protect couples from the risk of transmitting or contracting a sexually transmitted disease. These diseases are transferred in body fluids, such as saliva or semen. Both men and women should use condoms if any potential risk of sexually transmitted disease exists.

“How old is ‘too old’ for a couple considering vasectomy reversal?”

All women lose the ability to conceive by late middle age. Women over the age of 40 may experience difficulty conceiving with assisted reproductive techniques (ART).

Men can remain potent and father children even after the age of 70. However, a man may not want or be able to parent a new child at a later stage of life. The older you are, the fewer the years that you have left in which to raise an infant to adulthood. And older couples often have more health problems as they age.

“My husband does not want more surgery-he says that sperm aspiration is easier and just as effective as vasectomy reversal. Is it?”

A vasectomy reversal, performed under general anesthesia, is virtually painless, more natural and more likely to result in pregnancy than an assisted reproductive technique (ART) that begin with sperm aspiration as the first step. Besides a lower rate of success, ARTs have much higher costs, involve a greater number of complex, uncomfortable procedures, and take considerably more time than that required to perform a comparatively simple and safe reversal.

In a straight comparison, reversal surgery is preferable to ART and should be considered first, unless conception and pregnancy cannot be achieved any other way.

“What if we just want one child. Would not sperm retrieval and in vitro fertility be more efficient?”

Not necessarily. The rate of multiple order births–twins or triplets–is several times higher with in vitro fertility than with natural conception following a vasectomy reversal. The risk of having twins with IVF is 20 to 50 percent depending on which IVF center one is treated at.

In Summary:

  • A vasectomy should be considered permanent, so have reasonable expectations about the success of reversal surgery. Be informed and discuss all your options with your spouse and your physician.
  • Some men or couples may not be well suited or economically prepared for a vasectomy reversal or second family, particularly if either partner is over the age of 40 or in poor health. Vasectomy reversal microsurgery is often evaluated as a first course option; generally preferable to assisted reproductive techniques for many couples.

Does it matter where the vasectomy site is if having a microscopic reversal?

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The vas deferens closest to the testicle and just before the epididymis is the convoluted portion of the vas. As you see above the vas then “straightens out” the further you get away from the testicle.

Above you see the “old vasectomy” site marked and it is in the mid scrotal area and in the straight not convoluted portion of the vas. This is the ideal location for the reversal doctor because it is away from the inguinal area and up from the smaller and more difficult to isolated convoluted portion.

Although you can feel the vasectomy site through the scrotal skin preoperatively, you really cannot tell where in the course of the vas it actually is.

Recently I performed a reversal and both sides of the vasectomy site were in the convoluted portion of the vas and close to the epididymis. This required more dissection to reach and it is tricky to get a portion of the convoluted vas to reconnect that is straight (as opposed to curved away from the other side of the vas).

So yes if the person who did the vasectomy happened to do it in the middle, that is away from the inguinal area as well as away from the convoluted portion of the vas then the procedure is much easier to locate, to prepare for the reversal, and to perform the reversal.

You might ask, ” Why wouldn’t every urologist make a point to do the vasectomy in the best position in case a reversal has to be done years later.”

Well a reasonable enough question but there are two factors to consider as to why urologists don’t think this way.

  • Vasectomies are usually done in the office under local anesthesia and depending on the patient and the patient’s scrotal anatomy…he gets the vas where he can get it…i.e. sometimes you can’t pick and choose a site the patient’s anatomy dictates that.
  • Also, the vasectomy is supposed to be considered permanent and the primary goal is a good vasectomy and prevention of pregnancy. Vasectomies are not and probably should not be done with the idea in mind that the patient will reverse it.
  • In my practice if I were asked to do the vasectomy so it could be more easily reversed, I’d probably tell the couple to re consider a vasectomy until they felt it was permanent and they had no plans for further children.
  • Having said that, a urologist can try to make a point to be “in the middle” but as I mentioned sometimes you take the vasectomy site where the patient’s scrotum gives it to you.

Myths about Vasectomy Reversal

The following is from a vasectomy reversal doctor in England. The process is similar to but not exactly the same as at Georgia Vasectomy Reversal, however it is informative and adds to the data base of the couple contemplating a vasectomy reversal.

Vasectomy reversal myths debunked

If you decide to undergo a vasectomy reversal, having accurate information at your fingertips will ensure you are as informed as possible. Here are some of the most popular myths associated with reversing a vasectomy.

If you’re too old, you can’t have a vasectomy reversal

The reality is, a vasectomy reversal can be performed at any age, so long as an individual is healthy enough to undergo the treatment.

A vasectomy reversal rarely works after 10 years

This is a popular misconception and is based on outdated studies. Modern techniques used today have increased the vasectomy reversal success rate even if the original vasectomy was performed years ago. Even after about 20 years, you still stand an 84% chance of success following a vasectomy reversal.

Anti-sperm antibodies cause infertility even after a vasectomy reversal

It is widely believed that anti-sperm antibodies attack healthy sperm following a reversal and can cause infertility. In actual fact, antibodies are present in the blood and not in sperm following a vasectomy reversal, so are normally not responsible for any fertility problems that may arise following the procedure.

IVF is a better option than vasectomy reversal

You will need to weigh up the pros and cons of choosing IVF or vasectomy reversal, but there are many benefits to choosing reversing a vasectomy over IVF. For starters, a vasectomy reversal is a quick, single procedure that has good success rates, enabling you to conceive a baby naturally. In contrast, IVF is a gruelling process that often requires several attempts to increase the chance of success. The cost of a vasectomy reversal is also much lower compared to IVF procedures. Bear in mind also that there is a greater chance of multiple pregnancies when opting for IVF, so if you are only hoping for one baby, a vasectomy reversal is easily a better option.

Vasectomy reversal successes are the same whoever you choose

This is not the case at all. Doctors and standards vary, so if you want to achieve the best results possible choose a surgeon who is specialised in vasectomy reversal and has extensive experience. Mr Harriss has many years of experience and is available to answer any questions that you may have.