From The Atlantic
A handful of studies have tried to pinpoint a number of children that maximizes parents’ happiness. One study from the mid-2000s indicated that a second child or a third didn’t make parents happier. “If you want to maximize your subjective well-being, you should stop at one child,” the study’s author told Psychology Today. A more recent study, from Europe, found that two was the magic number; having more children didn’t bring parents more joy.
In the United States, nearly half of adults consider two to be the ideal number of children, according to Gallup polls, with three as the next most popular option, preferred by 26 percent. Two is the favorite across Europe, too.
Ashley Larsen Gibby, a Ph.D. student in sociology and demography at Penn State, notes that these numbers come with some disclaimers. “While a lot of [the] evidence points to two children being optimal, I would be hesitant to make that claim or generalize it past Western populations,” she wrote to me in an email. “Having the ‘normative’ number of children is likely met with more support both socially and institutionally. Therefore, perhaps two is optimal in places where two is considered the norm. However, if the norm changed, I think the answer to your question would change as well.”
First interesting thing: Getting an infection is uncommon. Most urologists do not place a suture in the small opening necessary for doing the procedure and this may be protective.
Second interesting thing: If there is a sperm granuloma or some swelling or tenderness under the scrotal skin, it usually resolves on its own and…is it almost always just on one side. In my experience it is rare to have an issue with both sides of the procedure. Each side is independent of the other. Go figure!
More questions? Go to the vasectomy page and read the eBook.
The question on vasectomy.com is about IVF however a microscopic reversal is also a reasonable option in this scenario.
It takes two to tango but only one testicle to conceive!
There are two areas that have to heal after a vasectomy reversal procedure.
- The subcutaneous tissues and the skin which have been incised to reach the vas tubes has to heal.
- What the patient sees is the skin sutures. These sutures dissolve and go away in about two weeks.
- Although the skin will appear healed on the surface, microscopically full healing occurs at approximately six weeks.
- The scrotum is not like an abdominal incision where excessive straining prior to complete healing could cause extrusion bowel or create a hernia.
- The skin of scrotum healing is independent of straining but excessive activity and motion could delay the healing process.
- Sometimes the sutures dissolve prior to complete healing of the skin. Some areas of the suture line may open minimally and this is of no concern and will close over (epithelialize) within a week.
- In regards to the skin healing process, a patient can shower in a few days with care for water not to hit the site directly, and one should place Neosporin ointment on the site daily.
The Reversal Site
- The repair is done with 12-14 permanent sutures in a tension-free and water-tight fashion.
- Compression shorts are recommended for approximately three weeks.
- This allows for the inner and out layers of the repair to heal without the undue stress of the testicles and hence the vas deferens moving up and down and potentially delaying the healing process.
So although the two primary areas that need to heal before strenuous physical activity or sexual activity are different in character, the magic number of time is around three weeks-four weeks.
Anecdotally, I have had a patient present to my office the day after a reversal stating that he was having bleeding at the incision site. He confessed that he had had sex the night of the procedure. I reassured him the bleeding was from the skin edge and nothing to be concerned about.
This couple had a baby almost 9 months later to the day. Go figure!
I have done over a thousand vasectomies and to my knowledge have not seen this syndrome in my practice.
Having said that, I do believe this malady does exist. But here is the thing, when a patient has a vasectomy reversal to alleviate the pain, it may not be the reversal per se that makes the pain go away.
I recently did a vasectomy reversal on a patient that wanted the procedure to have another child. He did, however, mention that he was told that clips were used for his vasectomy and that he had had pain in the right testicle since the procedure. At the time of the reversal on the right side I found a sperm granuloma (an inflammatory mass in the area of the vasectomy as a result of the body’s attempt to correct the trauma of the surgery and response to sperm which the body views as a foreign body) and marked surrounding inflammatory changes. There were clips noted and dissecting the granuloma out, cleaning the two ends of the vas and removing the “inflammatory glob” was more difficult than the usual dissection. So at the end of the reversal on the right side the patient had the granuloma removed and pristine ends of the vas reconnected with microscopic suture.
It is too early to say if the reversal in terms of pregnancy and patency was successful. But what if his right testicular pain goes away? Maybe it is the removal of the sperm granuloma and not reconstituting the vas. In other words a vasectomy reversal done of post vasectomy pain syndrome that is successful, might have been because of removing the scar tissue and not the reversal.
I had a reversal patient several months ago tell me as he was leaving our surgery center that the primary reason for having the reversal was for pain and not children. He failed to tell me that preoperatively and if he had I would have discouraged having a reversal for that purpose alone. (Surgeon’s rule number one: Don’t operate on folks for pain.) As it turned out, he wrote me a note complimenting my staff at our surgery center and that he was very pleased with the results, i.e. no more pain not that there was a pregnancy.
In summary, there may be something to having a reversal to alleviate chronic post vasectomy pain but it may have more to do with removing the sperm granuloma and inflammatory tissue than restoring the flow of sperm.
As most of our microscopic reversal patients are from out of town, we offer free accommodations at Gainesville’s Holiday Inn-Lanier Centre. This hotel is less than two miles from our surgery center and depending on the travel needs of the patient, we can reserve a room the night before or after the procedure.
Considering the time, expense and emotions involved with having any surgical procedure, we are happy to offer this small convenience to our out of town patients. At scheduling, Kathy (ext. 113) will happily arrange for you.
Just like the Marines…only the strongest, the fastest, the finest “get through.” And this is natures way of assuring the best sperm for the job.
“Cracking the egg” is very competitive!
A link between vasectomy reversals and birth defects has not been convincingly demonstrated.
If you are considering a vasectomy reversal, even if you are unsure who you will choose to perform it, it is a good idea to have a preoperative consultation. You can ask the pressing questions that concern you, you can get a concept of the procedure, the time it will take, the cost, and as a result of the exam of the previous vasectomy site-you will know if there are any contraindications for the procedure pertinent to you. It is also an opportunity to get to know the physician that may be doing the procedure.
The reason it is not unusual for a consultation to be free for reversals is that the visit and the subsequent procedure is usually not covered by insurance. The free consultation is beneficial to both parties and by being at no cost encourages the couple to take that”first step” to the journey of having another baby.