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Wednesday, May 22, 2013
Men who've chosen the most permanent form of birth control (vasectomy) and now want to have children should consider surgical reversal before they pursue artificial conception methods. Doing so could result in faster pregnancy and save the couple thousands of dollars-not to mention the stress and heartbreak of the multiple failed conception attempts that are commonly associated with artificial methods.
A vasectomy is an elective surgery to make a man unable to conceive children (sterile). During the procedure, a surgeon cuts off and ties the vas deferens, the tube that carries sperm from the testicles for release through the urethra. Once this tube is blocked the man can only ejaculate fluid devoid of sperm, eliminating the risk for pregnancy.
Although the National Institutes of Health estimates that one in six men over 35 choose to have a vasectomy, about 10 percent of vasectomized men eventually seek reversal.
The three Ds'- divorce, disaster and death- can put life into perspective and often cause men who've had vasectomies to reconsider fatherhood. The most common reason my patients seek reversal is remarriage and the desire to have children with their new partners.
Vasectomy reversal, known medically as vasovasostomy, involves reattaching the tubes that were cut during the initial surgery to reestablish sperm flow. The procedure is done through small incisions on each side of the scrotum using a microscope and specialized tools. It is performed under general anesthesia and takes 1 1/2 to 2 1/2 hours. Patients can usually go home the same day as the surgery and return to normal activities, including sex, within three weeks.
Not every man is a good candidate for this surgery because reversing the operation can be complicated and involve more risks than the initial sterilization.
It's important to remember that it takes two to make a baby, so before a man decides to have his vasectomy reversed, a physician should confirm that he and his partner are fertile and physically capable of conceiving a child naturally.
For couples who are capable, vasectomy reversal yields better results for becoming pregnant and having a live birth than most means of artificial conception. It also gives the couple the option to have more children in the future, without additional costs.
Vasectomy reversal costs about $6,000 (including physician, operating room and anesthesia fees) and results in a 70 percent pregnancy success rate compared with in vitro fertilization, which typically results in about a 25 to 40 percent success rate and can cost up to $12,000 per treatment.
Another key factor influencing pregnancy success after vasectomy reversal is the length of time that has elapsed between initial surgery and reversal. Men who are more than five or six years out from their initial surgery are more likely to have scar tissue from fluid build-up in the tubes where sperm develops. This causes irreparable damage that has to be carefully bypassed before sperm flow can be reestablished.
There are alternative conception options for men who have had surgical sterilization, including sperm extraction combined with in vitro fertilization. This involves syringing sperm from the testicles, then combining it with the female partner's egg in the lab and injecting the fertilized egg into the woman's womb.
It isn't just about helping a couple get pregnant. It's also about managing the emotions and expectations involved with having a child. A team of gynecologists and urologists can help the couple make an educated decision about their fertility and choose what will give them the very best chance to conceive a baby.
This article originally appeared in UC Health Line (8/22/06), a service of the University of Cincinnati Academic Health Center Public Relations Communications Department and was adapted for use on NetWellness with permission, 2006.
Last Reviewed: Feb 24, 2011
Ahmad Hamidinia, MD
Professor of Clinical Surgery
College of Medicine
University of Cincinnati