Re-establishing Fertility

It's The Woman's Responsibility

Over the years, the responsibility for pregnancy has been laid at the feet of the woman. In antiquity, if a woman was infertile, she was promptly given a bill of divorcement. Of course, nobody assumed the man was infertile. It was always the woman. The views remained the same in modern times as women were saddled with the responsibility of conception, or protection from conception. Tubal ligation was a common choice for birth control in the past forty years as it rendered the woman incapable of conceiving a pregnancy and thus the pressure was off.

Then Things Changed

Then, along came the vasectomy-male sterilization. It was a panacea of sorts and certainly left a woman with more options, should she leave a relationship and still want to have children. Nearly half a million men request vasectomies each year and of that number, about five percent will change their minds and want to have the procedure reversed. This is often due to remarriage, the death of a child, or improved conditions allowing for more children. In the past twenty years, the procedure of vasectomy reversal, called vasovasostomy, has proven to be very successful, allowing men to re-establish their fertility. The success rate is 99 percent in men who have sperm at the time of the surgery.

When Everything Goes According To Plan

To reconnect the vas deferens, which carries the sperm from the testicle through ejaculation, it is necessary first to free both ends from scar tissue. A drop of fluid from the testicular end of the vas is taken and analyzed to establish the presence of sperm. This step in the process is particularly important because it will determine the type of microscopic surgery required to re-establish fertility. The testicle continues to produce sperm after the vasectomy, so it is expected that the fluid would contain sperm. The best-case scenario when checking for sperm is that whole sperm is found. If this is the case, then both ends of the vas deferens can be sewn together. The channel inside the vas deferens in which the sperm swim is about the size of a pen dot, so it is next to impossible to perform this surgery effectively without the use of a microscope.

Sometimes Things Are More Difficult

In some cases, the fluid is thin and contains only parts of sperm or no sperm at all. In still other situations, the fluid is thick and there is no sperm to be found. This particular situation would indicate a possible rupture in the epididymis, which allows sperm to leak out in the same way water would leak out of a burst pipe. The body attempts to heal this rupture by creating scar tissue, which causes a second blockage in the epididymis. In order for the sperm to get out of the vas deferens, the blockage must be bypassed. If this type of blockage is not recognized when the surgeon attempts the vasovasostomy, then the procedure will fail. Bypassing the vas to allow sperm to flow through a different tubule is called a vasoepididymostomy. This technique is more difficult to perform and the results are not as good as with a vasovasostomy.

Couples who experience infertility due to the man's vasectomy may opt for other methods of treatment. T.D.I. (therapeutic donor insemination) or IVF/ICSI (in-vitro fertilization with intracytoplasic sperm injection) may help to restore male fertility. However, vasovasostomy seems to be the most optimal and least expensive solution.