Dear Dr G,

I read with interest last week’s article on the “reversal of misfortune in infertility”. My wife and I do not have any fertility issues, but we are reconsidering our family planning and hope you can help.

I am in my late forties and my wife is five years younger. Our children are grown up and have left for boarding schools abroad. We were looking forward to a carefree life without the kids, but my wife is experiencing depression due to empty nest syndrome.

After having two children, I had a vasectomy twenty years ago.

It has had no impact on my sex life, and I never imagined fathering a child near my fifties. However, as my wife is still ovulating, she thinks this is our last chance to start the journey of being parents again.

Although I generally agree with her intention, I thought I’d better consult Dr G before committing to a U-turn in contraception.

Can you tell me how a vasectomy reversal is done? What are the common reasons people change their minds about the snip? Is the operation painful or complicated? Is it possible to do the reversal twenty years later?

What is the success rate for vasectomy reversal? Is there any risk for the baby? Lastly, do you think I am too old for a U-turn and fatherhood in my sixties?

Thanks for helping.

Regards,

U-turn Yusof

A vasectomy has become one of the most popular forms of contraception in recent years. The convenience and ease of the operation have contributed to this shift, giving men the option to share the responsibility of family planning.

It is estimated that between 40-60 million individuals worldwide have undergone a vasectomy, constituting 5-10% of the modes of birth control among couples.

With the rise in vasectomies, it is natural for some men to regret the decision and reconsider this form of contraception. Half a million men undergo a vasectomy each year, and literature reveals that 6% to 10% regret the decision.

About 5% proceed with reversing the procedure for various reasons.

Numerous reasons have been cited for men requesting a vasectomy reversal. The most obvious reason is the desire to start a family with a new partner following a relationship breakdown or divorce. In other cases, long-standing couples may change their minds when existing children approach adulthood, especially if financial circumstances improve. Sadly, tragic events such as the death of a child may also prompt men to reverse the decision of sterilisation. Some couples decide to have more children without any specific reason for the U-turn.

The reversal of a vasectomy is medically known as vasovasostomy and is a relatively complex operation. The surgery involves reconnecting the male reproductive tract after it was severed during a vasectomy.

Advances in microsurgical interventions have made vasectomy reversals significantly more effective; the operation is generally performed under general anaesthesia and can be costly due to its intricacy.

To discourage indecision, doctors often lead patients to believe that a vasectomy is an irreversible procedure.

The success of vasectomy reversal is usually measured by two parameters: patency rates and pregnancy rates. A recent study found that 80% and 95% of men will have motile sperm in their ejaculate within three months and one year following the procedure. Despite high patency success, overall pregnancy rates may not be optimal. Prognostic factors for both patency and pregnancy depend on the duration since the vasectomy and the age of the woman. As a general guide, reversal within three years can achieve high patency and pregnancy rates of more than 90%, while reversal after ten years has a success rate of less than half.

Despite the possibility of reconnecting the severed sperm ducts, natural pregnancy rates after reversal may not be as high as expected. Experts believe low pregnancy rates after a long duration of vasectomy result from “back pressure” damage to the sperm. Some men also develop anti-sperm antibodies, which impair fertility rates.

With that said, the most important predictive factor for pregnancy is the age of the woman. Pregnancy rates following any fertility treatments, including vasectomy reversal, fall significantly when the woman is over 40-years-old. Apart from reversal, men can opt for direct sperm retrieval from the scrotum using techniques such as MESA (Microscopic Epididymal Sperm Aspiration). This allows for the wonders of IVF (in-vitro fertilisation), bypassing natural selection and harvesting the healthiest sperm and eggs for baby creation.

Despite the ease of vasectomy, men are constantly reminded to be firm with their decisions and not regret them later.

With modern microsurgical interventions and Artificial Reproductive Technology (ART), it’s not just God who permits U-turns; scientists can also make them less troublesome. Men under pressure from their wives due to empty nests, contemplating fatherhood beyond middle age, often put Dr G on the spot. His view is that if you are still doing U-turns going down the wrong street like Mick Jagger, even God and scientists cannot help you in your stroller-pushing sunset days!