Vasectomy Reversal -
Common Myths & Misconceptions
Myth #1: Men stop
making sperm after a vasectomy
Fact:
Men continue to make sperm regardless of how long it has been since the
vasectomy unless other factors are involved. Some of those include
injury to the testicles, exposure to chemicals or toxins, and certain
serious medical problems. Aside from these situations, no investigation
need be undertaken prior to a reversal to assess sperm production. Some
physicians recommend and perform testicular biopsies prior to vasectomy
reversal, but this is no longer
considered to be necessary under most circumstances.
Myth #2: Vasectomy
reversals don't work after 10 years.
Fact:
This is a common misconception that I have heard by both gynecologists
and urologists who don’t perform many vasectomy reversals. This
misconception is based on older studies of vasectomy reversal prior to
the refinement of vasoepididymostomy surgery. Back then, all patients
who had a vasectomy reversal underwent a vasovasostomy even if they had
a second blockage in the epididymis. Obviously a vasovasostomy will
generally fail if the blockage is not addressed. Success rates for older
vasectomies have increased dramatically with the advent of the refined
vasoepididymostomy and new microsurgical techniques. A study to look at
success rates of vasectomy reversal performed 15 years or more after
vasectomy (published in Fertility and Sterility, March 2002) shows that
the pregnancy rates for intervals 15-19 years, 20-25 years and
greater than 25 years are 49%, 39%, and 25% respectively.
Myth #3: Even if sperm
are present after a vasectomy reversal, your wife won't get pregnant
because of anti-sperm antibodies.
Fact:
Antibodies are small molecules that the body produces to fight off
infections and other substances that the body believes do not belong.
The antibodies stick to the invader and help destroy it. What does this
have to do with sperm, you might ask? Sperm are made in the testicle and
shielded from the immune system so in the normal situation the body
doesn’t know they are there. When a man has a vasectomy, the vasa are
cut and the sperm may leak out if the ends of the vas are not properly
closed. The body’s natural reaction is to produce antibodies to try and
remove the sperm. If we analyzed the blood of men who underwent
vasectomy then we potentially would detect antibodies to proteins
located on sperm in the blood. Only antibodies measured on the
sperm themselves, however, not in the blood play a role in hindering
pregnancy. Most patients do not have antibodies present on their
sperm after a vasectomy reversal and most couples don’t have a problem
getting pregnant after vasectomy reversal because of antibodies. A
partial blockage of the vas after the reversal usually appears to be
responsible for poor sperm quality and not anti-sperm antibodies. While
antibodies can cause problems for some patients, they are clearly not
responsible for most cases of post-vasectomy reversal infertility.
Myth #4: You shouldn't
have a vasectomy reversal if your wife is over 37.
Fact:
While female fertility does start to decline when a women is in her
thirties, many women can still conceive into their forties. The
pregnancy rates for women ages 36-40 and greater then 40 years old whose
husbands underwent vasectomy reversal are 32% and 28% respectively.
(Fertility and Sterility, March 2002)
Myth #5: In-vitro
fertilization is a much better alternative to vasectomy reversal.
Fact:
One problem that a patient is faced with when there are two reasonably
good treatments for the same condition is which one to choose? Both
vasectomy reversal and in-vitro fertilization with sperm harvesting and
intracytoplasmic sperm injection yield good results. In fact, the
overall pregnancy rates for IVF and reversal (taking in to account all
patients and female ages) are almost identical, but the overall cost of
IVF is substantially greater per pregnancy. Of course, there is that
thing of having to go and get the sperm for this process, a procedure no
man would voluntarily embrace.
We believe in giving
couples all their options and having them choose what is best for their
own situation. IVF may make more sense than freezing and storing sperm.
We frequently hear from patients who see female fertility specialists
that vasectomy reversals do not work. This is plain and simply not
true. They are then convinced to undergo an IVF cycle based on false or
inadequate information. While there is nothing wrong with choosing IVF,
it should be because you had the opportunity to evaluate accurate
information and make an informed decision.
The pros and cons of
vasectomy reversal and IVF
are the following: If a vasectomy reversal is successful then it can
lead to natural conception which for most couples is more desirable,
cost effective and certainly a lot more fun! It requires only one
procedure be done and then most people are on their way. Reversal is
usually much less expensive than a single cycle of IVF when all expenses
are added up. Total costs are at least three times higher to deliver a
child with IVF versus the average cost for a vasectomy reversal. The
cons of reversal are that it doesn’t always work, some men don’t want to
have a reversal and that it may take some time to conceive after a
reversal. The mean time to pregnancy is about 12 months following a
reversal but this is distributed on a bell shaped curve so some people
will get pregnant sooner and others later than 12 months. This wait can
be frustrating for many couples and it is easy to become discouraged. I
have also had one patient go to another urologist who was closer to his
home for a semen analysis and be told that he was sterile and needed to
have the procedure repeated. I elected to refer him to a reference
laboratory for a neutral reading as his wife was most upset. The
analysis returned with a count of 80 million sperm, but coincident with
this report, he informed me that his wife was already pregnant.
Fortunately, this was one of my earliest pregnancies, which further
helped to improve his wife’s disposition.
The Pros of IVF are
that it offers the quickest way to get pregnant in a given month but it
doesn’t always work. As a matter of fact most couples will have to go
through more than one IVF cycle to deliver a baby. Remember that
pregnancy rates don’t mean a live baby. IVF is an excellent alternative
if a vasectomy reversal has failed or if there is female factor
infertility as well as male factor problems. Sometimes a vasectomy was
performed in a manner that will make it difficult to reverse. I have
also encountered a patient who married a woman who had undergone a tubal
ligation procedure in addition to his vasectomy.
The cons of IVF are
several. IVF is expensive, much more expensive for the same statistical
result as reversal. Many women do not react well to taking weeks of
fertility injections and the medications can have side effects ranging
from very mild to very severe. Many couples are hesitant about having a
test-tube baby unless it is the only alternative. The whole process also
requires that a man undergo a procedure to harvest sperm for the IVF
procedure. This sounds kind of like a farming adventure, but not the way
I want to get in touch with nature! Lastly, approximately 30% of people
choosing IVF may have multiple births.
Myth #6: If you only
want one more child then In-vitro is a better option than vasectomy
reversal and than having a vasectomy again.
Fact:
Vasectomy reversal is usually a better option for couples wanting only
one more child. Actually, this probably describes the desire of most
people who elect vasectomy reversal in the first place. Couples are
often told to have IVF rather than a reversal and another vasectomy.
This is usually very appealing to the husband but not so for the wife
who has to go through the injections and egg harvesting procedure. The
truth is that it is still way less expensive to have a reversal. If a
repeat vasectomy is desired, this is usually a quick 10 -minute office
procedure. Remember that it will take time to conceive and carry the
pregnancy to term so most men won’t need another vasectomy by the time
it is all over, even if it is something they think they will.
Myth
#7: I should have my vasectomy reversal performed by someone who
only performs this procedure.
Fact:
This question is
a little misleading. Specializing in vasectomy reversal as opposed
to doing nothing else is probably a better question. I feel it is
important that a surgeon have and maintain full staff privileges
with a hospital. Most Urologists feel the same way although no one
really likes to take call. In order to maintain full staff privileges, a
physician is required to take one's share of the emergency call
for his or her specialty. There are not many emergency
vasectomy reversals being performed that I am aware of and it is
important to be competent taking care of all urological emergencies if
that is what you are on call to do. If you should need to be
hospitalized for any reason, it is also important that your urologist be
able to do this for you rather than having to send you to someone else
you do not know. A physician can loose his or her staff privileges for
many reasons, and this may be a greater reason for you to have further
concerns.
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