The weight of contraception is not only on the shoulders of women. In Quebec, nearly 14,000 vasectomy men each year to become sterile. Apart from the definitive nature of this method, can this method be reversed?
Vasectomy is a medical procedure called “permanent” because without surgery, it is effective for life. Indeed, by breaking the vas deferens from each testis, sperm cannot develop and reach the ejaculatory ducts. Ejaculation is therefore free from spermatozoa.
If the majority of men with vasectomies remain, between 2% and 6% of them will want to regain their fertility. Fortunately, it is possible thanks to vasovasostomy, an operation which consists of restoring the vas deferens connection through two incisions in the scrotum. Although complications inherent to the procedure (infection, coagulation problems and / or healing problems) are not excluded, vasovasostomy is considered a minor medical procedure.
In hospitals, it is generally done under general anesthesia, while in private clinics, vasovasostoie is done under local anesthesia. Less risky than other assisted procreation methods, several elements must be analyzed before determining whether a vasovasostomy will be performed or not. “As a precautionary measure,” Dr. Pierre Miron, President and CEO of the Fertilys Clinic, “spermogram and genital examination by urologists and hormonal tests are performed.” Patients must also undergo routine pre-operative testing.
Besides everything listed above, when the patient is older (after age 65) he must undergo an electrocardiogram (ECG).
Award: Dr. Marois
Opportunities decrease with time
Keep in mind that technical success, namely reconnecting the vas deferens and restoring its permeability, is not always rhythmic with procreation. After vasovasostomy, the success rate depends on several factors including the surgeon’s experience, the interval between vasectomy and vasovasostomy and the type of vasovasostomy. “Men with intervals between vasectomies and vasovasostomies less than 10 years are significantly more likely to get pregnant than those with intervals of more than 10 years,” the expert said.
After vasovasostomy, 80% of patients have returned sperm production and 20 to 40% of their partners will become pregnant. After vasovasostomy, 85 to 90% will experience spermatozoa and 50 to 70% of their partners will become pregnant. Miron added, “There is still controversy in the literature about the superiority of one technology over another. The experience of the surgeon is also important in the success or failure of surgery.”
Important point: about 60% of men with vasectomy will develop antispermatozoid antibodies. This can reduce the chance of pregnancy even though technically a vasovasostomy is successful.
To evaluate the technical success of vasovasostomy, a spermogram is performed every two to three months after the procedure. “In the absence of sperm after 6 months,” Dr. Miron, “we are talking about failure. The best choice then becomes the use of in vitro fertilization after sperm sampling.” In cases of failure or poor sperm quality (also some spermatozoa or too slow) after vasovasostomy, intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) with micro sperm injection into treatment.
Some couples decide with the choice not to have a vasovasostomy and go directly to sperm collection followed by IVF-ICSI because, per month (monthly fertility rate), in vitro fertilization is far more efficient than vasovasostomy.
It is understood that if it is medically possible to reverse a vasectomy, the possibility of rebuilding fertility is not guaranteed, let alone the success of the pregnancy. When in doubt, before thinking about final sterilization, it may be better to consider a less invasive contraceptive method.
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Vasovasostomy is the practice of restoring fertility which, like tubal reanastomosis, is covered by RAMQ (Quebec health insurance plan).