Fertility U-turn

Dear Dr. G,

I am a bit ashamed to email you, but I hope you can help. I am in my early sixties and just ended a 30-year marriage recently.

After the divorce, I thought I had gained my freedom and was really looking forward to a single’s life as a divorcee.

However, I recently met someone nearly half my age (please don’t judge) and fell in love all over again. Now I am engaged and my fiancée is 35 years old.

My fiancée has expressed a keen desire to have a child after we get married but the truth is that I already went for the snip and stopped thinking about fatherhood after having two children.

Since the vasectomy has absolutely no impact on my sex life, I thought I’d better put Dr. G on the spot prior to committing myself to a U-turn.

First of all, can you tell me how a vasectomy reversal is done, and is the operation painful or complicated?

Also, is it possible to do the reversal twenty-years down the line, what is the success rate for such reversals and are there any risks 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 Eugene

A vasectomy is gaining momentum as a popular form of contraception in recent years, as more men are taking on family planning responsibilities.

It is estimated between 40-60 million individuals have had a vasectomy – a figure that comes up to 5-10% of couples – and this cultural shift is due to the ease of the operation.

Needless to say, with an increasing number of men undergoing a vasectomy, some are bound to regret and do a u-turn in the future. It is estimated that 5% of men in the United States had a reversal of vasectomy after the initial procedure. However, one study predicted the actual number of men inquiring about the reversal is significantly higher, but many are put off by the complexity and the costs of the reversal.

The reversal of the vasectomy is medically known as a vasovasostomy and is an operation carried out to reconnect the male reproductive tract after the surgical interruption caused by vasectomy. For obvious reasons of not having too many patients changing their minds, doctors would lead patients to believe that a vasectomy is an operation that is a permanent form of sterilization. However, advances in microsurgical intervention have allowed for a vasectomy to be reversed with significant efficacy.

The success of the vasectomy reversal is usually measured by two parameters: the patency rates and pregnancy rates. In a recent study, 80% and 95% of men after the reversal will have motile sperm in their ejaculate within three months and one year respectively following the procedure. Although the high patency success of the reversal is achieved, the overall pregnancy rates achieved are only around 55% if the reversal is done after less than ten years, and it dropped to 25% over 20 years.

While there are a number of reasons that drive men to decide to reverse the vasectomy, the main reason is a desire for a family with a new partner following a breakdown in a relationship or a divorce. In other situations, long-standing couples may also change their minds when the financial circumstances improves due to existing children leaving the home.

Having said this, despite the possibility of reconnecting the severed sperm ducts natural pregnancy rates after the reversal may not be as good as initially anticipated.

Experts believe the low pregnancy rates after a long-duration vasectomy is due to a prolonged “back pressure” that has a damaging effect on the function of the sperm.

Moreover, many men also developed anti-sperm antibodies that may impair the fertility rates. Lastly, the advancing age of men clearly has some impact on his fertility.

However, the single most important predictive factor in pregnancy is the age of the woman. The pregnancy rate following any fertility treatments including vasectomy reversal falls significantly when a woman is older than 40, but the wonder of in- vitro fertilization or IVF can bypass the need for natural selection, allowing scientists to directly harvest the healthiest sperms and eggs for baby creation.

The beloved American financial advisor and broadcaster, Suze Orman famously said that “if you are going down the street and you are going the wrong way, just remember – God permits u-turns” and despite the ease of a vasectomy, men are constantly reminded to be firm with their actions and not regret the decision afterwards.

However, with the help with modern microsurgical intervention and Artificial Reproductive Technology (ART), it is not just God that permits U-turns as science can also make the U-turns less troublesome.

When men are requesting a vasectomy reversal and still contemplating fatherhood beyond middle age are putting Dr. G on the spot, he says that “if you are still doing a u-turn going down the wrong street like Mick Jagger, even God and scientists cannot help you in your stroller-pushing sunset days!”