Dear Dr G,

I am a man in my mid-forties and my wife is three years younger than me.

My wife and I have been married for twenty years and have two amazing children who have both grown-up and started their careers abroad after graduating.

As both children have left home to pursue their lives, my wife and I now have an empty nest and as such, my wife recently mentioned she is very keen to start a family again.

In fact, both my wife and I regret that we have never had a child born in the Year of the Dragon and as such we are keen to nurture a dragon baby.

However, I had a vasectomy after my second child was born and after consulting a specialist, and the only issue left is for me to undergo a reversal of the procedure or sperm retrieval.

I just would like to put Dr G on the spot for help to make a calculated risk-benefit assessment on my U-turn.

Can you please tell me what would the reversal entail, what is the success rate of a vasectomy reversal and is there any risk in making the wrong decision?

Also, how is the success rate calculated?

Yours truly,

Reversal Raymond

A vasectomy is believed to constitute the form of birth control used by 5-10% of couples.

Such male-orientated birth control is gaining popularity recently as more men take up the responsibility of family planning and the convenience and ease of the operation are believed to be important reasons for such a cultural shift.

It is estimated that between 40-60 million people have had a vasectomy worldwide and it is natural that some regret their decision and do a U-turn at a later date. Of this, it is notable that an estimated 10% of men in the United States have opted for a reversal of their vasectomy.

While there are many reasons why men decide to reverse their vasectomy, the main reason is wanting a family with a new partner following a breakdown in their relationship or a divorce.

Another reason is that a couple may also change their mind about having more children when the financial circumstances improve or existing children approaching the age where they leave home.

A reversal is an operation carried out to reconnect the male reproductive tract after the surgical interruption caused by a vasectomy.

Medically, the operation can take the form of vasovasostomy or vasoepididymostomy and this depends on the technique needed to reconnect the two severed tubes. For obvious reasons due to few patients changing their mind, doctors will lead patients to believe that a vasectomy is a permanent sterilisation operation.

In truth, advances in microsurgical intervention have allowed a U-turn of a vasectomy with significant efficacy.

The success of vasectomy reversal is measured by three parameters; the patency rates, the pregnancy rates and live births.

Recent studies have demonstrated that 95% of men will have motile sperm in their ejaculate within three months following the procedure. However, high patency is not the only determining factor as the overall pregnancy rates is also dependent on the interval of obstruction after a vasectomy.

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 that low pregnancy rates for those who have had a vasectomy reversed after a long period is due to prolonged “back pressure” that has damaging effects on the function of sperm.

Moreover, many men also developed anti-sperm

antibodies that may impair their fertility rate.

Lastly, the advancing age of a man clearly has some impact on his fertility with one study revealing that the pregnancy rate is 63% if the reversal was done within three years, 55% if the procedure was carried out between three to eight years and this will drop to 44% and 30% when the reversal is carried out between 8 to 15 years and beyond 15 years respectively.

That said, the single most important predictive factor in pregnancy is the age of the female partner. The pregnancy rate following any fertility treatment including vasectomy reversal falls significantly when the age of the female age exceeds 40-years-old.

However, the wonders of IVF (in-vitro fertilization) can bypass natural selection, allowing scientists to directly harvest the healthiest sperm and eggs to create babies.

Despite the ease of a vasectomy, men are constantly reminded to be firm with their action and not regret the decision afterwards.

With the help of modern microsurgical intervention and Artificial Reproductive Technology (ART), science can make the U-turns less troublesome.

Men requesting a vasectomy reversal often put Dr G on the spot for the U-turn risk-benefit assessment after the snip. He reckons that time is fast running out, therefore put your trust in the clinicians and scientists to ensure you have a second chance to reverse fortunes and put a dragon baby in that empty nest.

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