Empty nest syndrome: Get a vasectomy reversal?

Dear Dr. G,

I am a man in my mid-forties and have been married for the last 25 years. My wife and I were childhood sweethearts, and we got married after college.

In the first two consecutive years, we were blessed with two amazing children.

With our family completed, I opted for vasectomy 20 years ago as a form of family planning.

The children are now grown up and live abroad.

Both of us are experiencing the empty nest syndrome and contemplating starting a family all over again.

My wife and I consulted a urologist, who told me my two options were either a reversal of vasectomy, or test-tube babies after direct retrieval of sperms.

I 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 and the test-tube babies entail? What are the success rates of the reversal?

Can you calculate the odds of getting a baby with the reversal or the IVF?

I know it sounds odd for a couple in our mid-forties to think about starting a family all over again. However, the empty nest syndrome is really affecting my wife and me.

Yours truly,

Empty-nest Ernest

Vasectomy is believed to constitute 5-10% of birth control method amongst couples. Worldwide, it is estimated that between 40-60 million individuals (about twice the population of Texas) have had a vasectomy. Such male-orientated birth control is gaining popularity as a form of contraception in recent years, as more men are taking responsibility in family planning.

The convenience and ease of the operation are believed to be important reasons for such a cultural shift. With such an increasing number of men having vasectomy, some are bound to regret and do a U-turn in future days. It is estimated 10% of men in the USA regret the decision and opted for a reversal of vasectomy. Doctors often emphasise that vasectomy is a sterilisation procedure intended to be permanent to discourage patients from undergoing the operation with the expectation that it can easily be reversed.

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. There are many reasons that men decide to pursue vasectomy reversal, amongst the main reasons being wanting a family with a new partner following a breakdown in relationship or divorce. In other situations, couples may also change their minds when their financial circumstances improve. Empty nests amongst couples who started families early in life is also a common reason for the U-turn.

Reversal of the vasectomy is an operation carried out to reconnect the male reproductive tract after the surgical interruption caused by vasectomy. Medically, the operation can come in the form as vasovasostomy or vasoepididymostomy, depending on the techniques to reconnect the two severed tubes. The advancement in microsurgical interventions increases the efficacy of reversal of vasectomy with significant efficacy. The success of the vasectomy reversal is measured by three parameters, including the patency rates, the pregnancy rates and live baby births. Recent study demonstrated that 95% of men after the reversal will have motile sperms in the ejaculate within three months following the procedure. High patency success of the reversal is not the only determining factor, as the overall pregnancy rate is also dependent on the interval of obstruction after vasectomy.

Despite the infinite possibility of reconnecting the severed sperm ducts, the natural pregnancy rates after the reversal may not be as good as initially anticipated. Experts believed the low pregnancy rates after the long duration of vasectomy is due to prolonged “back pressure” that has damaging effects on the function of the sperms. Moreover, many men also developed anti-sperms antibodies that may impair the fertility rates. Lastly, the advancing age of men clearly have some impact on his fertility One study revealed the pregnancy rate of 63% if the reversal was done within three years, 55% if the procedure was carried out between three and eight years. This will drop to 44% and 30% when the reversal is carried out between 8 ando 15 years and beyond 15 years, respectively.

The single most important predictive factor in pregnancy is the female’s age. The pregnancy rate following any fertility treatments, including vasectomy reversal, falls significantly when the female age exceeds 40 years old. However, the wonders of IVF (in-vitro fertilisation) can bypass the needs of natural selection, allowing scientists to directly harvest the healthiest sperms and eggs for baby creations. Naturally (or unnaturally), this carries the best chance of success for live baby birth.

Despite the ease of vasectomy, men are constantly reminded to be firm with their actions and not regret the decisions afterwards. With the help of modern microsurgical intervention and artificial reproductive technology (ART), the “U-turns” become less troublesome.