Reconnecting for a New Beginning

“What is so fascinating and yet frustratingly great about life is that you are constantly starting all over. And I Love it!” These are the wise words from funny man, Billy Crystal, whom I adored in When Harry Met Sally.

How time flies, another year and yet another challenge of starting all over again in 2015. I have just returned from spending a quality time family vacation with my two teenage children aged 13 and 15. I must say, I do enjoy traveling with them these days and not worrying about strollers and nappies in a foreign land, unlike the good old days. As far as parenthood is concerned, I do wonder if I have the stamina or the mentality to start all over again?

I recalled starting the conversations with my wife about raising another child in our forties. Needless to say, she does not take what I say seriously and assume this is just another crazy mid-life crisis idea. Although, my thoughts were dismissed, at the back of my mind, I do wonder the feasibility of my intention.

In reality, many men face the same questions when they embark or re-embark on a relationship later in life. I guess that takes us nicely to answer an email of a reader who is contemplating “reconnecting” for a new beginning.

“Dear Dr. G,

Happy New Year!!

The reason I am emailing you is to ask about my predicament.

I am 52 and had been divorced for ten years.

In my previous marriage, my ex-wife and I had three children, all of whom are grown up now.

After my ex-wife gave birth to my third son twelve years ago, I was persuaded to undergo vasectomy as a form of contraception. The procedure was very simple and uneventful. The sterilization is working well until today.

I recently found the new love of my life and we have been married for more than one year. As my wife is 37, we are naturally considering having children of our own.

I would like to find out more about the reversal of vasectomy? How is the operation done? Is it as simple as the vasectomy? What are the success rates for the operation? What are the chances of my wife getting pregnant after the reversal?

Will there be any complications from the operation? Will the surgery cause decrease in libido or erectile dysfunction?

Finally, just would like your opinion about parenthood, do you think I am too old to start all over again at the age of 52.

I look forward to your response.

Jay

The reversal of the vasectomy is also referred as vasovasostomy. Technically, this is the operation performed to reconnect ligated and segmentally excised vasa, occluded for the purpose of sterilization during vasectomy.

Although before embarking on vasectomies, we strongly advise patients to consider the operation as permanent and non-reversible. In many circumstances, the “U-turns” are possible, especially performed in early stages.

The reversal of the vasectomy is not as simple as vasectomy. A typical intervention will take two to four hours of surgery, and mostly require a skilled surgeon assisted by microscope. Although the operations can be performed in a day care facility, general of regional anesthesia is necessary.

The success of vasovasotomy inversely correlates to the gap between to two excised vasa. The longer the segment excised during vasectomy, the less success of reconnection. The other important prognosis of success is the interval of the occlusion. If the interval since the vasectomy is less than 15 years, the better chance of pregnancy is observed.

The other two factors that will influence the success of the reversal of the vasectomy are the influence of the anti-sperm antibodies and the age of the female sexual partner. Although the patency of the occluded vasa may be successfully reconnected, the presence of the antibodies and the advancing female age will adversely affect the pregnancy rates.

In general, the men who make the U turn for vasectomy within 5 years can expect the patency success of 90% and pregnancy rate of 80%. Between 5 to 10 years can observe a patency success of 80% and pregnancy rate of 70%. And beyond ten years, the patency success will decline to 70% and the pregnancy rate as low as 40%.

Many men who embark on the new relationship do not make a U turn and decline to undergo the reversal of vasectomy. The modern technology of percutaneous retrieval of sperms for the purpose of IVF will avoid the operations. However, such option is only possible if the couple agrees to IVF.

Although the reversal of the vasectomy is technically meticulous and challenging, it is a relatively risk free intervention with minimal complications. Most men can expect mild scrotal swelling and bruising that may last for a week. The utilization of ice pack can usually ease the symptoms. Sexually function and erectile rigidity is usually unaltered after the operation.

Before the reversal of vasectomy, many men would doubt their decision and worry they may be too old to start all over again. I often tell them (and I tell myself) that age is merely a state of mind and you are as old as you feel. Put it this way, the second time round gives you the advantage of being experienced. I am sure the new parenthood will bring more joy than fear.

George Elliot once said: “One can begin so many things with a new person! Even begin to be a better man.” With that note, Dr. G wishes you good luck in the reconnection and the new beginning! Happy New Year