“I’m 36 & DH is 38. He had vasectomy Nov ’15. We want to have it reversed to have baby of our own (1 girl each from previous marriage). Should I have fertility testing 1st? Any advice related to having a baby at 36+ after a vasectomy?”
This request was posted on an online forum in May 2017 and illustrates well what couples seeking a reversal are going through and hoping for. One of the main reasons men seek a vasectomy reversal is regret, discovering that some years after their sterilization, they would like to be a father again. Then, the big question is whether a reversal is going to work.
We want to encourage these men to pursue a reversal when possible, and at the same time present a realistic picture of the process and outcome, so that men who are thinking about getting a vasectomy know what a reversal takes if they change their minds later.
The effectiveness in getting pregnant
In a recent interview with Natural Womanhood, Dr. Joseph F Harryhill, Associate Clinical Professor of Urology at the University of Pennsylvania, explains that the effectiveness of a vasectomy reversal is measured in two different ways. One is whether sperm can flow back normally through the ducts and mix in with the seminal fluid to produce fertile semen. Dr. Harryhill reports that this is usually the case for 80 to 90% of reversals, if the vasectomy happened less than 10 years prior to the reversal. The rate goes down after 10 years.
The second aspect of effectiveness is what most people are really aiming for with a reversal: the ability to conceive a child that will result in a live birth. That rate is much lower, ranging from 50% down to 30%. There are several factors involved which will determine how effective a reversal will be. Besides the mechanics that allow sperm to flow back in its proper track, the quantity and the quality of the sperm is a critical factor in conception. As we reported in our article “The reality of vasectomy risks and side effects,” a vasectomy can lead to sperm leaking into the scrotum, where they will trigger an autoimmune reaction over time, negatively affecting the quality and viability of sperm.
How does a vasectomy reversal work?
One reason a reversal may not succeed is because of the complexity of the surgery.
A man’s fertility is comprised of two main functions:
- The production of seminal fluid by the prostate and the seminal vesicles, and
- The production of sperm by the testicles
Sperm is transported and added to the seminal fluid via two small tubes, known as the vas deferens, which connect the testicles with the seminal vesicles.
During a vasectomy, the doctor cuts a section off the vas deferens, preventing sperm from reaching the seminal vesicles and mixing with the seminal fluid. After a vasectomy, a man will still ejaculate but his semen will be sperm-less, and therefore infertile.
In order to restore fertility, the vas deferens has to be repaired. This tube is very fine (about 3/16 of an inch in diameter), and it must be sutured back under a microscope using a line that is finer than a hair. The operation takes two hours, even when there are no complications.
Sometimes the vas deferens has to be reattached directly to the epididymis, a coiled tube that rests on the back of each testicle, where sperm is stored and matures. This makes the reversal surgery much more complex, and more likely to fail.
The cost of a vasectomy reversal
A major hurdle for men and couples eager to reverse a vasectomy is the cost. Dr. Harryhill explains that the cost, which is not usually covered by health insurance, varies from $8,000 to $15,000. “Some highly specialized practices in New York might charge you as much as $70,000,” he says. Obviously, this puts a vasectomy reversal out of reach for many couples. The exorbitant cost of a reversal should therefore be a consideration when deciding for a vasectomy in the first place, given that up to 20% of men may regret their vasectomy at some point following the procedure, according to Dr. Harryhill.
While it is noble for a man to want to share in the responsibility of the couple’s family planning instead of leaving the burden to his wife or partner, a vasectomy is neither easy nor affordable to reverse. To quote the Cleveland Clinic: “You should consider vasectomy a permanent means of birth control. Men who are married or in a serious relationship should discuss this issue with their partners. If you’re thinking about a reversal now, perhaps you should take more time to decide if a vasectomy is right for you.”
Doing “the noble thing”
So what’s a man to do, especially if he is concerned about his spouse using hormonal contraceptives or other forms of birth control that can be annoying at best, and harmful to her health at worst? A fertility awareness method (FAM) or method of natural family planning (NFP) can provide a man the opportunity to step up to the shared task of family planning—without requiring him to go under the knife, or his partner to use birth control. Using NFP, while it may be somewhat demanding in the beginning, allows couples to share responsibility and improve their communication, while leaving a door open if they change their mind about having more children in the future.
WATCH: Vasectomies and Reversals with Dr. Joseph Harryhill
Additional Reading:
Done with kids: thinking of sterilization?
Male Sex Hormones Are a Big Deal, Too
