Is it possible to recover fertility after a vasectomy?
Between 2 and 4% of men who have had a vasectomy wish to regain fertility for various reasons. Generally it is due to a change of partner, usually a younger woman who has not had children, although there are other causes such as the death of children or psychological intolerance to vasectomy. Faced with this demand there are two possibilities; one is to perform in vitro fertilization – with sperm obtained from the testicle and microinjected into the couple’s eggs – or vasovasostomy, which consists of reattaching the vas deferens by means of microsurgical techniques.
What is the vas deferens?
The vas deferens is the second segment of the so-called seminal duct through which sperm travel from the testicle to the urethra.
Which men can benefit from a vasovasostomy?
Vasovasostomy can also be performed in cases where the vas deferens has been obstructed or severed, for example in childhood or in the course of surgery for inguinal hernia. But the most frequent is the desire for fertility after a vasectomy has been performed. In these situations, one must imagine that, as we mentioned, a young woman who has not had children would find it more logical for a man who has undergone a vasectomy to undergo this relatively simple surgery to rejoin the vas deferens. In these cases, if the surgery has a good result, one or more pregnancies are achieved naturally without the woman being involved in the process as in the case of in vitro fertilization.
How is this surgery performed?
Vasovasostomy can be performed under local or general anesthesia through a small incision in the root of the testicle sac of the scrotum. Both vas deferens are externalized, the obstructed segment is sectioned and the two healthy ends of the vas are spliced together. This is a surgery that lasts between one and a half and two hours. The post-operative period is very well tolerated and the only precaution to be taken is not to maintain sexual activity until approximately one month has passed. The stitches fall out on their own during this time and 3 months after the surgery the first semen analysis is performed to check whether or not there are spermatozoa and their quality. The results of this surgery are the presence of spermatozoa in 70-90% of the cases and pregnancies in 40-60% of the cases.
There are men who decide to freeze semen during vasovasostomy, what is the reason for this and to what extent is it advisable?
If during the surgery we find spermatozoa at the end of the vas deferens coming from the testicle in principle, performing the splice – the anastomosis – we have a high percentage of spermatozoa appearing practically in the first seminogram performed after three months. Sometimes, in certain circumstances and if the patient wishes, it is always possible – in the case of finding motile spermatozoa, because otherwise it does not make much sense – to freeze them for future use with in vitro fertilization techniques, in the event that the surgery does not give the expected result.