BMI St Edmunds: Increase in vasectomy reversal procedures, according to specialist

Dr John McLoughlin

Dr John McLoughlin - Credit: Archant

A vasectomy is long-established as a safe and permanent method of contraception.

But circumstances change and what might have been the ‘right decision’ at the time can be regretted in the future. That is why we have seen such a massive rise in vasectomy reversals over the last few years.

“Traditionally, a vasectomy reversal operation had a low success rate as it involved the surgeon operating on tiny tubes using his own unenhanced eyesight with instruments that were probably not designed for that specific purpose,” Dr McLoughlin said.

“But, over the last 10 to 15 years, technology has advanced to such a degree that using microsurgical operating instruments is now the norm.”

New equipment now allows the surgeon to magnify the operating field, giving them perfect vision, perfect lighting. This means they can precisely re-align the vas tubes that were cut during the original vasectomy operation.

“During my training I spent a number of years on a transplant unit performing small vessel operations on patients awaiting kidney transplants. It was thus a natural progression for me to look at operating on tiny tubes as part of my wider urological practice when I became a consultant in the early 1990s,” he added.

A vasectomy reversal is undertaken using general anaesthetic and can be a long procedure - in some cases up to three hours. The inner diameter of the vas tubing is about a millimetre and the stitches thinner than a human hair. Almost all of these operations are performed as a day surgical procedure with the patient returning to full activity quickly.

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Dr McLoughlin explained: “There are a number of factors that can affect the success rates after a reversal procedure. First and foremost is the time period between the vasectomy and the request to reverse. More couples achieve success where it is less than seven years, with success rates falling progressively after seven years.”

The way the original vasectomy was undertaken can also effect the operation and recovery period.

“Some vasectomies involved cauterising the tubes or removing a large portion of the tube which makes the operation technically more difficult - although this might not affect the success rate,” he said.

“However, it is important to point out the difference between a positive sperm count after a vasectomy reversal and a positive outcome in terms of babies and pregnancies.

“Some men have a positive sperm count but do not go on to produce a baby. This is often not appreciated by patients, but, even without ever having a vasectomy, we see men who have a good sperm count but struggle to produce a pregnancy. This needs to be explained carefully and honestly to any couple seeking help,” Dr McLoughlin said.

There are alternatives to vasectomy reversal using assisted reproduction such as harvesting the egg from the woman and extracting small numbers of sperm from the tubes near the testes.

These techniques can be also used to rescue a failed reversal operation for some couples.

stedmunds@bmihealthcare.co.uk