U-turn in contraception


Dear Dr. G,

I read with interest last week’s article on how to “breed like Mick Jagger”.

I may not be breeding like Jagger (yet), however doing a U-turn on my contraception may get me on course to do so.

I am in my late fifties and ended a twenty-year marriage recently.

The kids are all grown up and I am looking forward to a carefree life as a divorcee.

I met someone nearly half my age (please don’t judge) and fell in love again.

We recently got engaged and my fiancée has expressed keen desire to have a child after we get married.

After having two children, I have already had a vasectomy twenty years ago.

The vasectomy has absolutely no impact on my sex life, and I never imagine having to father a child in my fifties.

Although I am committed to my fiancée, I thought I’ve better put Dr. G on the spot, prior to committing myself to a U-turn in contraception.

Can you tell me how is vasectomy reversal done?

What are the common reasons people change their minds about the snip?

Is the operation painful or complicated?

Is it possible to do the reversal twenty years down the line?

What is the success rate for vasectomy reversal? Is there any risk for the baby?

Lastly, do you think I am too old for U-turn and fatherhood into my sixties?

Thanks for helping

Regards

U-turn Eugene

Vasectomy is one of the most popular forms of contraception in recent years. The convenience and ease of the operation are believed to be reasons for the cultural shift, giving men the options to shoulder the responsibility of family planning. It is estimated around 40-60 million individuals have had a vasectomy. This constitutes 5-10% of the mode of birth control amongst couples. With such rising numbers of vasectomies, this is natural to have men regretting the decision and doing a U-turn on such contraception. Literature has revealed 5% of vasectomized men in the United States have had a reversal. However, one study predicted the actual number of men contemplating the reversal is significantly higher but put off by the complexity and the costs of the intervention.

Numerous reasons have been cited by men requesting for reversing their vasectomy. The most obvious reason being wanting a family with a new partner following a breakdown in a relationship or divorce. In other situations, long-standing couples may also change their minds when existing children approach the age of leaving home, especially if the financial circumstances improve. Sadly, tragic circumstances such as the death of an offspring may also be the reason for men to reverse the decision of sterilization.

For reasons of not having too many patients changing their minds, doctors would lead patients to believe that vasectomy is an irreversible operation. The reversal of vasectomy, or medically known as vasovasostomy, is a relatively complex operation. The surgery involves reconnecting the male reproductive tract after being severed during vasectomy. The advances in microsurgical interventions have allowed the U-turn operation of the reversal of vasectomy with significant efficacy. The operation is generally done under general anaesthesia and can be quite costly due to its intricacy.

The success of the vasectomy reversal is usually measured by two parameters: the patency rates and pregnancy rates. In a recent study, 80% and 95% of men after the reversal will have motile sperms in the ejaculate within three months and one year, respectively following the procedure. Although the high patency success of the reversal is achieved, the overall pregnancy rate achieved is only around 55% if the reversal is done in less than ten years. It drops to 25% if the reversal is done after 20 years.

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 believe the low pregnancy rates is due to the long duration of vasectomy that results in “back pressure” that is damaging to the sperms. Some men also develop anti-sperm antibodies which impair fertility rates. The single most important predictive factor in pregnancy is the female age. The pregnancy rate following any fertility treatments, including vasectomy reversal, falls significantly when the female age exceeds 40 years old.

Apart from the vasectomy reversal, men can also opt for direct sperm retrieval from the scrotum using techniques such as MESA (Microscopic Epididymal Sperm Aspiration). This also allows the wonders of IVF (in-vitro fertilization), bypassing natural selection, harvesting the healthiest sperms and eggs for baby creations.

The beloved CNBC American financial advisor and broadcaster, Suze Orman famously said: “If you are going down the street and you are going the wrong way, just remember - God permits U-turns.” 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), it is not just God who permits U-turns, but scientists can also make the U-turns less troublesome. When men requesting a vasectomy reversal and still contemplating fatherhood beyond middle age, is putting Dr. G on the spot. His view is: “If you are still doing U-turn going down the wrong street like Mick Jager, even God and scientists cannot help you in your stroller-pushing sunset days!”

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vasectomy , contraception , Dr G

Dr George Lee

Dr George Lee

Dr George Lee is a consultant Urologist and Clinical Associate Professor whose professional interest is in men’s health. The column “Ask Dr G” is a forum to help men debunk the myths and taboos on men’s issues that may be too “hard” to mention. You can send him questions at askdrg@thestar.com.my

   

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