snip today, stitch tomorrow
by Jenny Bryan
When Julian Turner decided to have a vasectomy at the age of 25, it seemed the obvious solution to his contraceptive needs. Happily married with two children and owner of a thriving garage business, he couldn't have imagined that seven years later, his life would be very different.
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'I spoke to my GP about it, he referred us, I got an appointment through a week later and a week after that I was having the operation done,' he remembers.
At 32, divorced and with little access to his children, he has met and married 28-year-old Tracy Baker and both would like to start a new family.
'I've always wanted children and, when I met Julian, the vasectomy wasn't an issue because we weren't planning on getting serious,' Tracy explains. 'By the time we realised we'd fallen in love and we were committed and serious about each other, we started looking into how to reverse the vasectomy.'
It's a story that North Wales surgeon, Miss Christine Evans, has heard so many times that she refuses to perform vasectomy operations on young men:
'I'm against vasectomy not because it isn't a good procedure for contraception but because you just don't know what's going to happen in your future life,' she points out. 'Half of marriages are failing and the woman usually keeps the children. So we have men in their 30s and early 40s who see their children often only at weekends or not at all and, to all intents and purposes, cannot have any more children.'
having the snip
Nearly one in five men in the UK has had a vasectomy, and the operation is 99% effective in preventing pregnancy. During the operation, the tubes which carry sperm from the testicles to the penis are cut. These tubes, called the vas deferens (vas), are tied back so that there is about a 1cm gap between the cut ends – leaving no chance for any sperm to get through.
After a vasectomy the testicles still make sperm – tadpole-shaped cells that move along by flicking their tail from side to side. But they just pile up behind the cut ends of the vas, die and are mopped up by scavenger cells.
bridging the gap
Reversing a vasectomy means opening up a man's scrotum and painstakingly searching for the breaks in the vas to each testicle. The tubes are tiny – just 0.2-0.4mm across – and the thread which is used to rejoin the broken ends is as fine as a human hair. During much of the two- to three-hour procedure, surgeons wear magnifying spectacles to see what they are doing.
Once the gap in each tube has been found and the ends trimmed to remove damaged tissue, fluid is carefully squirted down the cut end of the tube that leads to the penis. This is to ensure that the tube hasn't become blocked with debris since the vasectomy. There's little point in rejoining the ends of the vas if sperm still cannot get into the urethra – the tube in the penis from which they are ejaculated.
The surgeon will also take a sample of fluid from the other cut end of the vas, leading back to the testicle, to check for sperm. No sperm may mean a blockage or damage further back, near the testicle. If this is the case, the surgeon may need to join the vas to the epididymis – the coiled tube that lies on the testicle where sperm develop. This is a far from perfect solution, as sperm need to travel the full length of a normal vas to give them time to mature and perfect their swimming skills, ready to travel up the woman's vagina, through her womb and into her fallopian tubes.
what chance of success?
The longer a man waits after his vasectomy to get it reversed, the less likely it is to be successful. The tubes are more likely to be blocked and the sperm to be less mobile.
Surgeons who do vasectomy reversals quote two levels of success. The first is the patency rate – the proportion of men who have sperm in their semen after surgery, demonstrating that their tubes are working well enough for sperm to get through. A figure of 80-90% is quite common. The second measure of success – the pregnancy rate – is much lower, often around the 40-60% mark. This lower rate reflects the poor mobility of sperm after a vasectomy.
Vasectomy reversal is rarely available on the NHS and an operation is likely to cost £2,000-£3,000. In choosing a clinic, it is worth asking about success rates – both patency and pregnancy rates. Also ask about additional procedures, for example, removal and storage of a sperm sample from the epididymis for possible use in IVF if the vasectomy reversal is unsuccessful.
help and info
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organisations
British Infertility Counselling Association (BICA)
69 Division Street
Sheffield S1 4GE
Tel: 0114 263 1448
E-mail: info@bica.net
Website: www.bica.net
Seeks to promote the highest standard of counselling for those considering or undergoing fertility investigations or treatment. It is committed to the total wellbeing of people with fertility problems before, during and after treatment and of those who choose not to undergo any kind of medical intervention.
Infertility Network UK (I N UK)
Charter House
43 St Leonards Road
Bexhill on Sea TN40 1JA
Advice line: 08701 188 088 (Mon-Fri 9am-5pm; choose option 2)
Evening counselling line: 08701 188 088 (Mon-Fri 7.30pm-9.30pm; choose option 1)
Website: www.infertilitynetworkuk.com
A national network for those experiencing fertility problems, offering face-to-face and telephone support and information at regional and national level. By writing to I N UK (with an SAE to the address above) members can request a medical opinion on their condition or treatment received. Various factsheets and other sources of information are available on the website.
General Medical Council
Regent's Place
350 Euston Road
London NW1 3JN
Tel: 0845 357 8001 (general enquiries) (Mon-Fri 8am-5.30pm)
Tel: 0845 357 0022 (doctors' fitness to practise)
E-mail: gmc@gmc-uk.org
Website: www.gmc-uk.org
Holds general and specialist registers of doctors practising in the UK. The registration department can provide registration details of specific, named doctors, free of charge. Contact them to check if the doctor or surgeon you have chosen is on their register.
websites
Hartlepool Vasectomy Reversal Clinic
www.vasectomyreversals.co.uk
Specialises in vasectomy reversals. Website contains information about vasectomies and vasectomy reversal.
Infertility
www.malehealth.co.uk/userpage1.cfm?item_id=124
This article from the Men's Health website gives an outline of the causes of infertility and the main treatments available.
The Patient's Guide to Vasectomy Reversal
http://cpmcnet.columbia.edu/ ...
US-based site that aims to assist men who want to restore their fertility through vasectomy reversal surgery. Outlines the procedures involved, from the initial examination to surgery and the post-operative period, and includes diagrams of the vasectomy procedure itself and the two types of vasectomy reversal.
Vasectomy Reversal
www.vasectomy-reversal.org
Free message board run by the International Center for Vasectomy Reversal in Arizona. The board is frequented by two vasectomy reversal doctors and an andrologist, and is a good place to ask questions and talk about the issues related to the vasectomy reversal procedure.
Vasectomy Reversal
www.bpas.org
This British Pregnancy Advisory Service online factsheet answers common questions concerning vasectomy reversal on the 'bpas for men' page.
Vasectomy & Vasectomy Reversal
www.child.org.uk/html/malta.php/factsheets/65/
Information about before a vasectomy, the vasectomy operation, after vasectomy and methods of vasectomy reversal.
reading
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Male Infertility by Anne Jequier (Blackwell Publishing, 2000) |
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Male Infertility – Men Talking by Mary-Claire Mason (Routledge, 1993) |
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Overcoming Male Infertility by Leslie Schover and Anthony Thomas (John Wiley and Son, 2000) |
'Outcomes for Vasectomy Reversal Performed after Obstructive Intervals of at least 10 years' by PN Kolettis et al in Urology 60(5) (Nov 2002) p885-8 |
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'Patient Characteristics Associated with Vasectomy Reversal' by JM Potts et al in Urology 161(6) (Jun 1999) p1835-9 |
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(June 2003, resources updated January 2005)
