2023 Author: Anita Thornton | [email protected]. Last modified: 2023-11-27 18:44
The burden of contraception does not rest on women's shoulders alone. In Quebec, nearly 14,000 men undergo a vasectomy every year in order to become sterile. Despite the finality of the method, is it reversible?
The vasectomy is a medical act described as "permanent" since without surgery, it is effective for life. Indeed, by breaking the vas deferens of each testicle, the sperm cannot progress and reach the ejaculatory ducts. The ejaculate is therefore free of sperm.
While the majority of vasectomized men will remain so, between 2% and 6% of them will wish to regain their fertility. Fortunately, this is possible thanks to vasovasostomy, a surgery that involves re-establishing the connection of the vas deferens via two incisions in the scrotum. Although the complications inherent in the procedure (infections, coagulation problem and/or healing problems) cannot be excluded, vasovasostomy is considered a minor medical procedure.
In a hospital setting, it is usually performed undergeneral anesthesia, while in a private clinic, vasovastolie is performed under local anesthesia. Less risky than any other method of assisted procreation, several elements must be analyzed before determining whether or not a vasovasostomy will be performed. “Out of caution, explains Dr Pierre Miron, president and general manager of the clinic Fertilys,a spermogram and a genital examination by the urologist and hormonal tests are carried out”. Patients should also undergo routine pre-operative tests.
In addition to everything listed above, when the patient is older (over 65) he will have to undergo an electrocardiogram (ECG).
Chances that decrease over time
Let's keep in mind that a technical success, that is to say a reconnection of the vas deferens and a return of their patency, does not always rhyme with procreation. After a vasovasostomy, the success rate depends on several factors including the surgeon's experience, the interval between vasectomy and vasovasostomy, and the type of vasovasostomy. "Men whose interval between vasectomy and vasovasostomy is less than 10 years are significantly more likely to conceive than those whose interval is more than 10 years," says the expert.
After a vasovasostomy, 80% of patients have a return of sperm production and 20 to 40% of their spouses will conceive. After a vasovasostomy, 85 to 90% will have sperm and 50 to70% of their partners will conceive. Dr. Miron adds: “Some controversy still persists in the literature as to the superiority of one technology over the other. The experience of the surgeon is also important in the success or otherwise of the surgery”.
An important point: about 60% of men having a vasectomy will develop anti-sperm antibodies. This could reduce the chances of pregnancy despite a technically successful vasovasostomy.
To assess the technical success of the vasovasostomy, a spermogram is performed two to three months after the operation. “In the absence of spermatozoa after 6 months, says Dr. Miron, we speak of failure. The best option then becomes the use of in vitro fertilization after a sperm collection”. In case of sperm failure or poor quality (too few or too slow sperm) after vasovasostomy, intra-cytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) with micro sperm injection becomes the treatment.
Some couples decide by choice not to have a vasovasostomy and go straight to sperm collection followed by IVF-ICSI because, per month (monthly fertility rate), in vitro fertilization is much more effective than vasovasostomy.
It is therefore understood that if it is medically possible to reverse the vasectomy, the chances of restoring fertility are not guaranteed and even less successof a pregnancy. If in doubt, before thinking about permanent sterilization, it may be better to consider a less invasive contraceptive method.
Good to knowVasovasostomy is a fertility restoration procedure which, like tubal reanastomosis, is covered by the RAMQ Quebec he alth insurance).
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