Vasectomy represents one of the most used contraceptive methods worldwide. It is estimated that vasectomy represents 8% of all contraceptive methods used worldwide. In contrast, 6% of vasectomized men seek medical help to be parents again.
THE MOST FREQUENT CAUSES THAT LEAD A VASECTOMIZED PATIENT TO REVERSE THIS SITUATION ARE:
- New wedding
- Death of child
- Desire for a new child in the same relationship
- Psychological intolerance to sterilization
See the figure for the different ducts being rewired to reverse the vasectomy.
A vasectomized patient has the best chance of paternity in surgical reversal. With the introduction of fertilization programs, contrary to popular belief, surgical reconstruction was even more indicated. For example, 15 years ago, when a vasectomized patient underwent reversion, the entire conception process would be by natural reproduction. In this situation, when the patient was vasectomized for a long time (more than 10 years), the semen quality could be impaired. However, with assisted procedures, with an anastomosis being patent, if the amount is not sufficient for the natural process, the patient can be placed in one of the assisted programs, with the advantage of harvesting sperm by masturbation, without any surgical intervention.
Although vasectomy reversal can be done without the aid of a microscope, the best results are obtained with microsurgery.
We must evaluate the partner to make sure that she does not present any absolute impediment. If the wife has a tubal problem or any other indication of in vitro fertilization, the most recommended is that the vasectomy is not reversed. In this case, the best option is to perform MESA, followed by ICSI.
Although they can be reconstructed without the aid of lenses or with a magnifying glass, the best results are obtained with microscopy (15 to 25 times magnification). Basically, two main techniques are used today. One in full plane, where the needle enters through the light of the different ducts and crosses all the layers (Howards) with mononylon thread 9.0 (4 cardinal points) and a reinforcement is made with stitches only in the adventitious tunic. In the other technique, known as the two-plane technique (Silber), the first mucous plane is made with 10.0 mononylon thread and then the muscular one is approached with 9.0 thread. Both one and the other have excellent results. In our experience, an average permeability of 90% and paternity of 75% can be expected. If the pregnancy does not occur normally, you should review your partner and propose the most appropriate program.
Here we see the final result after the surgery is completed.
References in Medical Literature:
- Lipshultz LI, et al. Surgical management of male infertility. In: Wein AJ, et al. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2007.
- Practice Committee of the American Society for Reproductive Medicine. Vasectomy reversal. Fertility and Sterility. 2008;90(suppl):S78.
- Vasectomy reversal. UrologyHealth.Org (American Urological Association).
- Lipshultz LI, et al. Techniques for vasectomy reversal. Urologic Clinics of North America. 2009;36:375.