Refertilization in men - very successful
Children after sterilization
More than 30,000 men are sterilized in Germany every year. Six and a half percent of the men would, however, like to reverse the procedure. The reason for this is usually a desire to have children in a new partnership. Through advanced microsurgical techniques, it is now possible to connect the severed vas deferens again, thus restoring fertility. The process is known as vasovasostomy (refertilization).
"Basically, any man who cherishes a renewed desire to have children after previous sterilization can perform a vasovasostomy," explains Dr. Stephan Neubauer, urologist at the KLINIK am RING in Cologne. Whether the intervention is successful depends largely on the sterilization (vasectomy) performed in the past. In the first three years after sterilization, the success rate of over 90 percent for refertilizations is very high. The chance to become fertile again, decreases gradually until it amounts to only 70 percent after 10 to 15 years.
If there is a desire for refertilization, the physician and the will discuss the benefits prior to any procedure. To this end, the urologist will through appropriate examinations, obtain a clear picture of the condition of the vas deferens especially in view of the previous sterilization. "In rare cases, it can lead to scarring after sterilization in the epididymis area or to a contraction of the testicular tissue," says Dr. Neubauer. In such a case, a vasovasostomy is not advisable. Prior to the scheduled surgery, the urologist should also clarify whether the partner is able to conceive, because the probability of pregnancy depends of course, on the partner’s condition.
Surgery requires experience and intuition
"The aim of Vasosvasostomy is to again connect the vas deferens severed in the previous sterilization and for it to regain consistence," explains Dr. Neubauer. The surgery is usually carried out under general anesthesia and takes about two hours. A hospital stay is usually not necessary.
The principle is simple: In a first step, the scrotum is opened through two small incisions in the skin to expose the vas deferens. The vas deferens are cut and the scar tissue is removed. During this procedure, seminal fluid will exit from the vas. This fluid will be collected and still during the procedure examined microscopically for functional sperms. Simultaneously, the lower portion of the vas deferens is checked with regard to the passage being open. Then the vas deferens are reconnected with each other with very fine sutures and a special multi-layer suture technique under a high-magnification surgical microscope. The sutures are not visible. The skin incisions are sutured only at the scrotum. The sutures dissolve after some time. Two inconspicuous scars will, however, remain. Just a few hours after surgery, the patient can usually be discharged back home.
The vasovasostomy (refertilization) is a complex microsurgical procedure that requires high dexterity and surgical skills. The procedure involves the working with very small structures - the inner mucosal layer encloses an opening of 0.5 mm in diameter – under a special surgical microscope. "This allows us a very precise suturing of the vas deferens," says the Cologne urologist.
After about four weeks, a test must prove success or failure. For the first time the urologist will test the success of the procedure through a semen analysis. The question is "are there viable sperm in the ejaculate, this then would be the proof of the continuity of the vas deferens," explains Dr. Neubauer. Now only patience is needed: usually it takes 6 to 12 months until pregnancy can be expected.
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