That tattoo you thought was a great idea in college? Maybe not so much now. And that perm you shelled out big bucks for in 1985...probably wouldn't be a discussion with your hairstylist today.
It’s a fact of life – situations change, minds change, decisions change.
For men and couples who make a decision not to have any (or any more) children, they might decide to have a vasectomy. But what if their minds change? Or, in many cases, a relationship ends, a new one begins and all of the sudden you do want to have children?
“A vasectomy is one of the most common urologic procedures and should be considered a permanent form of contraception,” says Puneet Masson, MD, assistant professor of urology in surgery and director of Male Fertility at Penn Medicine. “That being said, approximately five percent of vasectomized men express the desire for future children and one to two percent may seek consultation regarding options for future fatherhood.”
Dr. Masson sees men who are interested in having a vasectomy. However, he advises that they should only have the procedure if they are 100 percent sure they do not want any more children. A man can also cryopreserve sperm if there is any concern that someday he may desire more children.
“Of course, we understand that life is dynamic and unpredictable and that some vasectomized men are highly interested in achieving a genetic pregnancy,” says Dr. Masson. “There are two options for these patients: vasectomy reversal, and sperm extraction. Both pathways are equally effective at achieving future children and the decision depends on the preferences of the patient/couple.”
Reversing a Vasectomy
First, it’s important to understand how sperm is made. Sperm are made in the testicle in extremely small tubules called seminiferous tubules. This process takes approximately 60 days. Afterwards, they are slowly transported to the epididymis and continue to mature over a period of two weeks. Following this, they are ready to be ejaculated and are stored in the section of the vas deferens immediately next to the epididymis and part of the epididymis itself.
During a vasectomy, the vas deferens is cut and each end of the vas is tied, clipped, and/or burned. Thus, the semen of a vasectomized man should not contain any sperm. During a vasectomy reversal, the vas deferens is reconnected so that the man’s ejaculate contains sperm.
A vasectomy reversal typically takes four to six hours and is done under general anesthesia. Afterwards, the patient is able to go home the same day. Following a healing period, the man is “allowed” to resume unprotected sexual relations. Due to swelling in the vas deferens, which occurs as a natural part of healing, it may take up to a year before sperm are visible in the ejaculate. If the more complicated connection is done (vas to epididymis), it may take up to 18 months.
“What all patients should understand is that there is no guarantee that a pregnancy will be conceived through natural means following a vasectomy reversal,” says Dr. Masson. “Though most studies report a ‘natural’ pregnancy rate between 50 and 70 percent, some couples may still choose to participate in assisted reproductive therapy following a vasectomy reversal and do in utero insemination (IUI) and/or in vitro fertilization (IVF).”
“A sperm extraction procedure is also an excellent option for vasectomized men who desire future children,” says Dr. Masson. A percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), microsurgical epididymal sperm aspiration (MESA), and microsurgical testicular sperm extraction (microTESE) are procedures that directly extract sperm from either the epididymis or testicle. This can be done under local anesthesia, conscious sedation (aka “twilight anesthesia”), or general anesthesia, and can be completed in about an hour.
“What is important to understand is that all sperm extracted must be used in conjunction with IVF, where a woman undergoes an egg retrieval procedure and the sperm must be injected directly inside the egg,” Dr. Masson says. “After a few days, the developing embryo is placed into the woman’s uterus. Excess sperm that was not used for fertilization is usually cryopreserved and stored for future IVF cycles.”
All vasectomized men who are interested in future genetic children should be counseled on both options. A full female evaluation is also recommended, as this may aid couples in making an informed decision. Penn Fertility Care is committed to understanding a couple’s reproductive goals and preferences. Our team includes physicians, nurses, and financial counselors who can discuss all aspects of fatherhood after a vasectomy and individualize a plan for future family planning.