Biology Always Wins

The case of the month is an actual patient of The Turek Clinic.
“I hope you can help me, Doc. I’ve been shopping around to have my vasectomy undone, but I’m having trouble finding anyone who will do it. They say it won’t work. See, my wife is young and really doesn’t want to take all those drugs and needles that come along with IVF.”

Farmer in the Dell

He was in his early sixties, rugged looking, and dressed in a plaid shirt, Wrangler jeans and worn boots. His hands were strong and calloused, clear marks of one who has tilled the earth for most of his life. “I grow things, I’m a farmer.”
The problem was that his vasectomy was 32 years old. Yup, it was done the year the first Apple Macintosh computer came out. That year, Ghostbusters and The Karate Kid premiered at theaters. And Prince released Purple Rain. I was in still in medical school. A great year, that one.

One or Two, What to Do?

So what happens as vasectomies age? Well, they can get harder to reverse, as time is often unkind to the blocked reproductive tract. Since testicles continue to make sperm after the vasectomy, “pressure” builds up in the system behind the blockage and, like a tire slowly (but surely) filling with air, a “blow out” can occur. This typically happens in the epididymis, a small, innocent, comma shaped organ behind the testicle that most of the world has never heard of. And when that happens, it heals with microscopic scar tissue that introduces another blockage into the system, but much closer to the testis and more difficult to fix. And now there are two.
When reversing older vasectomies, it’s critical to figure out whether this newer, second blockage is present because if it’s missed, sperm will not flow freely into the ejaculate again. The fix involves a 9-syllable procedure termed an epididymovasostomy, and that takes some serious training and skill, as it rivals anything else done in the world of microsurgery.

Just the Messenger

“You think it will work?” he asked. “Sure,” I said. And here’s why. In our published series of over 1200 vasectomy reversals, including several hundred “older” ones ranging from 15 to 38 years of age, we learned the following:

  • Sperm production remains high in most men regardless of vasectomy age. Good to know that the engine keeps running when the exhaust is blocked for a while.
  • The need for epididymovasostomy surgery on both sides at reversal surgery peaks at about 40% of cases, even with a 4 decade-old vasectomy. This means that there’s a 60% chance that more complex surgery is NOT needed to unwind the tubes.
  • Microsurgical techniques have achieved new technological highs. The suture used now is 1/10 the thickness of hair and skillsets have evolved such that even the most complex procedures have a 75-85% chances of returning sperm to the ejaculate.

We did the vasectomy reversal, and to my surprise he didn’t have a second blockage, on either side. So, a simple vasovasostomy was done. In fact, during the surgery, the findings at surgery were what I might have expected for a much younger vasectomy, maybe a year old at most. While in the recovery room, I stood at his bedside as he awoke, and I clapped my hands softly. He looked at me, puzzled, and asked, “Why are you clapping?” I paused. “You showed me some fantastic biology today, and I am just admiring it. And you, my friend, are going to be a father.”