Reversing the “Older” Vasectomy: A Surgeon’s Point of View
I’m not sure exactly why, but I see a lot of men with “older” (>15 year old) vasectomies who want them reversed. It’s a daily occurrence. Sure, I have published and lectured on this topic, but I think patients also sense that I have a particular interest in these more complex cases. They fall smack into the crosshairs of my interest, skill and expertise.
There’s a lot more going on with reversing the “older” vasectomy than you might imagine. In addition to the simple problem of undoing a man-made blockage, there are a host of other issues to consider when reversing men with “older” vasectomies.
- Is he still making sperm? Although we have published that sperm production stays relevant constant as men age and gray, there is definitely a point, generally in the 8thdecade, where sperm production ceases entirely. It is a clinical art to identify those at risk for testis failure before attempting complex microsurgical procedures.
- Are his sperm healthy? We have published that sperm chromosomal integrity is well maintained after prolonged blockage from vasectomy. But, it’s also true that other, more subtle genetic issues can affect sperm as men age. The general consensus though is the healthier the man, the healthier his sperm.
- Will his kids be healthy? A discussion of the inexorable effects of advanced paternal age on the health of offspring is part and parcel of my practice.
- Does he know all of his options? Although vasectomies are reversible, doing this introduces the problem of contraception back into the couple’s lives. To some, simply retrieving sperm and leaving the much appreciated vasectomy alone can be an attractive option. To others a review of the cost-effectiveness of reversal vs. IVF is very important.
- When will she conceive? With many couples, the timeline of sperm recovery, time to pregnancy and pregnancy rates after vasectomy reversal matter greatly to family planning, especially when IVF, the “big hammer” of all treatments, looms large as an alternative.
- Will he recover well? This issue is man-handled with a proprietary on-line digital house call service that follows men daily for several weeks after procedures.
All in, both art and medicine are behind the decision to reverse the “older” vasectomy. In a sense, surgeons should have the bigger and longer view what will happen after surgery. Indeed, in the words of Pablo Picasso, the surgeon must “[wash] the dust of daily life off [their] souls” and foresee the true potential that patients have to be fathers again.