He came in to talk about a vasectomy reversal. “Doc, it’s been 15 years since my wings were clipped. Do my sperm still work? If I have kids, will they be ok?”
A Two-Sided Picture
Great questions! He was wondering whether being blocked so long from a vasectomy had fiddled with his sperm. Somehow messed it up. I broke this question into 2 parts:
- What disease risk does he bring to kids as an older father?
- What disease risk does he bring to kids having an older vasectomy reversed?
The Older Father
We’ve dealt with the older father issue before. Older fathers do bring issues to bear on their offspring. But, alas, the increased risk of transmitting heritable diseases in this way is quite low overall, much less than 5%, and there is nothing to test for in particular to know before you go. But this was not the meat of his questions to me.
The Older Vasectomy
The poignant issue here is whether sperm that are produced after prolonged obstruction with vasectomy might somehow be damaged or defective once the vasectomy is reversed. After all, how would a car engine to run if you put a cork in the exhaust for a while?
Well, I too was curious about this issue and published a neat study that addressed it a couple of years ago. In men undergoing vasectomy reversal, we tested the genetic fidelity of the sperm producing machinery after prolonged blockage. How good was the quality control process after being blocked for years? How did it compare with that of men of normal fertility who had not had a vasectomy?
Technically, what we sought to find out was how recombination errors during meiosis translate into chromosomal abnormalities in sperm. We found that the “factory” (testicle) and its “product” (ejaculated sperm after reversal) were both in remarkably good shape after prolonged blockage. In fact the genomic integrity of the sperm produced after reversal was no different than that of otherwise fertile men—you really couldn’t tell them apart. This was very encouraging and means that having a vasectomy should not lead to an increased risk of chromosomal diseases in offspring after reversal.
So, I told him that. “Sir, your sperm after reversal are fully the fellows they were before the your horses were reigned in.”