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Vasectomies, Like Love, Not Necessarily Permanent

Study finds reversals possible even after 15 years

FRIDAY, April 5, 2002 (HealthDayNews) -- Marriages aren't forever, and -- luckily for men hoping to start over -- it looks like vasectomies aren't, either.

An Oregon urologist contends in a new study that men can successfully reverse vasectomies more than 15 years after the original operation.

Some doctors have thought the success rate of reversals declined significantly over time, and some patients wanting to have children were forced to turn to in-vitro fertilization. However, Dr. Eugene Fuchs, a urologist at Oregon Health Sciences University, found half of his patients with old vasectomies were able to impregnate their wives the old-fashioned way.

"They do have a realistic chance of fathering a biological child," says Dr. Larry Lipshultz, professor of urology at Baylor College of Medicine.

In a vasectomy, a doctor snips the vas deferens, the tube that carries sperm to the urethra, and then seals off the two ends. Various methods are used for the sealing process; doctors use stainless steel clips or sutures.

No one knows how many vasectomies are performed in the United States each year, Lipshultz says., however, estimates the number at 500,000.

The man will be able to ejaculate after a successful operation, but no sperm will appear in his semen. The man's body still makes sperm, but it is typically reabsorbed.

However, some men -- the numbers are unknown -- later want to have a child.

"It certainly is an increasing number of men due to the increasing divorce rate. The most common reason is divorce and remarriage," Lipshultz says.

In the past, the common wisdom was vasectomy reversals would often fail after several years, he says. In some cases, sperm would back up behind the sealed vas deferens tube over the years, hindering its ability to work properly.

Another possible complication is blockage of the vas deferens due to scarring or inflammation.

A 1991 study in the Journal of Urology found that only 30 percent of vasectomy reversals after between nine and 14 years succeeded in producing pregnancies, says Dr. Rebecca Z. Sokol, director of andrology (male reproductive medicine) at the University of Southern California Keck School of Medicine.

Surgery techniques have improved over the last decade, Sokol says, and that may have contributed to f Fuchs' success rate. He was able to successfully reverse vasectomies in one-third of men who had their original surgeries 20 to 25 years ago.

Fuchs studied 173 of his own patients who had vasectomy reversals more than 20 years after the surgery. He reports his findings in the March issue of the journal Fertility and Sterility.

Fuchs found that the fertility of the men didn't seem to vary depending on their age. However, the age of women did affect the couple's ability to conceive: The pregnancy rate for women younger than 30 was 64 percent and 28 percent for those older than 40.

Fuchs examined a similarly aged sample of couples who tried in-vitro fertilization, and found that 40 percent of those couples had children.

During in-vitro fertilization, in which sperm is removed from the man and united with an egg from the woman in a laboratory. Fertilized embryos are then implanted in the woman.

Vasectomy reversal is not cheap. Lipshultz says it may cost between $7,000 and $8,000.

However, Sokol says couples may prefer it to in-vitro fertilization, which may require repeated attempts before a woman becomes pregnant.

What To Do: Learn about vasectomies from this Emory University fact sheet. The Urology Channel offers information on vasectomy and vasectomy reversals, including details of the different types of surgeries available for the latter.

SOURCES: Larry Lipshultz, M.D., professor, urology, Baylor College of Medicine, Houston; Rebecca Z. Sokol, M.D., professor, medicine and obstetrics and gynecology, director of andrology, University of Southern California Keck School of Medicine, Los Angeles; March 2002 Fertility and Sterility
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