A vasectomy is a reliable form of contraception and is popular among South Africans. But there is a small group of men – approximately five percent of those who undergo a vasectomy – who return to the doctor to have the operation reversed so that they can become a dad again.
"In principal a vasectomy is a permanent form of contraception, but there are ways to try and reverse it," says Dr Amir Zarrabi, a urologist with Stellenbosch University's Faculty of Medicine and Health Sciences.
A vasectomy is a surgical procedure whereby the tube that leads sperm cells from a man's testis (vasa deferentia) is severed and tied to prevent conception.
"It is a very good form of contraception for married couples. It's reliable, it's a minor operation without many risks, it doesn't have any hormonal influence on the body, and is a once-off expense," explains Zarrabi.
In most cases, men in their second or third marriages request vasectomy reversals when they want to start families with their new partners. "An increase in divorce is driving the demand for vasectomy reversal – men get vasectomies when they are in stable relationships and they think they won't have any more children, but then it doesn't work out," says Zarrabi.
According to him the average patient requesting a vasectomy reversal is in his mid- to late thirties.
"Patients should not have the perception that they can have vasectomies now and just reverse it later when they change their minds. Vasectomies are not done to be reversed, but there are methods of doing it which makes it easier to reverse at a later stage," he says.
The success rate of a regular vasectomy reversal (vasovasostomy) is only 15 to 20 percent, but with a special microsurgery technique Zarrabi learnt in the USA (vaso-epididymostomy) he achieves up to 80 percent success rate with vasectomy reversal.
In contrast with the regular procedure which just attaches the two ends of the vasa deferentia where it was severed with the vasectomy, Zarrabi does a bypass that directly attaches the vasa deferentia to the epididymis (a tube running just above the testicle) which circumnavigates any blockages which may have formed due to pressure in the testicles. The epididymis tube is as thin as a human hair and therefore has to be attached with microsurgical techniques and specialised microsurgical instruments.
There are also certain techniques that can be used with the initial vasectomy that may increase the chance of a successful reversal in future, without influencing the integrity or efficacy of the vasectomy.
With a standard vasectomy the vasa deferentia is severed and both ends are tied with a stitch or a metal clip. This practice, which is very common in South Africa, causes pressure to build up in the epididymis which can lead to blockages in the structure.
The technique Zarrabi follows, which is similar to vasectomy practice in the USA and Europe, leaves one end of the vasa deferentia open which prevents pressure from building up in the testicles, and closing the other end by burning it. A piece of tissue is also placed between the two ends to ensure that sperm cells don't land up in the seminal stream.
"This technique is just as safe as the standard vasectomy, but it also makes provision in case things change and the man wants to do a reversal," says Zarrabi.
Interesting facts about vasectomies
- Among certain cultural groups there is a perception that a vasectomy affects your manhood and libido, but this isn't true at all.
- Although a vasectomy is a very reliable method of contraception, about one in every 5 000 cases is unsuccessful.
- Although there are not many risks associated with a vasectomy, a small group of men (three out of every 100) develop post vasectomy pain syndrome.
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