Reversing the snip doesn't mean you'll be a father again



When James Gardner met Marcia, the woman who was to become his second wife, having children together was immediately an issue.



While James, then 41, had two children from his previous marriage, Marcia was 28 and desperate to start a family.



But there was a major stumbling block — James had undergone a vasectomy.

James Gardner with his wife Marcia and their children Connor and Aveline. He had a vasectomy reversal in 2002, six years after he had the procedure

‘It had been a mutual decision with my former wife to have the vasectomy and, at the time, I was happy to so we didn’t have to worry about contraception any more,’ says James, now 52, a telecommunications contract manager from Desborough, Northants.



‘I never thought I’d want any more children, but when I got together with Marcia, I knew she did and it seemed unfair that I had two children and she had none.’

Every year, 65,000 British men undergo a vasectomy — this simple, 15-minute procedure involves severing, then sealing off, a tube called the vas deferens, which carries sperm from the testes to the penis.



The procedure is often free on the NHS, or privately costs less than £400, and has a 99.9 per cent success rate.



But James is one of an increasing number of men who regret that decision and seek a reversal. With 132,000 couples divorcing every year and second marriages accounting for 40 per cent of all weddings, clinics are reporting an increase of up to 20 per cent in men requesting the operation over the past five years.



‘Around one in ten men having a vasectomy will want it reversed later on,’ says Frank Chinegwundoh, a consultant urologist at Bart’s Hospital, London.

‘Divorce, remarriage and meeting someone younger are invariably the reasons.’



Although vasectomy reversal is possible, the £3,000 operation is far from straightforward — and only a fraction of men can expect to have more children.



‘While a vasectomy is a quick, straightforward procedure carried out by and large under local anaesthetic, reversals are a much bigger job, taking an hour and a half to perform and requiring a general anaesthetic or deep sedation,’ says John Lemberger, a consultant urological surgeon based in Nottingham.



Clinics are reporting an increase of up to 20 per cent in men requesting a vasectomy reversal over the past five years

Vasectomy reversal involves reconnecting the two ends of the tube to the testes that have been cut, so sperm can once again be released from the testes.



A small incision is made in the scrotum and the two ends are joined back together in a delicate procedure that often requires a high-powered microscope and uses stitches that are thinner than a human hair.



Most procedures are technically successful, with surgeons rejoining the ends of the tube in 80 per cent of cases where the reversal is performed within ten years of the vasectomy.



However, whether the patient will be able to go on and start a family is another matter. That’s because the vas deferens tube can re-block with scar tissue over time — even if the reversal seemed successful — preventing sperm from getting through. One in 20 men experiences reduced sperm count over time caused by scar tissue forming.



After a vasectomy, around 60 per cent of men also develop antibodies that attack their sperm, reducing its motility and potentially causing infertility problems, although doctors don’t fully understand why this occurs. This is a significant problem for one in 100 men having a reversal.



The epididymis — the delicate sperm sac that takes sperm to the vas deferens tube — can also be damaged over time following a vasectomy. It normally takes around three months for sperm to appear in semen, but it can take longer, and most couples won’t conceive until 12 months after the reversal.



Overall, the chance of having a baby if a reversal is performed within ten years of a vasectomy is 55 per cent, and just 25 per cent if it has been longer.



There are also risks of complications — pain can occur, thought to be caused by scarring around the very fine nerves, and one in 25 men experiences long-term pain in the testicles, thought to be caused by scar tissue forming and the tubes swelling.



For James and Marcia, it has not been an easy road to having a family. James had a reversal in 2002, six years after his vasectomy. It was a success and Marcia became pregnant with their son Connor, eight, but when they tried for another baby a year later, they had no joy.



Tests showed James’s reconnected tubes had become blocked with scar tissue. Even after undergoing a second reversal procedure in 2007, Marcia didn’t get pregnant and the couple feared they would never be able to have another child together.



‘We had virtually given up hope. It was a very difficult time,’ says James.



Their luck changed after Marcia did some research on the internet and discovered another option — surgical sperm retrieval, which is used alongside IVF.



The £1,500 procedure, carried out under sedation or general anaesthetic, involves inserting a fine needle into the area of the testes where sperm is stored and drawing it out.



The sperm is then frozen and used in a fertility procedure called ICSI (Intracytoplasmic sperm injection), which costs a further £4,500. Here, a single sperm is injected directly into an egg before being placed back in the woman’s womb.



Whether the couple ends up with a baby depends on factors such as the woman’s age and whether there are any other fertility issues.



Aged 38 at the time, Marcia’s chance of success was around 40 per cent, says Dr Rahnuma Kazem, medical director at CARE Fertility Northampton, where the couple were treated.



Thankfully, James and Marcia’s first attempt was a success and their daughter Aveline was born in January this year. According to Dr Kazem, surgical sperm retrieval is becoming increasingly popular.

‘This is the only other option to vasectomy reversal and potentially you could do this instead of having any reversal procedure at all,’ she says.



‘However, it is not available on the NHS and means the woman has to undergo IVF and have her eggs collected, with all the costs and treatment that involves, so men normally try a reversal first.’



With demand for reversals increasing, some clinics are advising men to freeze sperm before they undergo a vasectomy ‘just in case’ their circumstances change.



Despite having to undergo a vasectomy, two reversals and surgical sperm retrieval, James says it has all been worth it.



‘We are so delighted and lucky to have Aveline. We made a pact that we would just have one attempt at fertility treatment and if it didn’t work, then that was it,’ he says.



‘The result couldn’t have been better — Connor has a sister and he loves her to bits.



‘I never found the procedures to be that bad, and have only ever needed a few days off work each time.

