All the King's Men: How to Put a Vas Deferens Back Together Again

More men are deciding they want to have kids after getting a vasectomy. Can the sterilization procedure really be reversed?

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Of the 500,000 people every year who get vasectomies, about 5 to 10 percent change their minds after the fact. The procedure, which sterilizes men by severing the tube supplying sperm to the urethra, was once considered a permanent operation. And in fact, doctors still generally discourage undoing a vasectomy. But, as MSNBC reports, technological advances and expanding coverage for vasectomy reversals among health insurance companies are leading to a rise in "unsnipping":

"Insurance companies are beginning to cover vasectomy reversals because the success rate of reversals is as good -- if not better -- than in vitro fertilizations (for women), in terms of live pregnancies," said Dr. Natan Bar-Chama, a male infertility specialist and urologist at Reproductive Medicine Associates of New York.

With the renewed interest in the tongue twistingly-named vasovasostomy, it's worth exploring just how these things work. Despite the common belief that you cannot splice once you've sliced, there are actually two ways patients can have their vas deferens restored to their former, intact state.

The first method is relatively simple. It basically involves reattaching one end of the cut tube to the other, and using tiny, microscopic sutures to hold them together. There are different ways to accomplish the task, including a simplified technique known as "4x4" that Indian surgeons pioneered in 2010, but the mechanics are roughly the same.

The second approach is usually only taken if the vas deferens has become blocked over time due to disuse. Doctors will attempt to connect the vas deferens directly to another tube at the back of the testicle called the epididymis, bypassing the part of the vas deferens that's no longer active. It's a more intensive process, but still gets the job done.

Since it's impossible to tell which method is needed based on inspection alone, surgeons will usually make a game-time decision after examining the patient's seminal fluid once he's been sedated. Either way, most patients will be out of the hospital the same day they go in.

In general, vasovasostomies have a high success rate -- whether your criterion is the return of sperm to the patient's semen after the operation (an outcome known as "patency") or actual pregnancy. In a nine-year study published in 1991 of nearly 1,500 Americans who'd reversed a vasectomy, 865 of 1,012 men who had a post-op semen analysis showed signs of patency. Among the 810 women in the study for whom conception information was available, about half said they managed to achieve pregnancy.

The longer you wait to have a vasovasostomy, the lower your chances of either patency or pregnancy. Men who decided to unsnip themselves after three years or less had the best chances of conceiving a child, with 76 percent of such patients achieving pregnancy with their partners. That figure dropped to 53 percent for men who waited up to eight years, 44 percent for those who waited up to 14 years, and 30 percent among those who waited 15 years or more to get a reversal.

For much of modern history, the responsibility for contraception has mainly fallen to women. Although more men are turning to vasectomies thanks in part to the recession, women who undergo sterilization procedures still far outnumber men. Now that vasovasostomies are getting cheaper and easier to reverse, though, it shouldn't surprise us if the imbalance begins to even out over the next few years.

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Brian Fung is the technology writer at National Journal. He was previously an associate editor at The Atlantic and has written for Foreign Policy and The Washington Post.

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