Snips and Reversals: Vasectomies and Male Fertility

A man decides to have a vasectomy for a variety of reasons – some say the lack of worry over conceiving a child prematurely leads to more satisfying sex, particularly if a woman doesn’t wish to use birth control – but the most common and overriding reason is to delay or even prevent impregnating a partner.

The minor surgical procedure, which can be performed in roughly ten minutes’ time in a doctor’s office under local anesthesia, is said to be almost 100% effective. And it shouldn’t impact post-operative sexual function – men can still ejaculate, and women can still reach orgasm. The procedure merely prevents sperm from being transported from the testes.

Though a man’s body continues to manufacture sperm, which are harmlessly re-absorbed into the man’s body, vasectomies can, in some cases, be reversed. However, Web MD reports that “reversing a vasectomy isn’t easy and doesn’t always work”.

For men who have already had vasectomies and/or wish to one day have them reversed, what are the effects on their fertility? Can simply interrupting the flow of sperm for a period of time really have any effect on the quality of sperm?

First, it’s important to remember that as a man ages, his sperm can suffer damage, as he produces a new genetic defect every 8 months. Delaying the start of a family for several years can also increase a man’s exposure to damaging chemicals and pesticides, as well as to harmful effects of pollution and even prescription drugs.

That said, a 2013 study published in the Asian Journal of Andrology examined the long-term effects of having a vasectomy on spermatogenesis, or the formation and development of sperm. The study involved 51 males over the age of 50 with a previous history of paternity and demonstrating no diseases involving the testes.

The study authors concluded, “Spermatogenic damage may occur after vasectomy”. More specifically, one month after having a vasectomy, the damage could be classified as “severe”, while at one to 20 years after the procedure, “a 20% -- 40% reduction in the number of spermatids [young sperm cells] may exist”.

Even so, some of the men included in the study saw no adverse effects on their sperm for as many as 40 years later, but this was attributed to a likelihood that sperm production may have reached an “equilibrium” at later points in the subjects’ lives, when the effects of aging were likely responsible for the lack of evidence of a vasectomy’s long-term effect on sperm.

When it comes to reversing a vasectomy, though, a report from Healthline warns that the longer a man waits to correct what he earlier decided to impede, the lower his likelihood of subsequently conceiving a child.

Vasectomy reversal also involves more complications than does a simple vasectomy. Surgeons can choose to use one or both of a pair of procedures: Vasovasostomy involves using sutures to re-tie two ends of the tubes that were severed at the time of the vasectomy, while Vasoepididymostomy takes things further by tying tubes directly to a duct located behind the testes.

According to the Mayo Clinic, success rates for reverse vasectomies range from 40 to 90 per cent. Factors influencing the degree of success, measured by whether a man can impregnate his partner, include the length of time since the original vasectomy; the age of his partner; and, the experience and training of the surgeon chosen for the procedure(s).

The Clinic further suggests that men considering a vasectomy procedure may wish to freeze semen beforehand in the event that the vasectomy isn’t effective. Men who choose to reverse their vasectomies will need to return for follow-up care, which will include the testing of semen to determine if the procedure was a success.

Sperm quality should register as normal within 3 to 6 months following a reverse vasectomy, says the University of Iowa Hospitals and Clinics, noting that “the count and the motility may be lower after reversal due to partial blockage or scarring”. And men should check for the effects of scarring every 3 months, given that the chances are about 7 to 10 per cent during the first year or two following a successful reverse vasectomy.

For men concerned about the effects of a vasectomy on their future fertility, proactively storing their assets before the procedure can prove a wise decision.