Vasectomy Reversibility: A status report
The current status of the reversibility of the effects of vasectomy is reported. A very small percentage of vasectomized men seek restorati on of fertility. Among those who do, remarriage after divorce or death of wife, death of a child, improved economic situation, and psychological considerations of adverse effects from vasectomy are the most often cited reasons. A successful reversibility technic may increase the popularity and acceptability of vasectomy, and could help remove some of the religious and cultural objections to vasectomy. The techniques of vasectomy and anastomosis are major factors in the success of reversibility, as well as the skill of the surgeon. The rate of success, as determined by the reappearance of sperm, varies from 40 to 90%, while success, as determined by subsequent pregnancy, varies from 18 to 60%. Reasons for anatomical failure include spermatic granulomas, obstructions, misalignment of the vas ends, and choice of technique. Injury to the testes, epididymides, or sympathetic nerve endings, low prevasectomy fertility, and, possibly, sperm antibodies are some reasons for functional failure. Vas anastomosis is presently the most widely practiced method. Recently, mucosa-to-mucosa anastomosis with a splint, and performed under an operating microscope, has been attracting attention. Vas occlusive devices, such as plugs, clips, intravasal thread, and vas valves are in the experimental stage. Another approach to reversibility is the storage of frozen semen, though this is also in the experimental stage because of its high cost, limited availability, and uncertain results. Research priorities in the developemtn of improved anastomosis techniques and vas occlusive devices include a better understanding of male physiology and suitable animal models for testing.