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For patients without a vas deferens (a problem they are born with, but which is diagnosed only much later on), the conventional treatment in the past consisted of creating a pouch surgically, into which the epididymis was made to open. This was called a spermatocele and sperm were aspirated from this and used for artificial insemination. However, pregnancy rates were very poor. The technique of PESA with ICSI (as described in the chapter on Microinjection) has revolutionised our approach to these men, and allows many of them to father a pregnancy.
Men often have this operation to render them sterile once they have completed their family. This is safe, easy surgery which involves cutting the vas deferens (the sperm carrying tube) and sewing it shut, so that sperm passage is blocked. These sperm are absorbed into the body so that although ejaculation is normal, there are no sperm in the semen.
If the man changes his mind after a vasectomy, and wants to father another child, microsurgery can rejoin the cut ends so that the sperm can once more pass through into the semen. This reversal surgery is called vasovasostomy or VVA (vasovasal anastomosis). It is expensive and only a few doctors are adequately trained to perform the operation - and even then success is not guaranteed. The best results are when the reversal process is performed within 5 years after the vasectomy before the development of antisperm antibodies. Good surgeons have reported pregnancy rates of as high as 80% using meticulous microsurgical technique.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
