If the increase in vasectomy reversals Edmund Sabanegh, MD, has seen at the Cleveland Clinic is any indication, the nation’s well-being is on the upswing. Requests for the procedure have risen 82 percent in three years.
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“People are thinking more about having children and having the financial means to undertake this procedure,” Dr. Sabanegh says, noting that it’s usually not covered by insurance.
Reversals fall into two categories. In the more conventional vasovasostomy, the surgeon reattaches the severed sperm delivery tube called the vas deferens. The other kind, called a vasoepididymostomy, occurs when patients have an obstruction in their epididymis—the coiled tube along the testicle where the sperm matures. If the epididymis is blocked, the surgeon will perform a more involved procedure, reattaching the vas deferens to the epididymis above the blockage.
“The idea [with the more conventional vasovasostomy] is you’re cutting out the bad segment where they did the vasectomy, and you’re very carefully hooking it up to healthy tissue,” says Dr. Sabanegh.
Both procedures are performed using microscopes that can magnify up to 25 times. “Microsurgery has been around for a long time,” says Dr. Sabanegh. “I think we’ve gotten better and better at it, and our sutures have gotten smaller and smaller.”
Between 6 and 10 percent of vasectomy patients change their minds after the procedure and seek a reversal, says Dr. Sabanegh, who has performed more than 600 reversals and is the director of the Center for Male Infertility at the Cleveland Clinic.
The typical suture for a vasectomy reversal is finer than a human hair—“really too small to see with the naked eye,” Sabanegh says. The interior lining of the vas deferens has the expanse of a large grain of sand, “and we will place 12 or more sutures in that area to get it to line up very precisely.”
Both types of reversal surgery have a quick recovery time. “Typically it takes a couple of hours to do it, and they go home that afternoon,” says Dr. Sabanegh. “They can go back to desk jobs in a day or two–or if they have a more physically strenuous job, they probably need to wait three or four days.”
Risks of bleeding and infection are “well less than half of one percent … so it’s considered a very safe and very recoverable procedure.”
Dr. Sabanegh says the most common reason people seek the procedure is they’ve remarried and want to have children with their new partner. “But we also see couples that just change their mind,” he says. “And the sadder situations are those where there’s been a loss of the child.”
Even then, the rewards are many. “My practice has dealt with treating cancer and a variety of really sad situations, and the happiest patients that I ever see are those that become fertile after these operations.”
A wall in Dr. Sabanegh’s office is papered with photographs of patients’ new babies. “I’m now on my third bulletin board,” he says. “So it’s very rewarding.”