Vasectomy reversal: first cut isn't final

(But at £3,000 for a reversal, it isn't a snip)

(Paul Tonge)

The rising divorce rate and boom in second marriages is leading to a surge in demand for an operation on the most sensitive part of the male anatomy. Breaking up, as the song says, is hard to do – but falling in love again and creating a new family poses a particular challenge for men who have had the snip.

Almost 40 per cent of weddings are second marriages and for men who have undergone a vasectomy, believing their family was complete, the only prospect of having children with their new partner is an operation to reverse it.

But surgery to restore male fertility is tricky, costly and not offered on the NHS, other than in exceptional circumstances. A spokeswoman for BPAS, the pregnancy advisory charity, said: "We are seeing a rise in enquiries about vasectomy reversals but there is no NHS commitment to fund them. Lots of men contact us but when they find the cost is £3,000 and the outcome is uncertain we don't hear from them again."

"Second and third families are being given a really hard time. Partners come together for whatever reason late in life and want to have children and we don't think that should be seen as a bad thing."

No figures are kept on vasectomy reversals but doctors say it is not limited to men in new partnerships. Some couples in stable relationships change their minds about wanting to enlarge their families at key moments such as when the children leave home for school or university.

Vasectomy reversal is not included under the guidance issued to the NHS by the National Institute for Clinical Excellence (NICE) on fertility treatment. One PCT in Yorkshire agreed to pay for surgery for the father of a family, but only because he had lost a child in an accident.

To fill the gap left by the NHS, private specialist clinics have sprung up around the country offering the operation and there is a thriving trade in Harley Street.

Around 16 per cent of men in Britain have had a vasectomy, according to figures from the General Household Survey. The operation is a simple 20 minute procedure, carried out under local anaesthetic, in which the tube carrying sperm from the testicles is cut and tied off. The man still produces semen, from the prostate gland, and can have sex and ejaculate in the normal way, but is incapable of fathering children. Some clinics advertise "laser vasectomies" but this offers no advantages because an incision in the scrotum must still be made and the laser used, in place of a scalpel, to cut the tube.

Reversing the operation is a difficult procedure, requiring precision surgery to reconnect the tube conducted with the aid of a powerful microscope under general anaesthetic.

Even if the surgery is successful and a normal sperm count restored – claimed success rates range up to 90 per cent – a subsequent pregnancy is not guaranteed. Sperm quality can be poor and some men form antibodies against their own sperm. The chances of ending up with a baby are put by BPAS at 55 per cent if the reversal is performed within 10 years and 25 per cent if over 10 years.

Duncan Harriss, a consultant urologist who runs a specialist vasectomy reversal clinic at Nottingham's private BMI Park Hospital, said he was performing 150 operations a year compared with 10 to 15 a decade ago.

"In the last three or four years I have done a lot more," he said. "I can't say how much is due to increasing demand and how much to the clinic becoming better known. Sadly, marriages break down, divorce is rising and people's circumstances change. People tend to come for treatment quite soon after remarriage when they realise the length of time since they had the vasectomy is important.

"Nowadays, specialist clinics offer reasonable value. It is better than going to a jobbing surgeon who does the odd one or two. I went to the US to learn the technique and I am far better at it than 10 years ago. We get a lot of people from London; costs are lower in the east Midlands."

Some doctors say the NHS should offer the operation because it has a moral obligation to reverse a procedure it has carried out. Latest figures show three out of four vasectomies were performed on the NHS in 2007-08. Although the number of reversals is not known, US research suggested 6 per cent of men change their minds at some point after vasectomy and seek to restore their fertility.

Sam Nag, a retired consultant urologist who still performs vasectomy reversals at the BPAS clinic in Brighton, said: "The NHS stopped doing the reversals in the late 1990s as a result of budget constraints. In my view, if you are offering one service you should also offer the other. The divorce rate is so high there are many cases where men will want to reverse what they had done earlier. But the managers holding the health authority budgets put it at the bottom of the list."

Men who request vasectomies are advised that the operation is irreversible and they should only contemplate it if they are confident that they will not want more children in the future.

One possibility for men who want to keep their options open is to consider freezing some sperm before the operation. The stored sperm can then be used in IVF should the need arise in the future.

In practice this is likely to present difficulties as it requires the man to contemplate a future in which he may not be with his current partner – at a moment when she is likely to be sitting beside him.

With men in whom vasectomy reversal has failed, the last option is the use of a technique in which sperm can be extracted directly from the testes. However, this is more expensive than a reversal and has a lower success rate.

Dr Nag said: "We do tell men seeking vasectomy that a reversal is possible but we warn them that it is an expensive procedure, not available on the NHS and the results are not that good. It is difficult to know what the results are in terms of pregnancies because the men often do not stay in touch. Follow-up is difficult."

Family affairs: Statistics behind the trend

*There are some 300,000 marriages a year, of which 110,000 are second marriages.

*132,000 couples divorced in England and Wales in 2006.

*The number cohabiting increased 65 per cent in the 10 years to 2006.

*Since 1997 the average age of men at divorce in England and Wales has risen from 40.2 to 43.7.

*Marriages last on average for 11.5 years.

*More than half of divorces involve custody of at least one child under 16.

*Around 16 per cent of men in England and Wales have had a vasectomy.

*One in five men and women divorcing in 2006 had been divorced before.

*Men over 40 are more likely to father a child with a birth abnormality.

Paul Johnson, Accountant, 43: My second chance at fatherhood

Paul Johnson and his second wife, Hayley, were overjoyed when they discovered last summer that she was pregnant. Max, their son, was born four weeks ago and is living proof that it is possible to restore a man's fertility, even 15 years after a vasectomy.

Mr Johnson has two children from his first marriage and had the snip in 1992, two years after his second son was born. The marriage broke down, he got divorced and later remarried to Hayley, who also had a child from a previous relationship. They both accepted that they would not be able to have more children together.

Soon after their marriage, however, they began to wonder if it might be possible. Mr Johnson searched the web on vasectomy reversal, looking at success rates and costs, and went to see urological surgeon Duncan Harriss at the BMI Park Hospital in Nottingham.

"He told me my chances were very slim because of the length of time that had elapsed since my vasectomy – from 1992 to 2007," Mr Johnson said yesterday. "If Hayley had been 35 instead of 34 he might have drawn the line because the duration of my vasectomy combined with her age meant a pregnancy would have been highly unlikely. My response was that I am a big believer in fate and if it is meant to work it will."

Three months later, he submitted a sperm sample to be tested: "Mr Harris called personally to tell me the results because he was so impressed by the sperm count."

Exactly a year after that, Hayley took a pregnancy test and discovered that their son was on his way. To cap it all, it was Father's Day.