Male refertilization is the restoration of fertility (fertility) after sterilization (e.g., vasectomy or vasoresection). Vasectomy is a surgical cutting of the ductus deferens (vas deferens), i.e. interruption of the vas deferens, resulting in infertility with undiminished potency. Vasorection refers to the surgical removal of a segment of vas deferens also for the purpose of sterilization. Approximately 6-10% of men have a renewed desire to have children after sterilization, possible reasons for refertilization are:
- Change of partner
- Psychological reasons
- Death of the children
- Improvement of economic conditions
Male refertilization is a microsurgical surgical procedure that requires the written consent of the patient. The success of the operation is proven by examination of the ejaculate. Spermatozoa (sperm) can be found in 80-90% of cases and the probability of pregnancy after a successful procedure is about 50-70%.
The chances of success are determined by different factors: Although the period between sterilization and refertilization has no influence on the success of the operation, the probability of pregnancy increases if the interval is short. The length of the vas deferens removed during vasectomy has a much greater influence, since if several centimeters are bridged, the surgical result may be worse. Below is a brief overview of the technique of the procedure and possible complications after surgery.
Indications (areas of application)
- Desire for children after sterilization
- Stenosis (narrowing) or obstruction (obstruction) of the ductus deferentes (vas deferens).
Before surgery
Before the operation, the patient should be informed in detail. In order not to jeopardize wound healing, cigarette consumption and anticoagulant drugs (e.g. acetylsalicylic acid/ASS) should be avoided seven to ten days before surgery.
The surgical procedure
Two surgical methods are used when performing refertilization. These are vasovastostomy and tubulovasostomy. Vasovasostomy is performed both for refertilization and for other obstructions (obstructions) or stenoses (stenoses) of the deferent ducts (vas deferens). In this procedure, the stumps of the severed vas deferens are visited, carefully detached from their surroundings and checked for patency. If the vas deferens are free, they are connected in an anatomically correct position. In the process, first the mucosa (mucous membrane) and then the remaining tissue are sutured in two layers. In tubulovasostomy, the surgeon makes a direct connection between the epididymid duct (duct of the epididymis) and the deferens duct. For this purpose, the epididymal duct is opened and also sutured to the vas deferens. Another method is epididymovasostomy in which a connection is made between the ductus deferens and the epididymis (epididymis).
After surgery
The external skin sutures usually heal in about 7-10 days, with complete healing of the reanastomosed (reconnected) vas deferens in about 3 weeks. After the operation, baths and saunas should be avoided for about 10 days, although showering is possible again after 3 days. In addition, physically strenuous activities should be avoided during this time. Sports activities, including cycling, should not be performed for a total of 4 weeks.
Possible complications
- Bleeding
- Inflammations
- Post-bleeding
- Scarring lumen obstruction of the vas deferens – narrowing of the vas deferens by scar tissue.
