During refertilization, a reproductive physician restores a person’s destroyed fallopian tubes or vas deferens, which were previously severed during sterilization. Thus, refertilization is used to surgically or minimally invasively restore fertility. For women, the procedure is associated with an increased risk of future ectopic pregnancies.
What is refertilization?
Refertilization is the term used by reproductive physicians to describe the artificial and surgical restoration of fertility. By refertilization, the reproductive physician means the artificial and surgical restoration of the ability to procreate. Refertilization can be performed on a woman as well as on a man. In a man, the vas deferens is restored. In women, it is the fallopian tube. In a narrower sense, the doctor speaks of a refertilization only when either the fallopian tube or the vas deferens is previously cut and reconnected during the operation. This means that refertilization is usually preceded by sterilization, which is now regretted by the patient. The sterilization is reversed by the refertilization surgery. According to statistics, people around 30 years of age most often undergo sterilization. According to the same statistics, refertilization most often takes place on people around forty years of age, which is about ten years after sterilization.
Function, effect and goals
Refertilizations affect sterilized women and men who regret the step of sterilization. During sterilization, the doctor cuts the patient’s fallopian tube or vas deferens to stop the ability to conceive. Refertilization can reconnect the severed components. In women, the surgeon first removes the destroyed fallopian tubes in slices. He checks the patency of the removed slices by means of a blue sample. As soon as the fallopian tubes are found to be passable, the doctor inserts a so-called splint into them. This is a thin tube that momentarily connects the discs and brings the ends of the fallopian tube discs into exactly the correct position relative to each other. At the splint, the physician sews the individual discs together piece by piece. Before the reconstructed fallopian tube can be reinserted, the physician removes the cotter pin. A few months later, the doctor checks the patency of the restored fallopian tubes. In some circumstances, the operation can also be performed endoscopically. However, with this minimally invasive procedure, the chances of success are much lower than with surgery. Endoscopy leaves larger scars on the fallopian tubes and makes it impossible to use a splint. This can affect later patency, as the ends may not be joined in exactly the correct position. There are two different procedures available to the man for refertilization. The regular operation is called vasovasostomy. On the other hand, if the epididymal canal needs to be connected to the vas deferens, reproductive medicine refers to this as a tubulovasostomy. Both procedures usually take place under general anesthesia. Through two minimal incisions in the scrotum, the vas deferens are first exposed and finally connected. This connection is ensured by a multi-layer suture technique. Usually, the surgeon uses finest nylon thread for this purpose. This material is intended to support patency. While the operation is still in progress, the sperm are examined for their viscosity. If no sperm parts reach the newly connected vas deferens, the construction is not patency. The patency is checked during the operation. If it is restricted, the physician usually decides spontaneously to perform a tubulovasostomy and makes a connection to the epididymis.
Risks, side effects, and hazards
For a woman in particular, refertilization is associated with secondary risks in addition to the common surgical and anesthesia risks. For example, studies suggest a link between refertilizations and high-risk ectopic pregnancies. In particular, pregnancies in the first year after refertilization surgery are thought to carry a significantly higher risk of ectopic pregnancy. For example, the fertilized egg is said to readily become entangled in the tubal suture on its way to the uterus shortly after refertilization.The egg normally reaches the uterus after about four to five days on its journey through the fallopian tubes. However, if the fallopian tube path is longer or difficult to negotiate, the fertilized egg will nest wherever it is on the fourth or fifth day. In order to reduce the general surgical risks and to generate higher chances of success, refertilizations for women ideally take place on the eighth day of the cycle or after two days without bleeding. The latest time should be the time of ovulation. Later, the mucosa is too highly developed and could thus feign tubal occlusion. The conditions for success in female refertilization also include an undamaged section of the fallopian tube about five centimeters long. In men, refertilizations are associated with higher chances of success and lower subsequent risks. According to studies, refertilizations are most successful shortly after sterilization. However, even 20 years after sterilization, male fertility restoration can still achieve relatively good success. Even in about 90 percent of all cases, fertility can be restored through surgery. For both the man and the woman, infections are the most significant risk of refertilization. However, the operation is now standard practice for reproductive physicians and is therefore considered relatively safe. At least 30 of these operations a year should be performed by an experienced reproductive physician.
