Vasectomy reversal: first cut isn't final

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

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.

PROMOTED VIDEO
Life and Style
ebookNow available in paperback
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Sport
Robin van Persie leaves the field at the King Power Stadium last Sunday
football
Arts and Entertainment
Martin Freeman and Benedict Cumberbatch as John Watson and Sherlock Holmes in Sherlock
tv

Co-creator Mark Gatiss dropped some very intriguing hints ahead of the BBC drama's return next year

News
In this photo illustration, the Twitter logo and hashtag '#Ring!' is displayed on a mobile device as the company announced its initial public offering and debut on the New York Stock Exchange on November 7, 2013 in London, England. Twitter went public on the NYSE opening at USD 26 per share, valuing the company's worth at an estimated USD 18 billion.
news

News
people

London 'needs affordable housing'

Arts and Entertainment
music Band accidentally drops four-letter description at concert
Life and Style
tech
News
peopleIan Thorpe addresses Ricky Martin rumours
Arts and Entertainment
'Africa' will be Angelina Jolie's fifth film as a director
film

Mr and Mrs Smith star admits she's 'never been comfortable on-screen'

Arts and Entertainment
Australia singer Iggy Azalea has been attacked by Eminem in a new rap
music

Singer was ordered not to 'blow her rape whistle' in song 'Vegas'

Extras
indybest
News
Myleene Klass
people
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Graduate Commercial Property Surveyor

    £18000 - £20000 per annum: Recruitment Genius: One of the leading firms of Cha...

    Recruitment Genius: Female Companions / Personal Assistants - Perm and Bank

    £9 - £10 per hour: Recruitment Genius: We are currently recruiting for a care ...

    Recruitment Genius: Groundworker

    £16000 - £20000 per annum: Recruitment Genius: Ground-worker required for an e...

    Randstad Education Cardiff: Maths Teacher

    £100 - £120 per day: Randstad Education Cardiff: We are currently recruiting f...

    Day In a Page

    US immigration: President Obama ready to press ahead with long-promised plan to overhaul 'broken system' - but will it get past a Republican-controlled Congress?

    Immigration: Obama's final frontier

    The President is ready to press ahead with the long-promised plan to overhaul America's 'broken system' - but will it get past a Republican-controlled Congress?
    Bill Cosby rape allegations explained: Why are these allegations coming out now? Why didn’t these women come forward earlier? And why has nobody taken legal action?

    Bill Cosby rape allegations explained

    Why are these allegations coming out now? Why has nobody taken legal action? And what happens next for the man once thought of as 'America's Dad'
    Four years of excruciating seizures caused by the 1cm tapeworm found burrowing through a man's brain

    You know that headache you’ve got?

    Four years of excruciating seizures caused by the 1cm tapeworm found burrowing through a man's brain
    Travelling to work by scooter is faster than walking and less sweaty than cycling, so why aren’t we all doing it?

    Scoot commute

    Travelling to work by scooter is faster than walking and less sweaty than cycling, so why aren’t we all doing it?
    Paul Robeson: The story of how an American icon was driven to death to be told in film

    The Paul Robeson story

    How an American icon was driven to death to be told in film
    10 best satellite navigation systems

    Never get lost again: 10 best satellite navigation systems

    Keep your vehicle going in the right direction with a clever device
    Paul Scholes column: England must learn to keep possession and dictate games before they are exposed by the likes of Germany and Brazil

    Paul Scholes column

    England must learn to keep possession and dictate games before they are exposed by the likes of Germany and Brazil
    Michael Dawson: I’ll thank Spurs after we win says defender as he prepares to return with Hull

    Michael Dawson: I’ll thank Spurs after we win

    Hull defender faces his struggling former club on Sunday ready to show what they are missing. But he says he will always be grateful to Tottenham
    Frank Warren column: Dr Wu has big plans for the professionals yet he should stick to the amateur game

    Frank Warren column

    Dr Wu has big plans for the professionals yet he should stick to the amateur game
    Synagogue attack: Fear unites both sides of Jerusalem as minister warns restoring quiet could take 'months'

    Terror unites Jerusalem after synagogue attack

    Rising violence and increased police patrols have left residents of all faiths looking over their shoulders
    Medecins sans Frontieres: The Ebola crisis has them in the headlines, but their work goes far beyond West Africa

    'How do you carry on? You have to...'

    The Ebola crisis has Medecins sans Frontieres in the headlines, but their work goes far beyond West Africa
    Isis extends its deadly reach with suicide bombing in Kurdish capital

    Isis extends its deadly reach with suicide bombing in Kurdish capital

    Residents in what was Iraq’s safest city fear an increase in jihadist attacks, reports Patrick Cockburn
    Underwater photography competition winners 2014 - in pictures

    'Mysterious and inviting' shot of diver wins photography competition

    Stunning image of cenote in Mexico takes top prize
    Sir John Major: Negative West End portrayals of politicians put people off voting

    Sir John Major hits out at theatres

    Negative West End portrayals of politicians put people off voting
    Kicking Barbie's butt: How the growth of 3D printing enabled me to make an army of custom-made figurines

    Kicking Barbie's butt

    How the growth of 3D printing enabled toy-designer to make an army of custom-made figurines