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Baby After Vasectomy

Newer Techniques Provide Options For Men

By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent

After fathering three children by the age of 23, Douglas Morrill Jr. decided to have a vasectomy. That was 17 years ago. But after divorcing and then falling in love again, he and his new wife began thinking about raising a family of their own. They wondered just how difficult that was going to be.

It turns out that it wasn't as tough as they had feared. Morrill, now 40, had day surgery to reverse his vasectomy and he and his wife, Lisa, had a baby boy two years ago. Today, Lisa is pregnant again.

"That operation turned my whole life around," says Lisa, now 32.

Dr. Abraham Morgentaler, urologist at Beth Israel Deaconess Medical Center who performed the vasectomy reversal, says advances in microsurgery techniques have made vasectomy reversals easier to do and more successful when it comes to their purpose -- allowing couples to have children.

"The vasectomy reversal is much better these days," says Dr. Morgentaler, also director of Men's Health Boston, a urology practice, and associate clinical professor of surgery/urology at Harvard Medical School. "The microsurgical techniques are better. The sutures are better. The microscopes are better. Today, vasectomy reversal is successful in as many as 80 percent of men."

Success in the procedure is determined by whether the man again will have sperm to contribute for a pregnancy. Actual pregnancy rates are somewhat lower, since the fertility status of the woman also comes into play, but are still "greater than 50 percent," according to Dr. Morgentaler.

New technology provides additional options even if the procedure is unsuccessful, or if a couple wishes to try an alternative approach that does not require surgery. This new technology allows extremely low numbers of sperm to be used to achieve a pregnancy.

The technique, called intracytoplasmic sperm injection or ICSI, allows for a single sperm to be extracted from the man and injected into a single egg, with the aid of a high-powered microscope. Once the egg is fertilized in a Petri dish, the pregnancy proceeds as if it were a normal IVF procedure. The technique only requires a few dozen sperm for it to be successful. Before ICSI, millions of sperm were needed for an IVF procedure to work, Dr. Morgentaler says.

If a man who has had his vasectomy reversed is unable to produce enough sperm to impregnate a woman during intercourse, ICSI can be tried later. Or the surgeon can extract sperm using ICSI at the same time of the vasectomy, freezing it for later use in IVF if necessary. Another option is for a man to simply opt for ICSI in the first place rather than undergo the reversal procedure.

"It can be done as a backup or instead of a reversal," says Dr. Morgentaler. "The bottom line is that if you've had a vasectomy, you can still have a family."

Having the reversal surgery and then getting pregnant through intercourse is probably the easiest, least expensive path, since repeated IVF tries are not required. That is how the Morrills did it. The operation itself is an outpatient procedure.

"I was a little sore, but I drove home the same day," says Morrill, who lives in Holyoke and works for the DPW.

Dr. Morgentaler had told the couple he could extract sperm for ICSI at the same time as he was doing the reversal, but informed Lisa during the operation that it was going so well that he was confident they could get pregnant naturally. "He asked me if I wanted him to take some sperm and freeze it, but that it was looking really good, so I said I'd take my chances," she says.

After the operation, it took the couple a year, but they got pregnant and had a baby boy, Braydon, in 2005. Another baby is due in May.

"I thank Dr. Morgentaler all the time," Lisa says. "I've sent him several thank you notes. I sent him one after I got pregnant the first time and another one after my son was born. I just recently sent him another one telling him I got pregnant again. He made my family."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted October 2008