Some 20 years after welcoming two daughters into the world — and 17 years after his vasectomy — Rick Perk found a second shot at love and yearned for a second chance at children.
So, then pushing age 50, Perk got unsnipped in 2010. But he didn’t know if the delicate operation worked until his current wife, Erin, 31, phoned while Perk was chauffeuring one of his girls home from a college visit.
“It was St. Patrick’s Day last year and Erin is Irish so her friends had wanted her to go out. She’d said no, that something was feeling different. She picked up a pregnancy test then called and broke the news,” Perk recalled. “I almost drove off the road, I was so excited.”
Last November, Erin gave birth to Lucy. Perk still has that positive test strip stashed at his suburban Cleveland home.
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A rising number of American men who underwent vasectomies — a procedure once considered permanent — are choosing microsurgeries to re-hook or reroute their reproductive tubes, effectively restoring their fertility, according to two leading urologists.
“There has been an increase in who men seek reversals,” said Dr. Edmund Sabanegh, chair of the urology department at the Cleveland Clinic. “This is (partly) because some men originally pursued a vasectomy, thinking it was an easily reversible form of contraception — a notion we discourage.”
According to Sabanegh, who serves as treasurer of the Society for the Study of Male Reproduction, more than a half million vasectomies are performed annually in this country and as many as 10 percent of those men later seek reversals. While more precise statistics on the increase in reversals among American men are not available, the rising trend is reported anecdotally among urologists.
The unsnipping surge has gained fresh momentum as more health-insurance providers opt to pay for the operation. Meanwhile, surgeons have gained the ability to magnify miniscule male sex machinery 25 times beyond the strength of the naked eye, allowing doctors to help men sterilized by choice once again produce sperm, the doctors said. The procedure works more than 90 percent of the time.
“Insurance companies are beginning to cover vasectomy reversals because the success rate of reversals is as good — if not better — than in vitro fertilizations (for women), in terms of live pregnancies,” said Dr. Natan Bar-Chama, a male infertility specialist and urologist at Reproductive Medicine Associates of New York.
“This procedure can result in pregnancy yet avoid the multiple births (often caused by expensive IVF treatments) — and avoid the medical complications associated with multiples,” Bar-Chama said “So, yes, more health care providers and more couples, of course, prefer a more natural way of conceiving.”
Men who want a vasectomy do-over typically offer one of three reasons to their doctors. Some believed they and their wife were done having babies but eventually come to realize they desire more kids. Some lost children to illness or accidents — “truly, the saddest stories,” Sabanegh said.
And many candidates like Perk already have older children but get divorced, then remarried.
“Erin and I just wanted to share that with each other,” said Perk, who works in sales for a tech company. “It was tough because I kept hearing that the longer you waited, the less your chances of success.
“We talked about it while we were dating, more seriously after we were married. And then we thought, let’s do it as soon as possible before our chances decrease even more and before I get too old to parent properly.”
Indeed, a lengthy gap between an original vasectomy and a reversal surgery can boost the odds that pressure will build “upstream” from the doctor-made dam in a tiny tubule called the epididymis. That narrow, coiled piping connects ducts in the back of each testicle to the vas deferens, a vessel that transports sperm before ejaculation.
Over time, too much pressure in a purposely plugged epididymis can cause a rupture, forming a secondary — albeit non-painful — blockage, Sabanegh.
“In those cases, because of that long-standing (secondary) obstruction, we can’t do a regular reversal,” Sabanegh said. “We have to do what’s known as a vasoepididymostomy” — essentially constructing a bypass to the epididymis, a man’s sperm-storage reservoir.
“We used to think if it got to be 10 years out, your odds of success were very low,” Sabanegh said. “We now realize that, with some of the new surgical techniques and (magnification) advances, the odds still stay pretty high.”
Despite the 17-year wait to undo his vasectomy, Perk learned that he required the most routine form of reversal, one in which a surgeon (Sabanegh) uses tiny incisions to implant 16 to 20 sutures — only visible under a microscope — in order to re-tie two severed ends of the tube that carries sperm.
The outpatient operation typically requires anesthesia and lasts two to three hours. Couples can start trying to conceive as early as three weeks after the surgery.
“We were really thrilled for Mr. Perk and his wife,” Sabanegh said.
With Lucy now almost 7 months old, the Perks are talking about conceiving again.
But after that, will Perk undergo a second snip job?
“Uh … no,” he said with a laugh as his wife listened a few feet away. “No, I will not do another vasectomy.”
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