Fertility Treatments After Sterilisation



Many men and women opt for sterilisation as a popular form of permanent contraception. Most people make the decision sincerely, with the intent to prevent additional pregnancies permanently.


But life is full of surprises and as circumstances change and relationships change, a person’s family-building goals may also change. It is not uncommon for men and women who have undergone sterilisation to find that they want to have more children.


In this article, we look at the options of restoring fertility for those who have previously been sterilised and are now again wanting to build a family.


Sterilisation for women – tubal ligation

Sterilisation for women by tubal ligation is a popular form of permanent contraceptive preferred by many couples.

The operation involves cutting, sealing or blocking the fallopian tubes. This prevents the eggs from reaching the uterus (womb) where they could become fertilised, resulting in pregnancy.

Sterilisation for men – vasectomy

A male sterilisation is called a vasectomy. This is a surgical procedure to cut, block or seal with heat the tubes that carry a man’s sperm from the testicles to the penis, to permanently prevent pregnancy. A man will still have erections and ejaculate after a vasectomy, but the semen won’t contain sperm and as such cannot fertilise a woman’s egg.

A vasectomy is a quick and relatively painless surgical procedure. It takes just 15-minutes and is usually carried out under local anaesthetic.

A vasectomy does not affect sex drive or ability to enjoy sex, but it is more than 99% effective and is therefore meant to be a permanent contraceptive. It should only be considered when couples are absolutely certain they don’t want any more children or don’t want children at all.

Can tubal ligation in women be reversed?

Not all types of tubal sterilisations are reversible, but it may be possible to reverse tubal ligation in some cases.

The reversal procedure involves a small abdominal incision and micro-surgical techniques to restore the connection between the interrupted fallopian tube segments.

If the remaining fallopian tube segments are not healthy due to previous damage, or if the segments are extremely short, successful reversal is not feasible.

Even if tubal ligation reversal is successful, it doesn’t guarantee that you can become pregnant. Pregnancy rates following reversal of tubal ligation vary greatly, from 30% to 85%, depending on a woman’s age and other factors.

If tubal ligation reversal is not possible, or successful, what are the other options? Fortunately for those women who cannot have their sterilisations reversed successfully, or who are not able to achieve pregnancy after a reversal, there is another option: an assisted reproduction technique called in vitro fertilisation or IVF.

IVF treatment was originally developed for women with damaged or missing fallopian tubes and has been the standard treatment for infertility since 1983. In the simplest terms, IVF treatment circumvents the fallopian tubes by fertilising the egg with sperm outside of the body in a lab to form an embryo, which is then transferred to the uterus, to hopefully implant and become a pregnancy. IVF treatment success rates are now comparable – and even superior – to those of nature.

Can a male vasectomy be reversed?

A vasectomy can be reversed through a vasectomy reversal, which is called a vasovasostomy.

This procedure repairs a surgically removed section of the sperm duct, which is called the vas deferens. Vasectomy reversals are usually performed by surgical specialists called urologists. This is a quick operation, usually lasting around two hours. After surgery, the healing process is carefully monitored and, after six to eight weeks, monthly semen analyses are done to track improvements in sperm count and motility. Reported pregnancy rates after successful vasectomy reversals range from 40% to 90%.

Many factors affect whether a reversal is successful, including the type of vasectomy, how long ago the procedure was done and the experience of the surgeon doing the reversal surgery. If 10 years or more have passed since the vasectomy was done, the chance of having sperm reappearing in the semen after a reversal is greatly reduced.

Should a vasectomy reversal not be successful, there are further treatment options to explore, including sperm retrieval, donor sperm and IVF or ICSI.

Which is best: IVF or tubal reversal?

The decision between tubal reversal or IVF treatment is not easy. It is a highly complex matter and factors such as age, cost, time, likely success rate as well as the presence of other potential infertility problems, have a profound effect on the final decision.

Before surgery is considered, a semen analysis for the male partner should always be done first. If the findings of semen analysis are abnormal, tubal reversal is unlikely to result in successful conception. First ruling out possible significant male factor infertility will prevent unnecessary and costly surgery and the possible risks it entails.

It is also important to consider the costs involved and the chances of success, as well as the couple’s age and long term plans.

For example, one should consider how many more children are desired? If the couple want to have multiple children and the female partner is young, tubal reversal might be the better choice. But, if only one more child is desired and the woman is older than 35 years of age, IVF may be the best choice.

Each couple must be assessed and counselled individually to ensure the treatment option chosen is best suited to their unique circumstances.

Which is best: vasectomy reversal or sperm retrieval?

With today’s advanced fertility treatments, sperm can be retrieved from the testicle or epididymis by either a needle aspiration or surgery.

The sperm obtained by such methods are then used to fertilise the eggs through in vitro fertilisation (IVF) and/or intracytoplasmic sperm injection (ICSI).

The decision between a vasectomy reversal or sperm retrieval for IVF or ICSI treatment depend on numerous factors such as the cost and time, the number of years since the vasectomy, and the age of the female partner.

Before considering a vasectomy reversal, it is important to confirm that that the male partner was fertile before the vasectomy. But even if a surgeon can join up the vas deferens tubes again, pregnancy may still not be possible, for example, if there are sperm antibodies in your semen after surgery, pregnancy is not possible.

In cases such as these, IVF or IVF with ICSI may be an option.

During IVF treatment, as described earlier, the eggs are mixed with the sperm in a petri dish for fertilisation to take place naturally. It is in this stage of the IVF process that the ICSI procedure can be used instead of natural fertilisation. During the ICSI procedure, qualified embryologists – using very fine tools in a process known as micromanipulation – inject a single prepared sperm cell directly into each suitable mature egg, substantially improving fertilisation rates to around 70%.

Since it was first used 30 years ago, ICSI has revolutionised the treatment of male infertility. Because a few normal sperm are needed for conception, even men who were previously considered to be completely sterile now have a strong chance to have their own child.

The next step

If you or your partner have been sterilised, but now want to have a child or another child, we invite you to meet one of our fertility specialists at Medfem Fertility Clinic.

Our team at Medfem believes in making world-class fertility treatments available for everyone. It is our joy and commitment to give you a positive outcome to your fertility journey, so you will have a fond memory of feeling empathy, caring and being part of the Medfem Fertility Clinic family.

Simply click here to book an initial consultation or contact us telephonically on +27 (11) 463 2244.

We look forward to meeting you!


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