In 1888 Bernhard Bardenheuer (1839-1913), a German surgeon who specialized in genito-urinary surgery, was the first to try to connect the seminal duct and the testicle in a man whose epipidymis had been removed because of tuberculosis, and in 1934 a thorough survey of all attempts made up to then was published by the German researcher F. Spath. Spath himself experimented on dogs: at the point where he had sewn together the two ends he left behind a soluble sewing thread made of catgut, thus preventing premature blockage by scar tissue. His results were disappointing, especially when the ends were tied together under tension. Vaso-vasostomy – the name by which a restorative operation after vasectomy is known – fell into obscurity. A few American researchers, however, persisted stubbornly into the 1960s and 1970s. Dogs proved to be excellent guinea-pigs. So what were the underlying difficulties related to a restorative operation? In the first place the spot where the ends were attached must not leak, or there would be an inflammatory reaction. It also became clear that the thread must not be under tension. Too large a section of the seminal duct must not be removed in sterilization and the ends must not contain too much scar tissue. Another finding was that tension could be produced by the simple fact that dogs, like humans, have hanging testicles.
In operating on humans use is often made of a splint, which is positioned outside the scrotum and removed after a few days. Stitching over a splint makes it impossible to sew up everything tightly. Initially many of those carrying out the operation removed a small section of testicle before finally deciding on a restorative operation. Later this was no longer considered necessary, at least if the testicles felt normal on physical examination. It also became clear that over half the men who had had a vasectomy had developed antibodies against their own sperm. However, a high level of antibodies does not mean that a restorative operation has no chance of success.
About 90,000 vasectomies are carried out in the uk each year. Nearly 600 vasectomy reversals are done every year in nhs hospitals, but many more are performed privately. So, the exact number of vasovasostomies is not known. (In the Netherlands 2.5% of vasectomized males have reversal surgery.)
There is an 80 per cent chance of achieving adequate throughput in the seminal duct if the restorative operation takes place within ten years of sterilization. The longer the interval, the less chance of success. Incidentally, adequate throughput does not mean that it will be easy for the partner to become pregnant, since sperm quality is virtually always inferior to that of non-sterilized men, meaning that in many cases assisted reproductive methods are required. The number of men who regret undergoing a vasectomy is large, given the previously mentioned testicular pain. The chance that a patient will regret the decision increases the younger the age at which the vasectomy takes place. In men below 25 the chance is over 11 per cent.
The reader may think: ‘Is anybody really sterilized at that age?’ Well, not in 2007, but they were in the 1970s. In those days it was quite normal for young guys to have themselves sterilized. It was an age of doom and gloom, mainly fuelled by the alarming economic and social reports of the Club of Rome, which invoked the approaching apocalypse with almost Calvinist fervour.