Vasectomy Reversal: The Story of My Journey

When I was a urology resident it was de rigueur that one learned how to do a vasectomy. We had to learn how to do the surgery for two reasons. First, when one did an “open” surgical removal of a benign prostate to relieve the occlusion caused by the enlarged prostate gland to allow a gentleman to void normally we would typically do a vasectomy to prevent post-operative inflammation of the testis (post-operative epididymitis). A long story…but suffice it to say that the era of modern antibiotics pretty much eliminated the need to do a vasectomy for that reason any longer. Second, one would learn to do vasectomies so one could electively sterilize men who did not wish to father any more children, a procedure that continues to be in great demand and is (frankly) a good source of income for urologists.

Well along came the day for me to do my first outpatient vasectomy under local anesthesia at my training facility. I was a “good” Catholic man who attended Mass on Sundays, etc, etc, but had not really thought through the moral implications of what sterilization was all about. I met this young man in our outpatient clinic, explained what I was going to do and how I am going to do it, injected the local numbing medicine into the appropriate areas, and then began the surgery. Forty-five minutes later I am still mucking around inside his scrotum on the first side, we are both sweating profusely, and I am unable to accomplish the task. Fortunately my senior resident showed up at this point in time and rescued me from continuing the procedure by taking over. This acutely painful episode really got my attention to focus on what the hell was I doing…?

Subsequent prayer and reflection crystallized the reality for me: The Good Lord saved me from mutilating a most vital part of that young man’s reproductive system. (Lest one recoil at my use of the term “mutilating” what else can one call the wanton and willful destruction of a perfectly good body part?!–and an important part of the system that allows the “transmission of life“ to one‘s life partner.) I subsequently met with my program director and explained I could not and would not do vasectomies because my religious beliefs would not allow me to do so. And that was the end of my vasectomy career.

End of the negative. On to the positive.

Urology is a really enjoyable medical field for those who like a good mix of office practice (helping folks overcome illnesses of the urinary tract with lifestyle modifications and medications) and various surgeries. And the kinds of surgery one does in urology include “open” procedures (making an incision to do the work), laparoscopic surgery (using small “portholes” in the abdominal wall with special instruments to accomplish the task), and transurethral surgery (entering the urinary tract through the urethra to operate upon the prostate, bladder, or upper urinary tract). Further reflection and prayer led me to consider yet a fourth kind of surgical procedure in urology: That of microsurgical vasectomy reversal. In the early 70’s this was an emerging subspecialty in urology popularized by a St. Louis, MO, physician, Sherman Silber, MD, and I was intrigued by both the technical challenges of the procedure and the possibility of doing something “pro-life” at the same time. But getting to the point of doing this surgery was a slow (many year) process and I did not develop the desire to pursue it until after I had graduated from my residency and was in private practice. Since I had no formal training during residency I did three things. First, I enrolled in a basic one-week microsurgical course to learn the technique applicable to all microsurgical procedures. Second, I purchased a dissecting microscope and set up a “mini-lab” so I could practice the procedure on a special desk I set up for that purpose. (When my partner and I would do a radical prostatectomy for prostate cancer—remove the prostate gland in its entirety including surrounding healthy tissue to ensure a surgical cure—I would set aside a portion of the vas that had been attached to the malignant prostate since it was going to be “pickled” in formaldehyde anyway and slice it up and suture it back together in order to hone my vasectomy-reversal skills). Third, I enlisted the help of a surgical technician that assisted the ophthalmologists doing eye surgeries and one gracious ophthalmologist himself to assist me on my first few vasectomy reversals since they were so comfortable and competent in the microsurgical setting.

Initially, in keeping with my desire to contribute to the “pro-life” movement, I did not charge any surgical fee for my vasectomy reversals. I would instead request the patient contribute to our local pregnancy counseling center and pay the hospital and the anesthesiologist only. Unfortunately this led to many “bottom feeders” showing up at my door who could care less about my motivation for restoring their male reproductive anatomy because it was a foundational component of God’s plan for marital love. They were just interested in the cheapest price. So several years later I revised my plan to include a very low, all inclusive fee (the patient pays me…and I pay the hospital and the anesthesiologist) and a pre-operative visit wherein I explore their impetus for having the surgery and explain my motivation for doing the surgery. As part of this process I give them a one-page essay discussing why they should restore their male reproductive anatomy regardless of the outcome because it is the morally correct thing to do.  And I reserve the surgery for only couples who are married. (Post-operatively the gentleman needs to begin ejaculating within a few weeks to help keep open his newly reconnected vasa. Morally-speaking this can only be achieved via marital intercourse.)

Today I can look back on a 30+ year experience of reversing hundreds of vasectomies. Only a few have let me know how they are doing after the procedure and whether or not they have sired any children. But some have, and one time my wife and I had the great pleasure of attending the Baptism of one of “my” children. I have reflected upon the logarithmic consequence of the number of persons that are now going to be born over generations if only a few of my reversals have resulted in children and the numbers are both humbling and staggering–and, tragically, very disturbing if you consider the number of people who are not going to see the light of day because their Dad chose to be sterilized.

Two final points in closing. First, if one is considering vasectomy reversal (vasovasostomy) you must be aware that the longer it has been since the vasectomy the greater the possibility that a secondary obstruction has occurred further up the line in the first part of the tubular system that drains the sperm from the testis–in the epididymis. The epididymis is a tiny coiled tubular system contained within a sheath stuck onto the side of the testis. The sperm appear morphologically the same at the beginning and at the end of their several-week journey through the epididymis, but biochemically they have changed and matured. Urologists who specialize in vasectomy reversal will skip past the original vasectomy site and connect the vas to the epididymis beyond this secondary point of obstruction or “blow-out”, but it is a technically-demanding surgery that needs an expert who does this on a weekly basis.(Just to give you an idea: The smallest surgical needle available fills a goodly portion of the epididymal tubule!) I do not do this procedure. Second, I must say that many of the couples I have had the pleasure of meeting over the years must be considered “heroic” in their decision to have this procedure: Those that have many children, yet regret their sterilization decision and wish to restore the male reproductive anatomy, using NFP to either conceive or not additional children afterward. Those who have lost children to trauma or cancer. A young grandmother (40) who formally adopted her granddaughter because her own daughter was trapped in a recidivistic cycle of drug abuse…and she did not want the child to grow up alone. And the stories go on.

So I thank our Gracious Lord for the many couples he has sent my way who are answering the Christian call to holiness via self-sacrifice, discipline, and the surgical restoration of their male reproductive anatomy. And thanks be to Him that all my patients have sailed through their procedure at my hands so well with a miniscule number ever having even the slightest post-operative problem. I will continue to do this very tedious yet very fulfilling surgery until the day He tells me to turn in my microsurgical instruments for a new set of golf clubs!

God bless all those who have had or who are considering to have restoration of their reproductive anatomy, men or women. And God bless all those lay persons, nurses, and physicians who invest their time and/or money in one of the many pro-life ministries.