Unplanned recanalization is where the vas deferens manages to “grow back” as well as reverse the vasectomy, making a male fertile again. Recanalization doesn’t necessarily indicate a full return of fertility. Any kind of re-growth is most likely to form a channel that is a lot smaller sized than the vas deferens was initially, thus fertility is likely to be minimized.
There are 2 classifications of recanalization–late and early. Early recanalization is likely to occur in the initial couple of weeks post-vasectomy but before being given the all clear. Most of the data surrounding vasectomy failure will refer to this time period. Approximately one percent of vasectomies are referred to as “technical failure.” Technical failure does not necessarily mean that the vas deferens has actually recanalized. Usually, it implies that the sperm analysis still shows live sperm after a set period– commonly 16 weeks.
All males take varying lengths of time to clear, and it’s not uncommon to take longer than 16 weeks for the semen sample to come back clear. Many guys eventually do clear, even if it takes longer than a few months. It’s not feasible to give statistics of recanalization and late clearance as most research studies stop evaluating men after a set length of time. The expression “Technical failure” refers to all men who have yet to clear for whatever reason at the end of the set time period.
Late recanalization is where the all-clear has been given, and the vasectomy spontaneously reverses itself afterwards. The reason doctors need their patients to return for post-vasectomy semen analysis is to make sure a technical failure hasn’t taken place. A vasectomy patient isn’t in the clear until it has actually been shown by semen analysis, and it is the patient’s obligation to supply samples as suggested by the medical professionals.
Since early failings ought to be picked up by sperm analysis as above, the rest of this article will focus on late vasectomy recanalization.
How Often Does Vasectomy Recanalization Happen?
All birth control methods have a possibility of failing; however vasectomy is one of the most reliable of all the methods offered. The percentage of failed vasectomies is approximately one in 2000 (0.05 %) after clearance has been offered. Therefore the chances of a vasectomy spontaneously reversing itself are extremely rare. According to Harvard Medical College, “A vasectomy can reverse itself, but it is an extremely rare event. It happens in only about .025% of cases, or one in 4,000 vasectomies”
While late recanalization is rare, research into the exact reasons why it happens is restricted by the small number of case studies offered during research. Quite frequently the published literature presents isolated individual reports, as opposed to larger case studies.
Exactly how is it physically possible for the vas deferens to grow back? There are at least two recognized processes for late recanalization to occur. The first is launched by the formation of sperm granulomas, and the second is micro-recanalization with scar cells. Additionally, there are various other elements such as length of vas deferens trimmed, method used, and the doctor’s experience and steady hand that affect the success of the vasectomy and the chance of recanalization.
After vasectomy, sperm frequently leaks from the vasectomy site or from a rupture in the epididymis. Sperm have quite antigenic(immune system stimulating) qualities and the immune system sees sperm as foreign agents and also attacks them as such. Sperm leakage creates an inflammatory reaction, and the body develops pockets to trap the sperm in scar tissue and inflamed cells. Spheres of cells (sperm granulomas) about a half inch in size form in a significant number of vasectomy patients. As researchers look for possible reasons why this happens, many studies find a strong connection between sperm granuloma and vasectomies that reverse themselves. One researcher states the existence of granuloma’s as “A constant.”
What occurs is that a nodule in the vas deferens arising from a granuloma progresses to a benign nodule recognized as Vasitis Nodosum. This growth could then join up with the distal vas, permitting sperm to flow through. Studies state that vasitis nodosa is more common than once believed, and though its growth could induce recanalization, it’s a rare event.
If there are bunches of scar cells present after a vasectomy, a process called micro-recanalization could occur allowing sperm to squirm their way through new and very small tears in the scar tissue. This happens because of the body’s many self healing responses. Micro-recanalization provides protection of the testis and also upkeep of spermatogenesis in males after vasectomy.
The development of microchannels is thought to be connected with poor technique throughout the vasectomy procedure, such as too loose tightening of vas, over-tightness that destroyed the vas, exposing the lumen opening, the tying of the cut vas deferens stopped surrounding blood circulation which caused a burst of tubes and increased the pressure inside lumen after vasectomy near the testicle, forcing the thread to cut the tube open.
There are a couple of research studies that have actually looked at scar tissue samples from males after vasectomy. One researcher discovered microchannels in “smooth muscle, connective tissue and scar tissue, in each section, testicular, abdominal and central, in the presence or absence of the vas deferens.” Another located “a collection of spontaneously recanalized ductus deferens and those of the contralateral ductus deferens showed numerous winding epithelial tubules increasing from the mucosal epithelium of distal stumps intruding right into the coarse scar tissue towards proximal stumps of the growing gland-like tubules may perform the spontaneous recanalization”.
Want To Avoid Recanalization? It’s in the Technique.
There are surgical strategies that have actually been proven to minimize the threat of recanalization. First, a method called fascial interposition included in the standard operating procedure is now approved as the most trustworthy method of performing vasectomies. For the standard technique, a short portion of the vas deferens is cut and taken out, and the two ends are linked. Fascial interposition includes pulling the sheath covering the vas deferens over one severed end, then stitching it shut to make an organic tissue barrier.
Some early studies report that when doctors use fascial interposition, recanalization is virtually impossible, though these studies are few. A Chinese study of seven methods including more than 2,000 male subjects found that vasectomy plus interposition is the most dependable vas occlusion technique. An analysis of previous studies released in 2004 found that five comparative studies, one of which was a randomized scientific test, offered great evidence that fascial interposition boosts the occlusive effectiveness of ligation and excision.
Second of all, there is strong proof that cauterizing the ends of the vas deferens helps provide dependability. Incorporating fascial interposition with cautery gives the highest degree of occlusive efficiency.
Third, the length of vas section removed may have a bearing on how reputable a vasectomy is. One study found that doctors with a high success rate tend to remove a significantly longer part of vas than doctors with higher rates of failure. To optimize the success of the vasectomy, a minimum of 15 millimeters of vas should be excised. Meanwhile, excised vas segments less than 15 mm were 25 times more likely to fail.
There is a version of vasectomy called the “Open Ended” method. Here, the testicular end is not closed. Provided fascial interposition and cautery are used on the other ends, this method is still as trusted as the standard technique.