Refertilization

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As Refertilization refers to the surgical repair of the fallopian tubes (in women) or vas deferens (the man) when previously by a sterilization were severed. These methods can bring about normal conception again.

Refertilization in women

Course of the operation

The destroyed fallopian tubes are removed slice by slice to avoid wasting a piece. A small disc is removed and the patency is checked with a blue sample. As soon as it passes through, a tube, the splint, is pushed into the interior of the fallopian tube ends. This way the ends come together correctly and exactly. The individual layers are sewn together one after the other over this splint. Once this is done, the splint is removed at the end of the operation. An attempt was made to leave the splint for 6 months and then remove it, but the result was an increased incidence of infections and deterioration in patency. In the case of endoscopic refertilization, this operation using a splint is not possible, the successes are significantly less, because there is more scarring inside the fallopian tubes. After 3 months you can check the patency of the fallopian tubes in various ways.

Time of the operation in the cycle

The 8th day of the cycle or after two days without bleeding, at the latest by the time of ovulation, is ideal. Later in the cycle , the mucous membrane is built up and may simulate an occlusion of the fallopian tubes.

Prerequisites for success

First of all, there should be at least 4–5 cm intact fallopian tubes , as the egg cell is fertilized on its way through the fallopian tube and ends up in the uterus as an 8-cell cell after 4–5 days . When this stage is reached, the fertilized egg will implant no matter where it is. If the fallopian tube is too short, decrease the chances of a pregnancy , because this stage is not reached, unless the egg travels slower. If the fertilized egg is in the fallopian tube because it gets stuck somewhere (at the suture or is too slow), an ectopic pregnancy can occur.

Risk of ectopic pregnancy

If the fallopian tube remains unchanged, the probability is 1: 100, after re-fertilization it is 2–3: 100. It was found that the frequency of disturbed pregnancies was highest in the first year after refertilization and lowest in the 2nd and 3rd year after the procedure.

Refertilization in men

If you want to have children again after a sterilization vasectomy, there is the option of surgical refertilization in men. The procedure is called a vasovasostomy. If a connection between the spermatic duct and the epididymal canal has to be established, it is called a tubulovasostomy. During this microsurgical intervention (mostly) under general anesthesia , the ends of the vas deferens are first exposed through two small incisions in the scrotum, checked for patency, joined together and connected with the finest nylon thread using a multi-layered suture technique so that the vas deferens are again passable for seminal fluid . Sperm samples are taken and examined during the operation (intraoperative spermiogram ). It is assessed whether the seminal fluid is still flowable ( viscosity ). The detection of sperm cells in the intraoperative spermiogram proves the patency of the testicular seminal ducts. In cases where no sperm cells or sperm cell fragments are found in the spermatic duct near the testicle, a direct connection to the epididymis can be established.

The chances for sterilized men to naturally father another child after such an operation are therefore extremely promising. Refertilization through vasovasostomy is now considered the therapy of choice. Approx. 90% of the operated men can detect sperm in the ejaculate after 3 to 12 months, pregnancy in the first year after the operation occurs in 50 to 70% of the cases, whereby the chances increase the shorter the time between Sterilization and re-fertilization is. The fertility of the partner is of course also important for the prognosis. In the first 5 years after sterilization, the chances of success are very good (permeability rate approx. 97%), up to 10 years (permeability rate approx. 91%) if the operation is carried out by an experienced microsurgeon. Even many years after a vasectomy, the production of sperm cells in the testes does not decrease significantly. There is also a good chance of natural pregnancy after microsurgical refertilization for patients with sterilization times of over 20 years. Refertilization appears to be at least as promising as artificial insemination.

Web links

Individual evidence

  1. ^ JU Schwarzer, H. Steinfatt: Current status of vasectomy reversal. In: Nat Rev Urol. Feb. 2013.
  2. JU Schwarzer: Vasectomy reversal using a microsurgical three-layer technique: one surgeon's experience over 18 years with 1300 patients. In: International journal of andrology. Apr. 2012.
  3. JU Schwarzer: Vasectomy reversal using a microsurgical three-layer technique: one surgeon's experience over 18 years with 1300 patients. In: International journal of andrology. Apr. 2012.
  4. R. Hautmann u. a .: urology. Edition 3. Springer eBook collection, Springer, 2006, ISBN 3-540-29923-8 , p. 338. books.google.de