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Second marriages bring men in to reverse vasectomies

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GINA R. HEINE
April 19, 2010
— When Todd had a vasectomy eight years ago, he was sure it was the right decision.

“Try as I might, there was just no way I could envision myself when I would want to have any more children,” the Milton man said. “I think that’s really common in our society.”


What’s becoming more common, one local doctor says, is reverse the vasectomy, a procedure Todd had after remarrying.


Technology is changing the procedure, too.


Todd was the first patient in Wisconsin to have a reverse vasectomy using a robot. Dr. Nicholas Gianitsos, urologist and medical director of Mercy’s Men’s Health Center, performed the surgery earlier this month.


More men in their second marriages want vasectomies reversed, he said, but the number of surgeries in a year is often tied to the economy. Insurance doesn’t cover the cost of the $10,000 procedure, Gianitsos said.


The economy appears to have the opposite affect on the number of vasectomies, he said.


Since the economy started sliding in fall of 2008, doctors have been flooded with men seeking vasectomies, he said. It could be that men don’t want children they can’t afford, or they want the procedure done before losing their job and their health insurance, he said.


Todd’s story

Todd, 42, remarried nearly two years ago, and his new wife was excited to start a family together.


“It took me two years to get used to the idea,” he joked.


Todd asked that his full name not be published because he doesn’t want to spoil the surprise for his family of a possible pregnancy.


He and his wife both have children from previous marriages, and at first he couldn’t imagine getting into a routine after combining two households, putting half the kids into new schools and working out schedules.


Like a lot of second-marriage couples, Todd said, he and his wife entered the marriage with the benefit of experience.


“(We) know things could go badly, we’re not naive or blind to the difficulty or challenges of marriage,” he said. “That’s one of the best things, too. (You) go in taking everything seriously.”


Now that the idea of having another child has set in, Todd said he might be more excited than his wife.


How it works

Reversing a vasectomy using the da Vinci Si HD dual-console robot is less invasive and about an hour quicker. It also allows for two to three layers of sutures instead of just one, Gianitsos said. It is an outpatient procedure.


Doctors use their fingers to control robot arms and hands. The robot removes scar tissue and reattaches the tubes that carry sperm from the testicles into the semen.


Without the robot, surgeons look through microscopes and use their hands to reattach tubes about the size of a pencil lead. The microscopes reveal tremors in even the steadiest hands, said Gianitsos, who is chairman of robotic surgery at Mercy.


“It’s very, very difficult to make up for that natural tremor when you magnify it,” he said. “The robot takes that into account, and the computer in the robot negates your tremor.”


Small studies have shown the robotic procedure leads to an earlier return of normal sperm counts, he said.


Todd had his surgery on a Friday and was back to work by Monday. He said initially the procedure was a little tougher to get through than a vasectomy, but the discomfort in the following days was better.


Mercy charges the same price—around $10,000—for a reverse vasectomy whether it’s done by hand or by robot.


Economy

A busy year means about 20 reverse vasectomy surgeries for Gianitsos, although that number can dip to fewer than five.


“It depends on how much people are willing to spend,” he said.


A lot of the men are in their second marriage, he said, and many seem to marry younger women who have no children.


“Eventually, the men will give in to the pressure, come in and (get it) reversed,” he said.


He guesses more couples would choose the option if a pregnancy could be guaranteed.


In the best situation, pregnancy rates are about 75 percent, but the rate drops depending on how long ago the vasectomy was done, Gianitsos said.


He said he tries to discourage men from having the reversal if it’s been 12 or more years since their vasectomies.


A lot of people are reluctant to spend out-of-pocket cash with the chance that it could be for nothing, he said. But the surgery can be more attractive than other options such as in vitro fertilization, which can run up to $25,000, he said.


When the economy goes down, the number of vasectomies seems to increase, he said. He personally does 100 to 150 a year, depending on trends.


Lately, they’ve been more popular, and Fridays can bring up to four surgeries in a day, he said.


“We don’t know if people are worried about losing insurance, or they don’t want bigger families,” he said. “We just saw this rash of vasectomies coming in.”



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