Refertilization

In the Refertilization If a reproductive medicine specialist restores a person's fallopian tubes or vas deferens that were previously severed during sterilization. Refertilization is used for the surgical or minimally invasive restoration of fertility. For women, the procedure is associated with an increased risk of future ectopic pregnancies.

What is re-fertilization?

The reproductive medicine practitioner understands re-fertility as the artificial and operative restoration of fertility. Refertilizations can take place in women just as much as in men. In men, the spermatic duct is restored. In women it is the fallopian tube.

In the narrower sense, the doctor only speaks of refertilization if either the fallopian tube or the spermatic duct is severed beforehand and reconnected during the operation. This means that a re-fertilization is usually preceded by a sterilization that the patient will now regret. The sterilization is canceled again by the re-fertilization operation. According to statistics, people around the age of 30 are most likely to be sterilized. According to the same statistics, re-fertilization most often takes place in people around forty years of age, around ten years after sterilization.

Function, effect & goals

Refertilizations affect sterilized women and men who regret the step of sterilization. In the case of sterilization, the doctor cuts the patient's fallopian tube or spermatic duct in order to prevent fertility. Refertilization can reconnect the severed components. In the case of women, the surgeon first removes the destroyed fallopian tubes in small slices. He checks the patency of the removed slices using a blue sample.

As soon as the fallopian tube parts prove to be continuous, the doctor inserts the so-called splint inside. This is a thin tube that connects the discs momentarily and brings the ends of the fallopian tubes into exactly the correct position. The doctor sews the individual discs together piece by piece on the splint. Before the restored fallopian tube can be reinserted, the doctor removes the splint. A few months later, the doctor will check the patency of the restored fallopian tubes. Under certain circumstances, the operation can also be carried out endoscopically. With this minimally invasive procedure, the chances of success are significantly lower than with an operation. Endoscopy leaves larger scars on the fallopian tubes and makes the use of a splint impossible.

This can have an impact on the later continuity, as the ends may not be connected in exactly the correct position. There are two different interventions available to men for re-fertilization. The regular surgery is called a vasovasostomy. If, on the other hand, the epididymal canal has to be connected to the vas deferens, reproductive medicine speaks of a tubulovasostomy. Both procedures usually take place under general anesthesia. The vas deferens are first exposed through two minimal incisions in the scrotum and then connected to one another. This connection is ensured by a multi-layer seam technique.

The surgeon usually uses the finest nylon thread for this. This material is intended to support continuity. The sperm are checked for viscosity during the operation. If no parts of the sperm reach the newly connected vas deferens, the construction is not continuous. The patency is checked in the course of the operation. If it is restricted, the doctor usually spontaneously decides to have a tubulovasostomy and connects it to the epididymis.

Risks, side effects & dangers

In addition to the common surgical and anesthetic risks, refertilization is associated with secondary risks, especially for women. Studies suggest a connection between refertilizations and high-risk ectopic pregnancies. Pregnancies in the first year after the re-fertilization operation in particular are said to carry a significantly higher risk of ectopic pregnancy.

For example, the fertilized egg should like to become entangled in the fallopian tube suture on its way to the uterus shortly after refertilization. The egg cell usually reaches the uterus after around four to five days on its way through the fallopian tubes. But if the fallopian tube is longer or difficult to walk on, the fertilized egg will implant itself on the fourth or fifth day, wherever it is. In order to reduce the general surgical risks and to generate a higher chance of success, refertilizations for women ideally take place on the eighth day of the cycle or after two days without bleeding. The latest time should be the time of ovulation.

Later on, the mucous membrane is too developed and could thus simulate an occlusion of the fallopian tubes. One of the prerequisites for success for the refertilization of women is an undamaged section of the fallopian tube around five centimeters long. Refertilizations in men are associated with higher chances of success and lower consequential risks. Studies have shown that refertilizations are most successful shortly after sterilization. Even 20 years after sterilization, male fertility restoration can still achieve relatively good results.

Surgery can restore fertility in around 90 percent of all cases. For both men and women, infections are the most important risk of re-fertilization. The operation is now standard for reproductive medicine and is therefore considered to be relatively safe. An experienced reproductive medicine specialist should perform at least 30 of these operations per year.