Simply reverse sterilisations? If only!

The state wanting to be in charge of reproduction is not new: when the population is spilling over, we get the 1-child policy, like in China from the 1960s onwards, or the promotion of vasectomies and sterilisations, as in South Korea a few decades ago.

However, the birth rate is almost always too low for political rulers, because citizens, taxpayers and soldiers are, and have been, needed ... as well as, in our day, carers for the aging population... It is precisely for this reason that in Austria abortions have been prohibited by law since the time of Maria Theresia. History repeats itself: abortions still feature in our criminal code today and can lead to prison sentences, and women have to bear the costs themselves – as well as those for contraception.

Now South Korea, the very country mentioned, and especially its capital Seoul are trying out a new way of increasing the population again: in view of the birth rate of only 0.55 – the lowest in the world – female and male sterilisation should be reversed.

As if it were that easy

Although promising prospects of success are advertised online, the reality is different: success rates depend on when the man was sterilised. The more recent the procedure, the more successful refertilisation can be. That’s because, over time, the number of sperm decreases, and their production ultimately dries up completely.

In women, recanalisation of the fallopian tubes is also possible, in principle, although it is, again, very arduous. It also carries risk: a scar is always left behind at the site where the fallopian tubes are reconnected, and so there is a chance of ectopic pregnancy for the rest of the woman’s fertile life.

The recommendation is therefore that “sterilisation should only be carried out once family planning is truly complete and no meaningful alternatives are available.”

A glimpse inside the operating theatre

In both men and women, sterilisation is actually intended to be an ultimate solution. In men, it involves the sperm ducts (ductus deferentes) being severed. The two ends are tied off so that it is certain sperm can no longer pass through.

Because of the small size of the sperm duct – the internal diameter is a tiny 0.3 mm – reversal surgery is very laborious. In the first three years after a vasectomy, there are usually still enough sperm present for recanalisation of the sperm duct to work, leading to pregnancy in approximately three-quarters of cases. After 15 years, however, the pregnancy success rate is just 30 percent. This means that surgical recanalisation can be performed in men, but is by no means a guarantee of success and is not certain to lead to pregnancy.

For sterilisation in women, a thin tube is inserted into the abdomen via a small incision in the skin near the navel. With visual monitoring on a display, the fallopian tubes can be closed and then, in most cases, severed. This is usually done by means of weak current (sealing or coagulation) and is referred to as tubal coagulation. Alternatively, it is possible to ligate the fallopian tubes using a plastic or metal clip or ring. As a result, egg and sperm cells can no longer pass through the fallopian tubes, making fertilisation no longer possible.

Men’s fear of being at the mercy of women

Men only have a few contraceptive options available and are therefore always in fear of becoming a father against their will. Condoms, extolled by the political world, have a ‘snag’: you need a clear head to use them properly – it’s a rational act from start to finish! But who has a clear head when it comes to sex?

Men thus also consider having a vasectomy, as we know from questions from our visitors. The Austrian Contraception Report has confirmed this: www.verhuetungsreport.at. What is important for both partners: neither the man nor his partner will notice any difference between before and after. Sperm only make up about 3–5% of ejaculate. Other than this, nothing changes as a result of a vasectomy.

What would be an ideal solution is if a man in Austria could have his sperm easily frozen for a later date, in order to make it easier for him to decide on an ultimate solution. Unfortunately, this is not possible, because that is only allowed in Austria if there is a medical justification, or the man slips away to another country for the freezing, where this is not a problem.

It is understandable then that the number of men who have had a vasectomy has doubled, as revealed by the Austrian Contraception Report. However, it is still only 4% of men.