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by Jim Holman.
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More Incredible than Creation

NEW SURGICAL TECHNIQUE REVERSES STERILIZATION

By James McCoy

Just as an increasing number of Catholic couples have reached the conviction that getting sterilized was an irrevocable mistake, new microsurgical techniques have become successful in reversing vasectomies and tubal ligations. And a few pro-life physicians in California stand ready to heal mutilated men and women who want to put things right.

In the past, vasectomies were only occasionally reversible. Today, thanks to microsurgery, the reversal success rate ranges from 20 to 50 percent, according to the "The Patient's Guide to Vasectomy Reversal," posted by Columbia-Presbyterian Medical Center on the Internet.

Still, reversal surgery is far from commonplace. There are approximately 500,000 vasectomies performed in the U.S. each year. But "The Patient's Guide" estimates that only one percent of men with vasectomies will seek reversals. Of that number, most, having remarried, want to father additional children. Others are seeking relief from pain in the scrotum, an occasional side-effect of vasectomy. The remnant will be those who had themselves sterilized in order to take charge of their married life, but who now see infertility as more of a burden than children.

"I sense a spiritual reawakening in our community," said Dr. Gregory Polito, a urologist in Whittier who does vasectomy reversals. Some married couples have let him know that their consciences are "very bothered" by contraception, which "unleashes selfish inattention to the body's natural harmonies and rhythms," Dr. Polito said. And the most definitive unleashing is done by sterilization--contraception of the most permanent sort.

The "vas" in vasectomy refers to the vas deferens which Dr. Polito described as a "drainage conduit" for sperm cells. Sperm are stored in the epididymis which Polito described as "a 'C" shaped tubular structure stuck onto the side of the testis." Sperm "exit the epididymis near the bottom of the testis," he said, "and proceed into the vas, a very muscular tube that propels the sperm up into the body cavity and into the prostrate. There they mix with prostrate and seminal vesicle fluids during ejaculation."

The "-ectomy" in vasectomy means "to cut through." The surgeon cuts through the vas and then places a clip or suture around the cut ends. "Vasectomy," said Polito, "is quite traumatic to this delicate system."

It can also be traumatic to the delicate ecology of marriage, according to a priest of the Los Angeles Archdiocese who requested anonymity.

Sterilization "ruptures the covenant relationship, just like any other contraceptive sex would," said Father "Ephrem." "It's an inherently selfish thing... It's a selfish thing that's life-changing. I have yet to see one couple where they don't regret it--if they're practicing Catholics."

Father has counseled couples who, having had major conversion experiences, ended up regretting their sterilizations: "What have we done?" they cry. "Those are actually very difficult cases," Father said. The couple "unfortunately made a mistake that is many times irreversible."

Dr. Polito explained why. "It takes a while for the testis to 'get the message' that something is awry," he said, "so it keeps producing sperm. This naturally increases pressure within the system and produces one or two consequences. "First," Polito went on, "the testis does progressively slow its sperm production. Second, the increased pressure may result in a 'blowout' or rupture within the delicate epididymal tubule." Since the sperm conduit has been shut off, pressure builds up in the epididymis, which can make it rupture. And the more years since the vasectomy, the more likely the blowout.

But that's not all. "The sperm have nowhere to go and are broken down in the testis as they age," Polito said, "releasing materials into the body that it is not used to seeing." As a result, the body develops antibodies against the sperm. Ninety-seven percent of the men with vasectomies have such antibodies.

That's why, "as yet, there is no way to predict who is a good candidate for even a technically successful vasectomy reversal," Polito said--meaning that sperm can be found in the ejaculation--"let alone a way to predict a truly successful result--pregnancy."

Yet pregnancy happens. And each time it does, it's more wonderful than the creation of the whole world, according to Steve Koob, founder of "One More Soul." This Dayton, Ohio-based apostolate dedicated to spreading information about the harms of contraception, gets its name, Koob explained, "because we believe that anything we can do to help a couple to be open to another child--or another soul--is incredibly awesome."

Catholic faith knows that the human soul is immortal and will last forever, but the universe will not. So when the parents cooperate with God in conceiving a new human life, "that's more incredible than His creating the universe," Koob said.

A retired Air Force engineer, Koob is married with 14 children, five of whom are adopted. One More Soul is most famous for the tape "Contraception--Why Not?" by Janet Smith, Ph.D., a professor at the University of Dallas. More than 200,000 of those tapes have been ordered, Koob said.

But One More Soul also went to press last week with its latest edition of the "NFP-only Physicians Directory." NFP stands for natural family planning, which uses the woman's natural periods of infertility to space pregnancies. Koob was inspired to develop this directory by the true story of an obstetrician and gynecologist who prescribed neither contraception nor abortion nor sterilization but taught NFP instead. He "was quite successful in his practice, even though he (also) catered to poor women and crisis pregnancies," Koob said. His directory now lists 213 physicians, 19 of whom are in California. Of these, "four do tubal-ligation reversals," according to Koob.

Dr. Howard Pennington, OB-GYN, of Madera, is listed, albeit as retired. But in a recent interview he said that, after some initial success, he no longer performs the reversals. "The first four that I did, they all got pregnant," Pennington said. "But then I ran into cases where there was a disease."

Venereal disease is a major cause of infertility among women in the U.S.

In the case of healthy fallopian tubes, if the ligation is "a surgical ligation where you just put a ring around the tube," Pennington said, then "it's easy to cut out that area" and to reconnect the fallopian tube, thus restoring the woman's fertility. But "pelvic inflammatory disease," Pennington said, "a sexually transmitted disease, will destroy the tube and close it, not only in one area but in many areas."

Fertility is a fragile gift. And that's why Father Ephrem, a parish priest, would advise any couple contemplating sterilization to first "find a good solid priest whom you can trust who can give you what the Church teaches and guide you to a moral decision."

But what about a couple already sterilized? What should they do, if anything?

While each case is unique, Father Ephrem uses guidelines for these matters developed by John Kippley, founder of the Couple To Couple League, which teaches NFP. Father cites Kippley's book, "Sex and the Marriage Covenant" in which Kippley first points out that sterilization is "mutilation." Destroying the function of a healthy organ is a sin, traditionally classified as being against the Fifth Commandment, "thou shalt not kill."

"The second type of sin," Kippley writes, "is the sin of using unnatural forms of birth control. Once a person has voluntarily had himself or herself sterilized for birth control purposes, each act of sexual intercourse...objectively contradicts the meaning of the marriage act, for it is a permanent way of saying, 'I take you for pleasure but not for the imagined worse of pregnancy.'

"The problem has been complicated," Kippley goes on, "by much misleading counseling over the past 25 years. Many people have confessed the sin of sterilization and have not been counseled about the need to change their way of life. "If truly repentant, they can be forgiven their sin of mutilation, but how can a person be forgiven now--today--for his future sins of contraceptively sterilized intercourse?" Kippley asks.

Kippley proposes three changes in behavior, since a change in behavior is the usual manifestation of a profound attitudinal change. The attitude of "if we had to do it all over again, we wouldn't get sterilized" can be reinforced by the couple practicing one of the following behaviors: 1. complete abstinence until the wife is past menopause ("I doubt that this option will have many takers," Kippley writes, "and I do not think it is necessary ..."); 2. reversal surgery ("My personal opinion is that there is a general moral obligation to have reversal surgery, but I would be hesitant to call it a serious obligation, i.e., the grave matter of mortal sin ..."); 3. periodic abstinence or the use of NFP ("In this way, they will not be taking advantage of their sterilized state, enjoying the fruits of their sin").

Is this yet another pharisaic attempt, by men whose "words are bold but their deeds are few," to "tie up heavy burdens, and lay them on people's shoulders"? Not according to Father Ephrem, who hears the confessions of sterilized penitents. "The couples that I've experienced are very open to that" change in behavior, i.e., practicing NFP.

"It makes sense," he went on, "because it means that you are going by the very same moral standard as any couple that has not been sterilized ... So in that way you're not benefiting in any way from that (sterilization).

"For every offense there must be a recompense," Father Ephrem added. That's not just a man-made law; "that's a divine law," he said. Couples themselves feel the need for "some kind of sign to themselves that they made a mistake," he said. "In a sense, it's an ongoing penance until the time they're no longer fertile." God will reciprocate their generosity by blessing their marriage with an increase in holiness, Father believes.

However, Father Ephrem said, when one couple "wanted to do everything possible to reverse the vasectomy," he could not "morally compel them to do that."

Said Dr. Polito, "I hated to see couples who had prayerfully come to the conclusion that they had erred by being sterilized not (being) able to restore their anatomy because of the cost." So for several years he offered his services without charge, "asking couples to simply donate a small sum to the local pregnancy counseling center, and pay for the anesthesiologist and surgery center."

But people abused the offer-- "Couples who could care less about the spiritual dimension of my intent and were simply shopping price," Polito said. "So my office staff sat me down one day and said, 'no more!' Our current all-inclusive cost is $3,000." Costs generally range from $5,000 to $15,000, according to "The Patient's Guide to Vasectomy Reversal."

Dr. Polito knows of no health insurance plan which covers vasectomy reversals. "It's always cash out of pocket," he said, "that's why it's problematic."

The more simple reversal, vasovasostomy, "is performed as an outpatient and takes two to three hours," Polito said. Local or general anesthesia may be used.

"At surgery," Polito said, "fluid can be removed from the testicular end of the vas and examined under a diagnostic microscope once the scar has been cut away. If sperm or even sperm parts are present the surgeon knows that the system is at least intact, and that a blow-out in the epididymis has not occurred. "If no sperm are present," he went on, "particularly if it has been 10 years or more since the vasectomy, a disruption has probably occurred and an even more delicate, technically demanding procedure may have to be attempted."

In that procedure, called vasoepididymostomy, the surgeon skips trying to put the vas back together again and instead reconnects the vas directly to the epididymis. But, Polito said, "This has a fairly low success rate."

After the operation, "I ask my patients to stay home for four to five days if they have relatively sedentary occupations, or seven to 10 days if they are very physically active," he said. "Prudence also suggests refraining from vigorous exercise for three to four weeks."

Prudence would also suggest the priests begin preaching about the sin of sterilization, said Father Ephrem, who often hears people mention it in passing, as if it's not really a serious matter for confession. Some Catholics actually believe that the Church only condemns pills and condoms and other temporary sterilizations, said Father, who devotes an annual homily to the evils of contraception. Vasectomy and tubal ligation, "just like the rest of contraceptive behaviors, are sins that priests do not want to talk about," he said. "And if we don't, I would say that we are somehow complicit in abetting others' sins."

Dr. Polito thinks that Pope John Paul II is doing his share of consciousness-raising, and Polito himself wants to open "a Catholic clinic for vasectomy and tubal ligation reversals and counseling in natural family planning...

"My only problem at the moment," he went on, "is locating a Catholic OB-GYN who practices his or her medicine in concert with the magisterium of the Church and who would be interested in working with me. Anyone out there interested?"

To receive a copy of the NFP Physicians Guide, please call 1 (800) 307-7685. Dr. Gregory Polito can be reached at (562) 907-7600.

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