Reversal of Vasectomy vs. In-Vitro Fertilization (IVF)
In the case of a vasectomy, where the tube or vas deferens, leading from the epididymis to the penis has been
surgically cut, sperm cannot get out. On ejaculation there is no sperm in the semen. Semen comes from the prostate
gland and the seminal vesicles and is not effected by the vasectomy. In cases where a man wants to have future child
bearing potential, he has two choices. One is to do a reversal of his vasectomy, the other is to do IVF and recover
sperm from the epididymis (MESA/TESA).
Advantages of Vasectomy Reversal
The advantages of doing a reversal of the vasectomy, known as a vasovasotomy, is that the couple can attempt pregnancy by having intercourse.
Disadvantages of Vasectomy Reversal
The disadvantages of a vasectomy reversal for patients in Scottsdale and Phoenix area are as follows:
- It is expensive and generally costs around $7,000-$10,000; similar to the cost of a cycle of IVF-ICSI.
- Not all urologists have the same experience and expertise and thus get different results.
- There may not be enough of the vas deferens to put back together because too much was removed at the initial
- Even if the vasectomy reversal is successful and the two ends can be put back together, it can close down or
become blocked within 1-2 months after the procedure.
- Even though the surgery is successful and there are sperm in the ejaculate, the quality of those sperm
parameters (numbers, motility and morphology) may be so low that neither intercourse or SO-IUI will be
successful and the couple will have to do IVF-ICSI to achieve pregnancy. The poor sperm parameters are generally
due to the consequences of a long standing vasectomy. Generally, when the vasectomy was done longer than 9 years
ago, although you can get sperm in the ejaculate, overall pregnancy rates are low. Even when the vasectomy was
done 2 years ago, the sperm parameters can be extremely low and IVF-ICSI has to be done to achieve pregnancy.
These poor sperm parameters are due to back pressure that develops in the testicle from preventing the sperm
from getting out with ejaculation. Even with a vasectomy, the testicles still produces sperm. With no way to get
out, pressure builds up in the testicle, damaging the "factories" or semeniferous tubules or cells that produce
sperm. In these cases of poor sperm parameters after a vasectomy reversal, Arizona Center for Fertility Studies
has found that fertility medications (Clomid), sometimes used to improve spermatogenesis in men with low sperm
counts, are generally ineffective and do not improve the sperm parameters. This is because the "factories" that
are producing the sperm are damaged and can no longer function properly to produce sperm. However, even though
the sperm parameters are poor, the sperm that is available can be very successful in fertilizing an egg when
IVF-ICSI is done, with good pregnancy outcomes.
- As a result of the vasectomy there is a break in the blood-testes barrier and sperm or sperm components can get
into the blood stream. Since the immune system has never seen sperm or sperm parts before in the blood, it makes
antibodies against these sperm, known as antisperm antibodies, which attach to the sperm. This is generally of
no consequence until the man wants future childbearing ability and decides to reverse his vasectomy. Since the
ASA are so small they can pass into all parts of the body including the testicules, epididymis and vas deferens.
As a result, after a successful vasectomy reversal, and there are sperm in the ejaculate, the ASA can attach and
bind to these sperm and immobilize them, so they have no motility and thus cannot fertilize or produce a
pregnancy. Arizona Center for Fertility Studies strongly recommends, that before any man has a reversal
vasectomy, he has his blood drawn to evaluate for ASA. An ASA showing less than 40% of the sperm bound by
antibodies is normal and if the man wants to proceed with the reversal instead of IVF, then it is okay. If the
ASA shows greater than 40% of the sperm bound by antibodies, and it is not atypical to see 80-90+% bound, then
reversing the vasectomy may be successful in regard to sperm production, but most, if not all of the sperm may
be non-motile and will be achieve a pregnancy.
- It requires surgery with anesthesia and there can be complications, although they are uncommon.
Understanding Advantages vs. Disadvantages
Arizona Center for Fertility Studies strongly recommends that before a man decides to have a reversal of his
vasectomy that he is given the pros and cons, as well as the risks and complications, finances of the reversal vs.
IVF-ICSI and the success rates of each, before the couple makes their decision.
Once the couple is aware of
the pros and cons of each decision, then they can make the choice that is best for them. Although, vasectomy
reversals can be successful in the hands of an experienced urologist; far too often, when it is unsuccessful or the
sperm parameters are poor, the couple has to be looking at doing IVF-ICSI to achieve a pregnancy, they state, "they
were never told of any other options".