Vasectomy Reversal

Men wanting to restore fertility using their own sperm after vasectomy have two options:

Vasectomy Reversal or IVF after TESE, using ICSI.

Overview

After vasectomy, patients have two options to help restore fertility. Vasectomy reversal or IVF combined with ICSI after testicular sperm aspiration (TESE). Most patients can expect good results combining IVF/ICSI with TESE after vasectomy as long as there are no additional severe causes of female infertility.

An alternative option for having a child after vasectomy not utilizing the partner’s sperm is use of a sperm donor for IUI or IVF.

An issue to consider in determining which option to pursue in situations when pregnancy is desired after vasectomy is the female partner’s age. It usually takes longer to conceive following vasectomy reversal compared to IVF. This may be a concern if the woman is over 35 years of age or has decreased ovarian reserve. In many cases in vitro fertilization (IVF) offers the best chance for pregnancy success following a vasectomy.

Our facility specialists are available to discuss all potential post vasectomy procedures in detail with each patient.

Challenges Due to Vasectomy

A vasectomy blocks or cuts the vas deferens so sperm stay in the testicles. When there is a desire to father a child after vasectomy, the vas deferens tubes either need to be restored through a vasectomy reversal, allowing sperm to once again travel through the semen, or sperm can be removed through TESE and used in IVF combined with ICSI. There are pros and cons with both procedures.

 

Treatment Options

Men wanting to restore fertility using their own sperm after vasectomy have two options:

  1. A vasectomy reversal surgically reconnects the vas deferens tubes. This is an invasive procedure and is not always successful. There must be enough tube remaining to perform the connection and tubes must be free of scar tissue that can prevent sperm passage. Typically, the longer it has been since the vasectomy, the lower the chance of success with a reversal as antisperm antibodies may contribute to decreasing pregnancy rates with time.
  2. In vitro fertilization uses testicular or epididymal sperm extraction through ICSI. This is a much less invasive procedure for the man and has a higher success rate than a vasectomy reversal. Normally, in vitro fertilization involves obtaining sperm from the ejaculate and combining it with the partner’s eggs in the laboratory. Frequently, intracytoplasmic sperm injection (ICSI) is used in help insure egg fertilization. Using ICSI, a single sperm is collected and injected directly into the egg. The injection procedure usually does not damage the egg. For men who have had a vasectomy, there are no sperm in the ejaculate to use for ICSI even though sperm continues to be produced in the testicle and can be found in other parts of the reproductive tract. In this case, a non-surgical testicular sperm extraction (TESE) is used to gather sperm. TESE is a “closed procedure” (no incision is made in the scrotum). Testicular tissue is obtained using a small thin needle similar in size to one used for drawing blood. This procedure is usually performed under IV anesthesia for optimal comfort but can be performed under local anesthesia if preferred. The small sample obtained is examined under the microscope in the laboratory for viable sperm. Identified sperm are extracted and injected into the egg using ICSI. Most of the time, small numbers of sperm can be obtained. The likelihood of not finding viable sperm from the testicle of a previously fertile male after vasectomy is less than 5%. If desired, a trial testicular aspiration can be performed prior to ovarian stimulation and egg retrieval. Another alternative is to have donor sperm available in the unlikely event sperm is not retrieved.
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