Alternatives to Vasectomy Reversal

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On average, 14% of men who undergo vasovasotomies and 40% of men with vasoepididymostomies have no sperm in their semen after surgery. If sperm are not present in the semen by six months after vasovasotomy or by twelve to eighteen months after vasoepididymostomy, then the vasectomy reversal surgery is considered a failure.

At this point the couple can consider re-operation or assisted reproductive techniques such as invitro fertilization (IVF) with intracytomplasmic sperm injection (ICSI). The sperm obtained for IVF/ICSI is obtained through a minor surgical procedure (sperm retrieval), where sperm is extracted directly from the testicles or the epididymis. Sperm obtained this way do not swim well, which is why they must be manipulated as opposed to just placed inside the female genital tract with these methods.

Invitro Fertilization (IVF)

IVF is a relatively new technique that can help initiate pregnancy for couples unable to conceive through natural methods. It involves incubation of a female egg with a male sperm in a culture dish. For fertilization, the egg must have optimal maturity and the sperm must function normally. Once a fertilized egg develops into an embryo, it is transferred back into the female. Pregnancy rates, however, are very low with routine IVF and the process is usually coupled with manipulations that require special preparation of the egg and the sperm.

Intracytomplasmic Sperm Injection (ICSI)

ICSI is the 'gold standard' micromanipulation technique developed so far to enhance IVF fertilization rates. This procedure involves a direct injection of a single sperm into an egg. Pregnancy rates are very low with routine IVF - about an 18% chance of pregnancy per cycle. The female partner must also undergo a surgical procedure to remove the eggs from her ovary before which she will receive various drug treatments and undergo numerous ultrasounds.

In one study, the cost of one cycle of IVF ranged from $8000 to $15,000, with the average cost to produce a pregnancy about $75,000. Comparatively, the average cost for a vasectomy reversal producing a pregnancy was estimated at $25,000.

Vasectomy Reversal Verses IVF

Among the reasons many infertility specialists suggest attempting vasectomy reversal before turning to IVF are:

• A successful vasectomy reversal and subsequent pregnancy is much less expensive than a pregnancy through IVF.
• A successful vasectomy reversal provides a long term supply of sperm and multiple opportunities for fertilization.

For the woman, there are situations where IVF becomes the preferred method of producing a pregnancy. Examples include where a woman's tubes are completely blocked or if she is at the end of her reproductive life cycle and may not want to wait the four months to a year it may take for the sperm to come through to the ejaculate.