Vasectomy reversal or IVF ?
It is common place for couples with wish to consider their pregnancy options after vasectomy to consider the range of available treatments. There are two main choices. The alternative to vasectomy reversal is IVF which is aimed at achieving pregnancy by fertilizing eggs and sperm outside the body in the laboratory. Obviously this involves medication, monitoring and procedures on your partner.
Decisions regarding which of vasectomy Reversal or IVF is personally best for you may require careful consideration and depend on your individual circumstance.
If you do not reverse your vasectomy, sperm can be surgically removed from your testes or epididymis. These sperm are never numerous enough to achieve pregnancy except through the use of IVF.
For most patients vasectomy reversal is a better option than IVF as it provides a higher overall chance of pregnancy and gives you the widest range of options in the future.
Importantly, you should understand that:
- The surgical sperm retrieval required for IVF reduces the prospect of a future successful vasectomy reversal
- Vasectomy reversal simplifies and optimises the prospect of future IVF if needed
IVF with surgical sperm extraction limits future vasectomy reversal success because sperm aspiration damages either the epididymis (which is a continuation of the vas deferens into the testis) or the sperm collecting system inside the testis (the rete testis).
On the other hand, should vasectomy reversal not work for any reason (no sperm, poor sperm or no pregnancy despite sperm), there is nothing about vasectomy reversal that limits the future success of IVF. Indeed, as most men who undergo vasectomy reversal have sperm present in the semen, they will not need a sperm retrieval procedure should IVF be needed later.
IVF with sperm extraction
IVF involves the use of hormone medications to stimulate the growth of multiple eggs in one cycle. A woman's bodily response to these drugs is monitored with blood tests and ultrasounds. Once eggs are mature they are removed from a woman's ovaries by aspirating ovarian fluid using a needle inserted from her vagina in to he ovary under ultrasound guidance. The fluid is examined for eggs. If you have had a vasectomy sperm are retrieved through a needle aspiration of the epididymis (PESA), a needle aspiration of the testis (TESE) or an open biopsy of the testis. The eggs are injected with the sperm aiming to produce embryos. A single embryo is then placed back in to the uterus five days after the egg collection procedure and the couple then wait another 10 days to determine if the treatment has resulted in pregnancy.
For many IVF is an appropriate treatment with a good chance of success. However, when a prior vasectomy has been performed then serious consideration needs to be given to whether avasectomy reversal or IVF is undertaken first.