Vasectomy reversal or IVF ?
It is common place for couples with wish to consider their pregancy options after vasectomy to consider the range of available tretaments. 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. The medication, monitoring and procedures that your partner will have to go through are considerable.
Decisions regarding which of vasectomy Reversal or IVF is personally best for you may require careful consideration and depend on your individual circumstance.
Because IVF requires the extraction of sperm from the tubules next to the testis (epididymis) or directly from the testis by needle aspiration or direct biopsy, there are too few sperm obtained by this method for simple insemination which is why IVF is always necessary.
For most patients vasectomy reversal is a superior option than IVF as it provides a higher overall chance of pregnancy and gives you the widest range of options.
Importantly, you should understand that:
- IVF markedly reduces the prospect of a future successful vasectomy reversal
- Vasectomy reversal simplifies and optimise's the prospect of future IVF
The reason for the limiting effect of IVF on future vasectomy reversal is that sperm aspiration damages either the epididymis (which is a continuation of the vas deferens up the side of 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, bad luck), there is nothing about vasectomy reversal that limits the future success of IVF. Indeed, as the overwhelming majority of men who undergo vasectomy reversal have sperm present in the semen, then this eliminates the need for a sperm retrieval procedure when attempting IVF.
IVF with sperm extraction
The process of IVF involves the use of a series of hormonal medications to stimulate the body to make available more eggs than would normally be so. A woman's bodily response to these drugs is then closely monitored through a series of blood tests and trans-vaginal pelvic ultrasounds. Provided that the response of the ovaries is adequate an egg collection procedure is performed which requires a need to be placed through the top of the vagina to extract the eggs. Usually a sperm extraction procedure is performed on the same day which either involves a needle aspiration of the epididymis (PESA), a needle aspiration of the testis (TESE) or an open biopsy of the testis. If eggs and sperm are both obtained then the eggs are injected with the sperm and hopefully they will fertilize 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 leads to a positive pregnancy test.
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 order in which of vasectomy reversal or IVF is undertaken.