Vasectomy reversal vs IVF, what’s the best option for you?
Men who have had a vasectomy have two options if they want to conceive. They can have the vasectomy reversed or they can have sperm removed from the tubules draining the testicles – or from the testicles themselves – and then proceed to in vitro fertilization (IVF). Both vasectomy reversal and sperm extraction procedures are performed by a urologist with special training in male infertility. Prior to performing either procedure, a urologist would typically perform a history and physical examination on the man in order to recommend the optimal procedure. As long as testosterone and FSH (follicle stimulating hormone) levels and a physical examination are normal, then sperm are likely being produced in the testicle. If there are signs that sperm production may be low for some other reason, and/or that extensive female fertility treatment is likely to be needed even after reversal, then sperm extraction and IVF may be the best option.
The length of time elapsed since the vasectomy is a very important factor.
One of the major factors that determines the ultimate success of a vasectomy reversal is the length of time that has elapsed since the vasectomy. The longer the time between vasectomy and the reversal, the less likely the reversal will be successful (15 years is typically the cut off for recommending a reversal). As there are many factors that will impact the success of a vasectomy reversal, each man should discuss the specifics of his situation with his urologist. Typically, however, pregnancy rates as high as 75-80% can be seen after a vasectomy reversal.
If a vasectomy reversal is not the best option sperm extraction may still be helpful
In the event that the urologist believes that vasectomy reversal is not the best option, then men may be advised to pursue a sperm extraction procedure. These procedures are typically much easier for the man to recover from than a vasectomy reversal, although they do have other drawbacks. The most significant of these is that when sperm are extracted from the testicles, they are often not fully mature. Sperm that are not mature cannot fertilize the egg on their own. In addition, only small amounts of sperm can be extracted from either the tubules or the testicles. Therefore, while this amount is typically more than enough for IVF, it is insufficient for intrauterine insemination (IUI).
Female partner evaluation is very important before a treatment plan is decided
Prior to deciding on the best route for the male to pursue, it is critical to have the female completely evaluated by a reproductive endocrinologist. If the female is of advanced reproductive age (35 and older), has diminished ovarian reserve, tubal disease, severe endometriosis, or significant pelvic adhesions, she may require fertility treatment to conceive herself. This may make IVF a better choice, as a vasectomy reversal can only be ultimately successful if both partners are otherwise fertile.
The combination of a thorough evaluation by a urologist (for the male) and a reproductive endocrinologist (for the female) will give you the information you need to make the best choice for your specific situation.
Contact us to arrange for a new patient consultation with Dr. James or Dr. Munch. If you have been trying to get pregnant, and suspect the cause may be male infertility, Our doctors have the experience and the skill to help most men successfully overcome a diagnosis of male infertility, so they can go on to have healthy children.