In the case of a vasectomy, where the tube or vas deferens, leading from the epididymis to the penis has been surgically cut, sperm cannot get out. On ejaculation, there is no sperm in the semen. Semen comes from the prostate gland and the seminal vesicles and is not affected by the vasectomy. In cases where a man wants to have future childbearing potential, he has two choices. One is to do a reversal of his vasectomy, the other is to do IVF and recover sperm from the epididymis (MESA/TESA).
Advantages of Vasectomy Reversal
The advantages of doing a reversal of the vasectomy, known as a vasovasotomy, is that the couple can attempt pregnancy by having intercourse.
Disadvantages of Vasectomy Reversal
The disadvantages of a vasectomy reversal for patients in Scottsdale and Phoenix area are as follows:
- It is expensive and generally costs around $7,000-$10,000; similar to the cost of a cycle of IVF-ICSI.
- Not all urologists have the same experience and expertise and thus get different results.
- There may not be enough of the vas deferens to put back together because too much was removed at the initial vasectomy.
- Even if the vasectomy reversal is successful and the two ends can be put back together, it can close down or become blocked within 1-2 months after the procedure.
- Even though the surgery is successful and there are sperm in the ejaculate, the quality of those sperm parameters (numbers, motility and morphology) may be so low that neither intercourse or SO-IUI will be successful and the couple will have to do IVF-ICSI to achieve pregnancy. The poor sperm parameters are generally due to the consequences of a long standing vasectomy. Generally, when the vasectomy was done longer than 9 years ago, although you can get sperm in the ejaculate, overall pregnancy rates are low. Even when the vasectomy was done 2 years ago, the sperm parameters can be extremely low and IVF-ICSI has to be done to achieve pregnancy. These poor sperm parameters are due to back pressure that develops in the testicle from preventing the sperm from getting out with ejaculation. Even with a vasectomy, the testicles still produces sperm. With no way to get out, pressure builds up in the testicle, damaging the “factories” or semeniferous tubules or cells that produce sperm. In these cases of poor sperm parameters after a vasectomy reversal, CCRM Fertility has found that fertility medications (Clomid), sometimes used to improve spermatogenesis in men with low sperm counts, are generally ineffective and do not improve the sperm parameters. This is because the “factories” that are producing the sperm are damaged and can no longer function properly to produce sperm. However, even though the sperm parameters are poor, the sperm that is available can be very successful in fertilizing an egg when IVF-ICSI is done, with good pregnancy outcomes.
- As a result of the vasectomy there is a break in the blood-testes barrier and sperm or sperm components can get into the blood stream. Since the immune system has never seen sperm or sperm parts before in the blood, it makes antibodies against these sperm, known as antisperm antibodies, which attach to the sperm. This is generally of no consequence until the man wants future childbearing ability and decides to reverse his vasectomy. Since the ASA are so small they can pass into all parts of the body including the testicules, epididymis and vas deferens. As a result, after a successful vasectomy reversal, and there are sperm in the ejaculate, the ASA can attach and bind to these sperm and immobilize them, so they have no motility and thus cannot fertilize or produce a pregnancy. CCRM Fertility of Arizona strongly recommends, that before any man has a reversal of his vasectomy, he has his blood drawn to evaluate for ASA. An ASA showing less than 40% of the sperm bound by antibodies is normal and if the man wants to proceed with the reversal instead of IVF, then it is okay. If the ASA shows greater than 40% of the sperm bound by antibodies, and it is not atypical to see 80-90+% bound, then reversing the vasectomy may be successful in regard to sperm production, but most, if not all of the sperm may be non-motile and will be achieve a pregnancy.
- It requires surgery with anesthesia and there can be complications, although they are uncommon.
Understanding Advantages vs. Disadvantages
CCRM Fertility of Arizona strongly recommends that before a man decides to have a reversal of his vasectomy that he is given the pros and cons, as well as the risks and complications, finances of the reversal vs. IVF-ICSI and the success rates of each, before the couple makes their decision.
Once the couple is aware of the pros and cons of each decision, then they can make the choice that is best for them. Although, vasectomy reversals can be successful in the hands of an experienced urologist; far too often, when it is unsuccessful or the sperm parameters are poor, the couple has to be looking at doing IVF-ICSI to achieve a pregnancy, they state, “they were never told of any other options”.
