Many men who have had a vasectomy wish to father another child. While one option is vasectomy reversal, there are alternatives to this costly and sometimes painful surgical procedure. Some men, prior to having a vasectomy, will bank sperm for the future. Realizing they may change their minds or their life situation may change and desire the option of future childbearing, sperm banking is an excellent way to ensure future fertility. This sperm can then be used to inseminate a partner if and when the need arises after the vasectomy has been done.
Another alternative to vasectomy reversal for men who wish to avoid surgery is artificial insemination by a donor. Likely the least expensive alternative to achieve a pregnancy following vasectomy, artificial insemination by donor (AID) allows the female partner to be inseminated and conceive a child through the donated sperm, and thus the genetic material will not be that of her partner. AID has been used by couples with male factor infertility for decades.
Sperm from the father can be obtained after a vasectomy through one of several procedures. The least invasive is percutaneous epididymal sperm aspiration (PESA). In this procedure, a needle is placed through the skin of the scrotum into the epididymis or the larger tube between the testis, where sperm is produced, and the vas deferens, the tube cut during a vasectomy. More invasive options to recover sperm are microsurgical epididymal sperm aspiration (MESA) and testicular sperm extraction (TESE) both of which require anesthesia and a small incision. In MESA a small incision is made to directly visualize the epididymis, withdrawing as much sperm as possible. In the TESE procedure, the testis itself is biopsied to remove the sperm. The open surgical removal of sperm allows for retrieval of a larger quantity of sperm which can then be stored and used in the future.
These procedures remove only sperm but no seminal fluid which nourish the sperm. In vitro fertilization or intra-cytoplasmic sperm injection of the genetic material from the sperm into the egg is used to fertilize waiting eggs. The fertilized eggs are then placed in the uterus of the woman who will carry the resulting baby. Because of the intense and coordinated care of both the man and also his female partner, these alternatives are more costly. It is also important to remember the success of these procedures is lower than that of vasectomy reversal.
