Surgical sterilization is often the first choice of couples over 30 contemplating permanent contraception, leading to approximately 500,000 vasectomies being performed every year. Between 6-12% of these men will seek a vasectomy reversal due to lifestyle changes, the loss of a wife or child, or out of the desire to start a new family after divorce. It can be a difficult and frustrating process, with the expenses mounting up. The surgery itself can be long, complicated, and may not provide the results desired. Failure rates can run as high as 40%. However, there are other procedures that can be utilized for conception other than a vasectomy reversal.
Men will be given the option to bank their sperm when deciding on a vasectomy, and if there is any thought of future children, this could be a good choice for couples. There are also several ways to retrieve sperm that do not include a complicated vasectomy reversal, such as sperm and tissue aspiration. These procedures are generally much less involved than a vasectomy reversal, less expensive, and may have a better success rate. Most procedures can be done in an outpatient setting, meaning the patient can return home almost right away with very little or no missed time from work.
Sperm Retrieval versus Vasectomy Reversal
For IVF or ICSI (intracytoplasmic sperm injection), sperm may be retrieved via PESA (percutaneous epididymis sperm aspiration) or TeSE (testicular sperm extraction). Both procedures use a small needle to extract sperm from either the testicles or epidiymis, and in the case of the TeSE, may provide enough material for several attempts at conception. These procedures are much less invasive than a vasectomy reversal, and up to 30% of couples experience success in conceiving with these methods.
Going a Little Deeper
Microsurgical epididymal sperm aspiration (MESA) and testicular sperm aspiration (TeSA) are two procedures in which actual tissue containing sperm is harvested, and can be frozen for several attempts at IVF or ICSI. Although a little more involved than PESA or TeSE, these two procedures are much less complicated than vasectomy reversal and are also done on an outpatient basis. The success rates for IVF and ICSI are typically less than for a vasectomy reversal, however, the risks for the complex surgery are much higher than for sperm aspiration. Additionally, if a long period of time has elapsed since the original vasectomy, sperm aspiration may be more successful than a vasectomy reversal.
Thanks to advances in technology, there are many options available to couples desiring children even after a vasectomy. Once thought to be a permanent solution to birth control, should circumstances change, there are choices for couples. A vasectomy reversal does not have to mean the end of the road as far as conception goes, which is good news for people who have embarked on a second life.