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Fertility Options Following a Vasectomy
Reasons why couples regret the decision to have a vasectomy vary. Probably the most common reason is remarriage, but the tragic loss of a child or the simple wish to have more children is another reason.
A typical vasectomy involves the destruction of a small section of the tube (vas deferens or “vas”) that carries the sperm from the testicle to the urethra.
The major options that can restore fertility involve a surgical approach that reconnects the end of the tubes or alternatively a sperm retrieval technique in the male coupled with in vitro fertilization (IVF) in the female partner.
Advantages and disadvantages exist with each individual approach. The surgical approach re-establishes the flow of sperm by reuniting the vas deferens or connecting the vas to another type of tubule called the epididymis.
Success rates with surgical reversal can be excellent, especially when the interval from the initial vasectomy to its reversal is of short duration. Such an approach can be desirable as conception can occur in a natural manner at home. It can take some couples a considerable period of time, however, to conceive in this manner and not all surgery is successful in restoring sperm to the ejaculate.
An alternative approach to this surgery involves the aspiration of sperm from the epididymis via microsurgical epididymal sperm aspiration (MESA), percutaneous epididymal sperm aspiration (PESE), or from the testicle via testicular sperm aspiration (TESA), or testicular sperm extraction (TESE). Sperm obtained in such a manner typically will not be capable of conception without the assistance of IVF and ICSI in the female.
Under most circumstances, MESA will give the highest quality and quantity of sperm, and can routinely provide enough quality sperm to allow for sperm cryopreservation. This allows for greater flexibility in timing of the IVF cycle and will often provide enough sperm to allow for multiple IVF attempts if desired.
Similar to the surgical reversal procedures, when MESA is coupled with IVF and ICSI, conception rates in excess of 50% of couples are possible. MESA can also be successful in patients where surgical vasectomy reversals are not possible or unsuccessful in restoring sperm to the ejaculate.
Many believe that it is best to consider a consultation with an urologist who is fellowship trained in microsurgery and has experience with the sperm aspiration/extraction techniques.
It would also be a consideration to consult with a reproductive endocrinologist, infertility specialist, to learn more about what is involved with IVF before a decision is made as to which approach is best for each couple.
We provide services for the diagnosis and treatment of infertility.
Our services include an outstanding IVF and donor egg program.
We offer all levels of treatment including infertility testing intrauterine insemination (IUI), medical treatment, and advanced laparoscopic surgery. Most of our patients become pregnant without requiring IVF.
Monday-Thursday 8AM - 5PM
Friday 8AM - 1PM
Our patients can reach us for emergencies 24 hours a day by calling our main number, and selecting choice #1, which pages our medical or nursing staff.
If your situation is life threatening, dial 911 or go directly to your local ER.