Conceiving after the snip: Vasectomy reversal vs. in vitro fertilization

Angeline Beltsos, MD and Meredith Martin-Johnston, MPH

So you or your partner has had a vasectomy... but now you have changed your mind, and would like to have a baby. What are your choices? There's both vasectomy reversal and sperm retrieval combined with IVF. Here's a look at the facts.

Vasectomy reversal
The procedure consists of a surgical procedure reconstructing your male partner's reproductive tract. This is usually a one day outpatient procedure, and is one of the more difficult procedures performed by urologists. Pregnancy most likely will not occur for 12 to 24 months after the procedure, but this also depends on discomfort and recovery time.

Usually, more recovery time will be needed than the time needed to recover from the first vasectomy procedure. In some cases, the reconstruction fails, and then sperm retrieval for IVF is recommended.

When a reversal is performed, a sample of sperm can be obtained and frozen which can be used for IVF in case the reversal is unsuccessful. This is easy to do and adds little cost to the procedure. Make sure to discuss this with your surgeon, since a repeat testicular surgery would be needed if the reversal does not work. Results are not immediate, and it may take 12 to 24 months to see the benefit of surgery.

Success rates
The success rates depend on what was cut, and what needs to be put back together. Depending on what needs to be reconstructed, a successful reconnection occurs 60 to 90 percent of the time, and the pregnancy rates that follow range from 40 to 70 percent. The longer the time between the initial vasectomy and the reversal, the less chance there is of success. Again, results are not immediate and may take 12-24 months to see the benefit of surgery.

Surgery costs
The cost of surgery is usually not covered by insurance since it is an elective procedure, and the cost can range from about $5,000 to $13,000. You should always check your coverage with your insurance company first.

Risks
Possible risks include postoperative pain, infection, tenderness, bruising, bleeding and swelling. There is also a chance of failure, in that the reconstruction of the reproductive tract does not take place. Risks also may include difficulty breathing, decreased urination or blood clots.

Other considerations include that the woman should also be checked beforehand to make sure that her fallopian tubes are open and that her ovaries are working properly. Also, if you want more than one child, a vas reversal may be a better choice. The advantages include that it is a one-day procedure; no drugs are needed for the female partner, and there is less chance of a multiple birth.

Sperm retrieval and IVF
This is a surgical procedure where sperm is extracted from the male partner's testes. In vitro fertilization, or IVF, involves both you and your partner. She will undergo ovarian stimulation with medication to produce several eggs. The egg retrieval is done with a small needle to remove the eggs from the ovary. The sperm are obtained from the testes with a surgical procedure. It is not as invasive as the reversal, with less expense, faster recovery and greater success.

This surgery can be done ahead of time and the sperm or tissue could be frozen or it can be done fresh on the same day as the egg retrieval. The sperm is injected into the egg, called intracytoplasmic sperm injection, or ICSI, and the fertilized eggs are placed back into your uterus. A pregnancy test can be taken two weeks later to determine pregnancy.

Success
IVF success rates can range from 25 to 50 percent. As women age, the success rates decrease significantly. A consultation with your OB/GYN or a reproductive endocrinologist is important before testicular surgery is done.

Cost
Insurance may cover for this procedure in certain states. Otherwise, you may be self-pay at a cost of around $5,000 to $10,000 for the procedure and around $3,000 to $5,000 for the medications.

Risks
Risks include ovarian swelling or hyperstimulation. There is a chance for complications of the egg retrieval, which is rare but may include bleeding or damage to the ovary. There is a 20 to 30 percent chance of a multiple pregnancy. The rare possibility of damage to the testicle or sperm can result from the sperm extraction.

Advantages include that it is a shorter period of time before you can begin to try for pregnancy. You may try immediately with IVF once the sperm retrieval has been done. This is much faster than the vas reversal where you may have to wait one to two years to see if it worked. IVF may also treat any female problems of infertility and it may be covered by insurance.

In summary, there are always choices and both of these should be considered after consulting both a doctor who does the reversal and a doctor who specializes in female reproduction to properly consider the best choice for you and your partner.