Due to many circumstances in life, men who have had vasectomies decide to become fathers once again. There are two alternatives for cases such as these:
– Surgical reversal of the vasectomy called vasovasostomy.
– in vitro fertilization (IVF – ICSI) after sperm is collected from the epididymis.
Some aspects must be taken into consideration so as to decide what is best for the couple. First of all is the woman’s reproductive capability: age, tube permeability, possibility of endometriosis, etc. If there is nothing to hinder spontaneous pregnancy on the woman’s side, then other aspects are analyzed as briefly shown in the table below:
Pros and Cons of each method
|More suitable for younger couples (pregnancy may take around 8 to 9 months)||More recommended in the cases where the woman’s age is 35 plus|
|Less invasive for the woman||Less invasive for men|
|Does not invalidate ICSI||It may invalidate reversal
(when epididymis is punctured)
|Requires practice in microsurgery||May only be performed in major specialized center or clinics|
|Gives back the couple’s reproductive autonomy (if surgery is successful)||There will always be the need to repeat the procedure whenever pregnancy does not occur in the desired cycle or in the case of other pregnancies|
|There is some risk even when surgery is successful||Higher risk of multiple pregnancies|
Another aspect which must be taken into account is the time lapse since the man’s vasectomy. The graph bellow shows that this period of time is critical for the results: the shorter the time, the higher the chances of success. This is due to the fact that the probability of a successful outcome (which means the semen must contain sperm once again) decreases with the length of time after the vasectomy. Also, pregnancy may not always occur despite a successful reversal. The vasectomized man may begin producing anti-sperm antibodies and, as a result, pregnancy cannot be achieved as the number of sperm is affected by this phenomenon.
As one may observe in the graph there is a success rate of 97% for the presence of sperm in the ejaculate and 76% for pregnancy when the reversal takes place up to three years after a vasectomy. These results drop to 53% for pregnancy when reversal occurs between three and eight years after the vasectomy, then 44% between nine and 14 years and, finally, a probability of 31% of the woman getting pregnant when reversal is performed more than 15 years after a vasectomy.
The best alternative may be ICSI (intra-cytoplastic sperm injection) whenever the woman has some infertility problem, her age is 35 plus, when the man is not willing to be submitted to the reversal surgery or the time lapse since the vasectomy is over eight years. A very thin needle and local anesthetic are used to collect the sperm directly from the epididymis.
Vida – Centro de Fertilidade recommends couples who find themselves in this situation to discuss their case both with the gynecologist specialized in Human Reproduction and the andrologist, so as to reach a consensus between the female and male factors regarding the treatment.