Vasectomy Reversal or IVF?
Men who undergo vasectomy do not plan on fathering any more children. That being said, life doesn’t always turn out the way we predict and worldwide about 5% of men will seek to have a reversal of their vasectomy performed.
Before the mid 1970’s vasectomy was considered a permanent form of contraception – a relatively small number of reversals were being performed but the surgical success rate (“Patency Rate”) was less than 20% and subsequent pregnancies (“Pregnancy Rate”) were considered a rare event. The advent of microsurgical techniques changed all of this and today microsurgical vasectomy reversal is successful in more than 90% of patients – even in cases where several years had passed since the vasectomy. (See “Success Rates”)
A vasectomized man wishing to father his own biological children again basically has two options:
- Vasectomy Reversal Surgery
- Assisted Reproduction Technology (ART such as Intracytoplasmic Sperm Injection (ICSI))
Experts have still not proven which technique is the “best”: vasectomy reversal or ART (IVF/ICSI), and they will probably not be able to do so any time soon…
The reason is simple: each couple that wants to have a baby is unique and has their own dynamics, preferences, and concerns. There is such a large number of variables, advantages, and disadvantages of these procedures to consider and each couple will interpret them differently. That’s what makes us unique.
As a couple, you will have to discuss these options. There is a mass of information available on the internet about vasectomy reversal and ART.
Here are some of the most important things to consider:
Success Rates
Depending on the area of the world and fertility institution, the success rate of ART is around 35% per cycle.
Depending on the Urologist doing the operation, the patency rate after microsurgical vasectomy reversal is 75-95% and the pregnancy rate 50-70%.
Number of children desired
When using ART, every pregnancy will require “starting over” with the fertility treatment cycles and the costs thereof.
Vasectomy reversal is a once-off procedure that restores the male reproductive ability – after successful vasectomy reversal, there will be no additional intervention or cost if you decide to have more than 1 child.
Risks of twins/triplets
Women who undergo ART have an increased chance of having twins and triplets. Twins or triplets are more commonly born prematurely and are at higher risk to have low birth weights.
Pregnancy after vasectomy reversal is achieved by the “natural” methods and there is no increased risk of twins or triplets or any birth defects.
Costs
It is very difficult to make a direct comparison between the cost of vasectomy reversal vs ART.
The cost of vasectomy reversal is once-off, whereas every new cycle of ART is going to be an expense. When performing ART there is not only the cost of all the procedures being performed on the female partner, but the male partner will also need to undergo harvesting of sperm from the testicle, which will result in an additional fee. Studies from different parts of the world seem to indicate that, when all variables are taken into consideration, vasectomy reversal is the more cost-effective option of the two.
Physical & Psychological Effects
ART usually involves placing of a needle into the ovary of the female partner to extract the eggs, after she had taken hormone medication to increase the production of eggs. For each of the IVF cycles, there is about a 35% chance of success (live birth); women often need more than one cycle of ART. Couples report emotional ups-and-downs when expectations of success are not realized and the process needs to be repeated. For ART / ICSI, sperm also needs to be harvested from the male partner – this involves a small surgical procedure where the sperms are taken directly from the testicle with a needle or surgical blade.
During vasectomy reversal, it is only the male partner who is subject to physical discomfort in the form of an operation and anaesthesia.
Your Personal / Work Schedule
ART may include more than 1 treatment cycle, and each of these will require a few visits to the fertility specialist: consultations, placing the embryos into the uterus and follow-up to see if it had been successful. The male partner will also need to undergo a procedure where sperms are harvested from his testicles.
For a vasectomy reversal, most male patients will only have to see me 2 times:
- A first consultation before the operation where we can discuss the procedure and questions that you may have
- The operation itself
The post-operative semen analysis will require an additional visit to a pathology laboratory. It is not necessary for the female partner to be present at any of these appointments. She is, however, more than welcome! Most men return to work a few days after vasectomy reversal surgery. A follow-up appointment with me at about 12 weeks after the operation to discuss the results of your post-operative semen analysis is usually done remotely (via phone or Zoom / Skype).