Many patients chose to control their fertility with permanent means of birth control with procedures like tubal ligation (cutting the fallopian tubes) for the woman or vasectomy (cutting the vas deferens) for the man. It should be emphasized that these two procedures are considered permanent even though successful fertility treatments such as the tubal reanastamosis (reconnect the fallopian tubes) or vasovasostomy (vasectomy reversal) are often possible.
A vasectomy involves surgically cutting the delicate tubes known as the vas deferens which transport sperm from the testicles to the penis. The middle portions of the tubes are tied, clamped or sealed using cauterization, which can cause scarring further insuring blockage of the vas deferens. The tubes may also be sealed using the “non scalpel” method. Using this procedure, a clamp holds the tube while a puncture incision is made with special instruments. The vas deferens are pulled through the puncture and sealed or cut then replaced into the scrotum.
Vasectomy reversal presents two options for men seeking fertility after a vasectomy who want to use their own sperm: 1) Surgical re-connection of the vas deferens tubes (vasovasostomy or vasectomy reversal) by a urological surgeon or 2) In vitro fertilization using testicular or epididymal sperm extraction and intracytoplasmic sperm injection.
Vasectomy reversal using surgery may be successful dependent upon several factors. The most important factor is that there must be enough tube remaining to perform the connection. The tubes must also be free of significant scar tissue that can impede sperm passage. The second issue is the length of time that has transpired since the vasectomy reversal. Typically the longer it has been since the vasectomy, the lower the subsequent chance of conception after vasectomy reversal. Antisperm antibodies may contribute to the decreasing pregnancy rate with time after vasectomy.
A third issue is the age of the spouse. It usually takes longer to conceive following reversal compared to IVF and this may be an issue if the woman is over 35 years of age or has decreased ovarian reserve. In many cases in vitro fertilization (IVF) offers the best chance for pregnancy success.
Normally, in vitro fertilization involves obtaining sperm from the ejaculate and combining it with the partner’s eggs in the laboratory. Many times intracytoplasmic sperm injection (ICSI) is used in help insure egg fertilization. Using ICSI, a single sperm is collected and injected directly into the egg. The injection procedure does not usually damage the egg.
In severe male infertility, such as men post vasectomy, there are no sperm in the ejaculate to use for ICSI even though sperm continues to be produced in the testicle and can be found in other parts of the reproductive tract.
Non-surgical testicular sperm extraction (TESE) is a “closed procedure” (no incision is made in the scrotum). A thin core of testicular tissue is obtained using a small thin needle similar in size to one used for drawing blood. This procedure is usually performed under IV anesthesia for optimal comfort but can be performed under local anesthesia if preferred. The small tissue sample obtained is examined under the microscope in the laboratory for viable sperm. Identified sperm are extracted and injected into the egg using ICSI. Most of the time small numbers of motile sperm can be obtained.
The likelihood of not finding viable sperm from the testicle of a previously fertile male after vasectomy is less than 5%. If desired, a trial testicular aspiration can be performed prior to ovarian stimulation and egg retrieval. Another alternative is to have donor sperm available in the unlikely event sperm is not retrieved. Alternative options for having a child after vasectomy include adoption and the use of a sperm donor.
Most patients can expect good results combining IVF/ICSI with testicular sperm aspiration after vasectomy as long as there are no additional severe causes of female infertility. Our infertility specialists are available to discuss all potential post vasectomy procedures in detail with each patient.
