Fertility Options After Vasectomy

Vasectomy (disconnecting the tubes (vas deferens) that connect the testicles to the outside world) is one of the most common forms of birth control for men in the United States. If you decide that you would like to have biological children after your vasectomy, there are two procedures that can help: a vasectomy reversal or reconnection of the vas deferens, or sperm aspiration with a small needle passed into the vas deferens. Your doctor can help you choose which procedure is better for you and your partner based on:

• How long it has been since your vasectomy
• Your age(s)
• The number of children you want
• The costs
• How quickly you want to conceive a child, either naturally or through in vitro fertilization.

What are the first steps I should take?

The first thing to do is see a urologist. A urologist is a doctor who specializes in medical care for a man’s reproductive organs. Your urologist will take your medical history and do a physical examination to make sure you have no other health issues that would affect your fertility. Your partner should also see her doctor to make sure she has no fertility issues.

What happens in a vasectomy reversal procedure?

There are two procedures to reverse a vasectomy. The procedure used depends on whether additional blockages have developed in the epididymis (the transport tubes upstream of the vasectomy site)

• A vasovasostomy (vas-o-vay-ZOS-tuh-me) reconnects the two ends of the vas deferens above and below the prior vasectomy site.
• A vasoepididymostomy (vas-o-ep-ih-did-ih-MOS- tuhme) reconnects the epididymis (coiled duct where sperm mature prior to entering the vas deferens) to the vas deferens. This surgery is used when a vasovasostomy is not possible due to additional blockages in the vas deferens.

Your doctor will decide which procedure is better for you during the operation. Both types of vasectomy reversal may let you and your partner have a baby naturally through sexual intercourse.

How is sperm retrieved from the vas deferens?

During this procedure, your doctor passes a small needle into your vas deferens and gently suctions a bit of sperm. This procedure is usually performed under local anesthesia (with the use of numbing medication) in the office. It can also be done under general anesthesia (when you are put to sleep). A small biopsy of the testicle may also be performed to directly retrieve sperm. Most men have some minor pain complaints after one of these procedures.

If you undergo the aspiration or biopsy procedure, there won’t be enough sperm to create a pregnancy with intercourse or inseminations. The sperm can only be used to fertilize eggs in a laboratory by using IVF. The sperm can either be aspirated the day of the IVF procedure or removed in advance and frozen for a future IVF procedure.

When this method is used along with IVF, it can be highly successful. It takes less time for to achieve a pregnancy if you undergo IVF and you won’t have to use birth control after a successful pregnancy. It is also a less invasive procedure than the reversal. However, it is more expensive to undergo IVF, and it is a more invasive procedure for the woman.