Are you Considering A Vasectomy Reversal or having Sperm Retrieval?
This is a question we are often asked and it occurs because a couple decide that they want a child and he has had a vasectomy. They have read that there are two options available to them: a vasectomy reversal or sperm retrieval.
However, it is not a simple either/or scenario. It is a maze of information to navigate around. This is because there are factors within both areas that need discussion and understanding before a decision can be correctly made.
During the reversal of a vasectomy and under the guidance of a micro-scope, a skilled surgeon reconnects the two ends of the vas deferens of both testes. It is a complex procedure and requires a skilled surgeon to maximise the prospect of a positive outcome, the presence of live sperm.
Some men are quite happy with their vasectomy so the long term plan is to always have the surgical method of male contraception and so whether to have a vasectomy reversal or sperm retrieval is vexing because the sperm retrieval seems to be the logical way forward.
But this is only logical if you are thinking that sperm retrieved is then inserted, vaginally, into the woman to bring about conception. It actually doesn’t work like that.
Surgical Retrieval of Sperm
This is performed as part of ICSI, (intracytoplasmic sperm injection) where the sperm is injected into the egg. It is performed under a general anaesthetic in the lab as part of ICSI InVitro Fertilisation (IVF). There are no turkey basters to be seen. It is a highly skilled, complex procedure and costly too.
To explain, if a man has had a vasectomy, then the problem that he has is that the sperm are unable to get out of him to impregnate his partner. Extraction, under a general anaesthetic, enables the removal of sperm so that the sperm can be selected and then injected into the egg.
To obtain an egg, the female has to have a regime of medication that artificially hyper-stimulates her ovaries to produce more than the usual one or two eggs. Under anaesthetic, the gynaecologist surgically extracts eggs that have all been artificially ripened at the same time. These eggs are then taken to the laboratory and the sperm are selected so that the “best” are injected directly into the egg. With everything crossed, it is hoped that the sperm fertilises the egg and conception occurs.
Pregnant or Not pregnant?
The egg injected with the single sperm is then left to let nature perform its amazing chain of processes. This is where fertilisation takes place and the egg starts dividing into a multi-cell structure called a zygote. After a period of two weeks, the zygote has divided sufficient times to be called an embryo.
Two weeks after the eggs and sperm have been surgically removed and placed together, the embryo or embryos are placed into the uterus. The day chosen for this is specific, when the hormone levels are agreeable to implantation, and beyond the gynaecologist’s skill, a pregnancy is entirely up to the female. It is purely a waiting game based on daily bloods taken to anticipate the best set of circumstances to enable the embryo to implant and pregnancy.
Some of the major concerns about using sperm that has been surgically removed for pregnancy, are these:
- the embryologist chooses the sperm rather than nature
- the female needs significant medication to bring several eggs to maturation at the same time and to enable the IVF process to run smoothly
- the cost for a cycle of IVF/ICSI is usually for one or two cycles meaning one or two months
- the chance of pregnancy is lower than if a couple tried to conceive naturally.
What about a vasectomy reversal?
Having a vasectomy reversal is not without its own problems but many choose this option when deciding vasectomy reversal or sperm retrieval for the simple reason that assuming the surgery is successful, there are many months of opportunity to conceive naturally.
So to do a direct comparison to the ICSI/IVF process:
- nature selects the sperm to impregnate the egg
- the female needs no medication to enable the process to run smoothly
- the cost for a vasectomy reversal enables monthly opportunities to conceive
- the chance to conceive reverts to normal as in the rest of the population who have not had a vasectomy reversal.
There are problems though and this would not be a balanced discussion without them.
The Problem with ICSI /IVF
It is an expensive process with no guarantees sadly. According to NICE, most women typically see success rates of 20-35% per cycle, but the likelihoodof getting pregnantdecreases with each successive round, while the cost increases.” There is pressure to have three rounds of IVF. An initial course of treatment is around £8000.
IVF is also known to be stressful to both involved. Partly due to the desire to have a baby, partly the cost but also the effect of the medication on the disruption of normal hormone balance.
The Problem with Vasectomy Reversal
There are no guarantees that a vasectomy reversal is going to work. It may be that over time, tiny blockages have developed in the testes and it is just not possible to unblock these with surgery. Therefore the audited results of a surgeon really matter as they give an indicator as to how successful he can be despite the fact that some men cannot have a successful outcome. Sadly there is not test to ascertain who will be affected in this way before surgery.
Scarring is another issue with having a vasectomy reversal though. Despite what the internet says, there are only a small number of men who are affected by this but again, it is not possible to understand who is going to be affected and why. All we can do is when faced with deciding if it will be a vasectomy reversal or sperm retrieval, sufficient correct information is available to help make the right decision for you.
There is no right decision except the decision that is right for you and your partner. We have had people come to us after a vasectomy and they have to considered IVF due to financial reasons. Others come to us and then have a low sperm count post-op and worry that they will never conceive naturally. We have had a few people find out they were pregnant days before starting IVF treatment. We have had people come to us after IVF whether it has been successful or failed and then decide to have a reversal. Finally, we have had couples who have had a successful vasectomy reversal and have their family and then contact Mr Harriss asking if they can have another vasectomy.
Everyone’s path is different. We are here to help as best we can.