Vasectomies are a widely used method of contraception today. The failure
rate is extremely low such that they are a very dependable way of avoiding
unwanted pregnancy. Sometimes a man who thought his family was complete
may change his mind and want to have more children after a vasectomy has
been performed. There are a couple of ways of resolving this dilemma.
The traditional approach has been to carry out a second surgical procedure
wherein the severed vas deferens (the tubes within the scrotal sac which
carries sperm from the testicles to the outside world) is sewn back together.
This is a microsurgical procedure which is actually far more technically
involved and complicated than the original vasectomy where a piece of
the vas was burned, removed or clipped. The procedure will typically take
a couple of hours to perform and is done by urologists with who have undergone
specialized microsurgical training. The procedure can be technically successful
in 60-70% of cases if the vas deferens was not excessively destroyed in
the original vasectomy procedure. Unfortunately, these results are not
always the case and the actual patency rate (i.e. sperm are found in the
ejaculate after the procedure) is lower. The other complicating factor
with surgical repair is the prevalence of anti-sperm antibodies. These
antibodies will prevent normal sperm function if they are present. They
are found increasingly frequently the longer it has been since the original
vasectomy was performed. Most researchers agree that they are rarely found
within 5 years from the original vasectomy and are almost always present
more than 10 years from the original procedure. In these latter cases,
even if the vasectomy reversal procedure is technically successful, the
sperm will not be normally functional therefore the surgery probably will
not lead to successful conception. It may take a few months to see sperm
within the ejaculate following a reversal procedure and unfortunately
in some cases despite sperm being present initially post-operatively,
there is progressive scarring which leads to re-closure of the vas.
The other approach available today is to carry out In vitro fertilization
(IVF) and intra-cytoplasmic sperm injection (ICIS) using aspirated sperm.
We've always been able to aspirate sperm using a fine gauge needle
directly from the testicles. Under local anesthesia, it is quite realistic
to pass a needle directly through the scrotum into the testicle itself
or the epididymis (the network of tubules adjacent to the testicle where
sperm finish their maturation process and are stored prior to ejaculation)
and aspirate sperm. The limiting factor has always been that we can only
retrieve thousands of sperm in this fashion and we need tens of millions
for intercourse to establish pregnancy or millions for inseminations to
do so. Using the technology of IVF/ICSI however, we only need one sperm
for each egg available. Since we may typically get 10-15 eggs during an
IVF cycle, we'd only need 10-15 sperm for success. Therefore the sperm
aspirated in this fashion are more than enough for multiple attempts.
The advantages of IVF/ICSI versus vasectomy reversal are multiple. Success
rates do not depend On how much damage was caused by the original vasectomy.
The presence or absence of anti-sperm antibodies is irrelevant because
the sperm do not need to be able to swim on their own during IVF/ICSI.
Also because IVF is being done, female fertility problems such as tubal
issues, endometriosis, ovulation problems and so on are all automatically
being bypassed. Success rates for IVF/ICSI using aspirated sperm following
vasectomy are among the highest in couples doing IVF and the live birth
rates are certainly equal if not better than those seen following vasectomy
reversal. Lastly this approach is far more efficient in that the whole
process from beginning of testing to starting obstetrical care could certainly
be carried out in a 2-3 month time frame whereas the surgery itself may
be carried out a month or so after testing, it may require months to see
normal sperm in the ejaculate and the couple may then have to try for
several months before conceiving.
For more information about conception after a vasectomy, and to schedule
an appointment with Dr. André L. Denis or any other of ACRM’s
fertility experts, call 678-841-1089 or