I often see patients who are potential candidates for vasectomy reversal and it makes me think of a smart urologist whom I have known for many years. We were at a meeting of a local surgical society and having a glass of wine and talking to a third mutual friend, who was a reproductive endocrinologist. The urologist told us that he had a patient that was 50 years of age and had a vasectomy 8 years earlier. He added that the man’s present wife was 29 years of age (this is not that uncommon in Los Angeles). He had just referred the couple for In Vitro Fertilization (IVF) with sperm extraction. He said he did this because the man was 50 years old. Unfortunately, while he was a good urologist, he didn’t specialize in—and knew very little about—infertility. After he walked away the reproductive endocrinologist looked at me and said exactly what I was thinking: that this was the perfect couple for a vasectomy reversal. The man had two kids and it had been less than 10 years since his vasectomy. The wife was young and fertile and ordinarily would not have needed IVF under other circumstances.
This was the perfect couple for a vasectomy reversal. The man had two kids and it had been less than 10 years since his vasectomy.
In patients less than 10 years from vasectomy the success rates for reconnecting the two ends of the vas together (thereby reversing the vasectomy) exceed 90% when there is sperm in the vas. The success rates are lower if there isn’t sperm, but the cost of a vasectomy reversal is less than one round of IVF. In addition, you can typically extract and freeze sperm at the same time as the reversal, so another sperm retrieval is unnecessary should the reversal fail.
So when is a vasectomy reversal the right choice?
Since the goal of a reversal is pregnancy, here are some good rules of thumb:
- In men less than 15 years from their vasectomies the rates of success and pregnancy are quite high.
- The younger the female partners, the greater the chance of making them pregnant following a reversal.
- A successful reversal is less expensive than one round of IVF; and most couples will need more than one IVF cycle to achieve a pregnancy.
- Unlike IVF, a successful reversal allows you to try every month to achieve a pregnancy.
While not all vasectomies are reversible, most are, and a reversal has many physical and economical advantages over IVF. Obviously, it’s wise to talk to your male fertility specialist about your options before proceeding and don’t hesitate to get a second opinion.