According to the Centers for Disease Control and Prevention (CDC), as many as 2.1 million couples each year struggle with infertility. But advances in medical science, including the development of assisted reproductive technologies (ARTs), have helped millions of couples conceive. While vasectomy reversal may be an option for restoring fertility, compare the benefits and drawbacks of vasectomy reversal alternatives to determine which approach is best for you.
What Are Assisted Reproductive Technologies?
Assisted reproductive technologies require the collection of both egg and sperm to increase the likelihood of conception. Eggs and sperm are harvested from the woman and man and evaluated to ensure that they are healthy. Once viable specimens are found they are combined together in a laboratory to make a fertilized egg. The four main types of ARTs are:
- In vitro fertilization (IVF): In IVF, a woman is given hormones to stimulate the production of eggs. (This method is used in all of the procedures below, too.) Once the eggs are harvested, they are combined with sperm in a Petri dish so that natural fertilization can occur. If healthy embryos develop, between one and three then are transferred back into the womans uterus through the cervix.
- Gamete intrafallopian transfer (GIFT): In this procedure, the gametes (sperm and eggs) are mixed together in this procedure, and then placed into the womans fallopian tubes using a fiber-optic laparoscope. This procedure is done through small incisions made in the womans abdomen. GIFT has a higher success rate than IVF, but can only be used if the woman has normal fallopian tubes and the man has adequate sperm. (Some women prefer this method because it does not involve the use of fertilized eggs, thereby avoiding ethical concerns associated with embryo creation, transfer, and storage.)
- Zygote intrafallopian transfer (ZIFT): In this procedure, a laparoscope is used to place fertilized eggs (zygotes) directly into the womans fallopian tube. This procedure is also done through small incisions in the womans abdomen. ZIFT has a higher success rate than GIFT because the egg has already been fertilized. This procedure can only be used if the woman has normal fallopian tubes.
- Intracytoplasmic Sperm Injection (ICSI): In this procedure, once the eggs and sperm have been collected, the surgeon uses a powerful microscope to fertilize each egg with a single sperm. The fertilized egg is then transferred to the womans uterus, as is done during IVF. This procedure can improve conception, but is more expensive than other types of ARTs.
While various techniques can be used for sperm retrieval (see below), the egg-retrieval procedure is fairly consistent. Before the egg retrieval, a woman is typically given follicle stimulating hormones (FSH) to prompt her eggs to mature. Once the eggs are ready for retrieval, they are removed with a hollow needle (guided via ultrasound) and then sent to the lab to be fertilized or frozen for future use.
Sperm Retrieval Techniques
The sperm-extraction process is also integral to ART, and methods vary depending on the mans fertility. The decision about which sperm retrieval technique to use is typically based both on the ability of the surgeon to retrieve sperm and the needs of the couple (i.e., Will sperm be needed for one fertilization attempt or multiple ones, and will they need to be frozen for later use?). The different procedures for sperm retrieval after a vasectomy include:
- Microsurgical Epididymal Sperm Aspiration (MESA): In this procedure, the surgeon makes an incision into the scrotum to identify the epididymal tubules, which typically contain fluid with a high sperm concentration. The sperm are aspirated with a small needle, then either used immediately for ICSI or frozen for use in later ICSI attempts.
- Percutaneous Epididymal Sperm Aspiration (PESA): In PESA, a small needle is passed through the scrotum into the epididymis to aspirate sperm. This is the least painful and invasive technique for sperm retrieval, but it typically results in the collection of only a small number of sperm. In some cases, no sperm may be retrieved.
- Testicular Sperm Extraction (TeSE): In TeSE, the surgeon makes a small incision in the skin of the scrotum to explore the testicle. Small pieces of tissue from the testicle are removed and the sperm is extracted from that tissue.
- Testicular Sperm Aspiration (TeSA): In this procedure, a needled is passed through the scrotal skin into the testicle. Using suction, small pieces of testicular tissue are removed, then sperm is ten retrieved from the tissue. Because TeSA only collects a small amount of tissue, the amount of sperm collected is small and is typically used for only one cycle of ICSI.
- Testis Perc-Biopsy: This procedure uses a larger gauge needle to remove sperm from the testicles. The process is similar to that of TeSA, but allows for the collection of a greater amount of sperm.
- Sperm donation: This is only an option for men who have not had a vasectomy, or men who have had a successful reversal that yields plenty of motile sperm but whose partners are still having trouble conceiving.
Success Rates and Costs for ARTs
According to the CDC, 37 percent of all ARTs led to pregnancy and 30 percent resulted in a live birth in 2009. The costs of these procedures vary depending on the method used, but the cost for one cycle of ART averages $12,500. Remember, that it may take several cycles to conceive. While the costs are quite high, some health insurance plans cover the procedure or certain related expenses.
If you are comparing success rates between vasectomy reversal and IVF, you will find that success rates for reversals are a bit higher, ranging between 40 and 75 percent. (It should be noted that the most successful reversals are those performed closer to the original vasectomy procedure.) Cost is also a consideration: Vasectomy reversal involves microsurgery and general anesthesia, both of which significantly increase reversal costs. Most insurance plans will not cover a vasectomy reversal, resulting in out-of-pocket expenses that may range from $5,000 to $13,000 for the patient.
Reviewed December 13, 2012 by Sarah K. Girardi, MD - Urologist
Asch A., & Marmor R. (2008). From birth to death and bench to clinic: The Hastings Center bioethics briefing book for journalists, policymakers, and campaigns. Assisted reproduction. Chpt. 2. (pp 5-10). Garrison, NY: The Hastings Center.
Pisipati S., & Pearcy R. (2010). The role of urological surgery in male infertility. Human Fertility, 13(4), 233-241.