Urologists frequently counsel couples about fertility and conception options. These couples often describe circumstances and ask questions that these medical specialists have heard many times.

In many instances, couples are embarking on second marriages and they want to have children together. They return to the doctor's office because the man previously had a vasectomy, and, now that their life circumstances have changed, they are evaluating their options, including a vasectomy reversal (vasovasostomy).

Any medical advice that a medical professional may offer, of course, is based on individual circumstances. But it's important to physicians that each couple has a thorough understanding of all the available options before deciding how to proceed. Once they weigh the options, they will often realize that vasectomy reversal is the best option.

Reversal vs. sperm retrieval.

According to most doctors, the most important question for these couples is, 'With all of the advanced reproductive techniques available today, is a vasectomy reversal necessary?' Couples may reason that if it is relatively easy to retrieve sperm, why should the man go through an operation? And the best usual answer to them is that a vasectomy reversal is the only way to achieve a natural pregnancy.

Any other attempts would require Assisted Reproductive Techniques (ARTs) that are more expensive, pose potentially greater risk to the mother, and have a lower overall success rate: approximately 30 percent, compared to 70 percent for a vasectomy reversal.

Education is important.

The most common problem most couples experience is a lack of understanding about what is involved in assisted reproduction. ARTs refers to methods such as Intrauterine Insemination (IUI), In Vitro Fertilization (IVF) and Intracytoplasmic Sperm Injection (ICSI).

These techniques may offer the best course for some patients. But, in the case of a man with a vasectomy, any form of sperm retrieval would have to be completed with In Vitro Fertilization. While IVF may be the only option for some couples, it is not without its own risks. It requires the wife to have injections for four to six weeks, it results in higher rates of twins and triplets (which is more risky to babies and mother) and it costs $10,000 to $15,000 per attempt.

Informed Decision.

In other words, sperm retrieval alone is a simpler procedure than a vasectomy reversal - and may be an "easier" option for the man. But, in light of all that is involved in achieving pregnancy, the couple should also understand the risks, the costs and the likelihood of success. This "cost-benefit" analysis often leads to the conclusion that a vasectomy reversal is the best option to consider first - and the only way to achieve a natural pregnancy.

When a couple has all this information, physicians agree, they are in a better position to make an informed decision. When they have these facts I feel more comfortable about their choice to pursue or not to pursue a vasectomy reversal.

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