What are available alternatives to a vasectomy reversal?

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Many patients ask whether or not they should have their physician aspirate (remove) the sperm from the epididymis for in-vitro fertilization (IVF) and skip a vasectomy reversal. Although there are cases when sperm aspiration is necessary, it is not a recommended first step for most couples.

Sperm can be procured directly from the testes, from the epididymis or from the end of the vas, and then used to inject into a partner's oocytes (eggs). However only small quantities of sperm can be harvested this way. Aspirated semen tends to have low numbers of motile sperm and generally commits women to a full cycle of IVF for every attempt at pregnancy. This means that each attempt at fertilization requires that the oocytes (eggs) be removed from the man's partner. This involves a series of injections, ultrasounds and a procedure to remove the eggs. Usually this is done through the vagina under anesthesia. The pregnancy rate for this procedure is very high but it does involve a fair amount of cost and intervention.

There are certain situations where this is clearly the preferred method of producing a pregnancy. A woman who would need IVF in any event (e.g., her tubes are completely blocked) would be a typical example of a patient for whom a sperm retrieval technique would be appropriate. Another example would be an older woman who is at the end of her reproductive life cycle and may not want to wait the four months to a year it may take for the sperm to come through to the ejaculate.

If, however, a woman knows she will not need IVF independently, then a vasectomy reversal is a better first option than sperm retrieval. The man's sperm will generally be of better quality and quantity and she can try to get pregnancy during mass cycles without having additional costs. In most cases a vasectomy reversal is the most natural, least invasive and cost effective method of producing a pregnancy. Before undergoing a vasectomy reversal, the wife should undergo a gynecological evaluation to assure that she has adequate fertility potential.

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