(Or Why a Vas Reversal is Usually the Most Logical, Common Sense Approach to Fathering Children after Vasectomy for Most Couples)
This review, by Dr. Sheldon Marks, summarizes many of the pros and cons of having a microsurgical vasectomy reversal vs. proceeding with in-vitro fertilization (IVF) with intra-cytoplasmic sperm injection (ICSI).
Recently Dr. Marks was honored to debate this topic at an international meeting of the world’s top fertility, vas reversal and IVF doctors at the ASRM (American Society for Reproductive Medicine) annual conference. The doctors of ICVR believe it is the doctor’s role to provide accurate, up-to-date information so that each couple can make an informed, educated, shared decision about what is right for themselves and their needs.
The bottom line – when thinking about having children after a vasectomy, it’s important to realize that for most, both the man and woman are healthy. For most, there is no disease or a genetic problem that needs to be overcome or bypassed. Instead, there is only a small blockage in the vas preventing the flow of sperm from the testicle into the semen.
The goals of a vas reversal and IVF + ICSI are different. The goal of a vasectomy reversal is to restore the man’s fertility to allow for natural conception with all of the natural filters and systems in place. The goal of IVF + ICSI is to bypass all these barriers with the man and woman and make a child (1). Here is a brief summary of the important pros and cons to each of the options, that include, but are not limited to what’s listed below.
Advantages of Vasectomy Reversal
Significantly less expensive – almost 1/3 to 1/5 the cost of IVF (depends on the state and country)
High success rates (up to 99.5%) in experienced hands
Very effective any number of years from vasectomy
Well tolerated, safe with very low risks (2)
Allows for natural conception
No increased risks to the mother or the offspring
Couples can continue to try to have more children every month at no additional costs or risks in the future
Advantages of IVF/ICSI
It allows you to have a child faster
Makes sense if there are female or male fertility factors that would prevent natural conception
Allows for gender selection and genetic testing of the embryos if there are any issues or concerns
Disadvantages of Vasectomy Reversal
Results and success highly dependent on the skill and expertise of the surgeon
Pregnancy can take time for natural conception, as with healthy couples that have never had a vasectomy and reversal
If you need an epididymal bypass your chances for having sperm in the semen are lower, at 70 to 90% with a more variable return
There is a small chance the repair can scar up over time, though this can usually be reversed with medications (3).
Disadvantages of IVF / ICSI
Extremely expensive, from $12,000 to $35,000 or more for the first cycle, with additional costs for every subsequent cycle. (Some couples report paying $50,000 to $200,000 with no child)
It can take 1 to 3 or more cycles for couples to have a child, with added costs and risks with each additional cycle
Not 100% successful so there are still couples that go through multiple cycles and still don’t have a child
Rare but very serious and potentially life-threatening risks to the mother (4) from:
-extreme hormone stimulation, which include strokes, blood clots, loss of a limb
-pelvic infection/abscess or hemorrhage from egg retrieval
-obstetric and delivery complications and hemorrhage from pregnancy with twins, triplets or more to include ectopic pregnancies and the need for C-sections with all the associated increased risks
Health risks for the babies are more common with multiple pregnancies – twins, triplets or more – which can be very serious with lifelong consequences to include infant death, brain injury and cerebral palsy
IVF/ICSI also requires invasive procedures for the man to retrieve sperm to inject into the eggs, with associated rare risks
For healthy couples where the only problem is the vasectomy, most experts agree that its smarter to choose the much safer, far less expensive and more natural vas reversal vs. IVF with all of it’s serious and potentially fatal risks to the mother and the offspring (5).
Just because it can be done does not mean it should be done.
Contact us: For more information or to set up a no cost consultation, please call or email us to talk about how a vasectomy reversal may be the right answer!
This page was reviewed, updated and edited by Dr. Sheldon H. F. Marks on March 27, 2024.
References:
1. Baker K, Sabenegh E. The Role of Microsurgical Reconstruction in the Era of ICSI. Sandlow, JI. Microsurgery for Fertility Specialists. Microsurgery for Fertility Specialists New York; Springer; 2013.
2. Marks SHF. Vasectomy Reversal: Manual of Vasovasostomy and Vasoepididymostomy. New York; Springer; 2018.
3. Perkins A, Marks MB, Peter Burrows PJ, Marks SF. Anti-Inflammatory Treatment for Asthenozoospermia Following Microsurgical Vasectomy Reversal. Presented at American Society of Andrology 38th Annual Meeting, San Antonio, Texas: April 13-17, 201.
4. Sullivan-Pyke CS, Senapati S, Mainigi MA, Barnhart, KT,. In Vitro Fertilization and Adverse Obstetric and Perinatal Outcomes. Semin Perinatol. 2017 Oct; 41(6): 345–353.
5. Pavlovich CP, Schlegel PN. Fertility options after vasectomy: a cost-effectiveness analysis. Fertil Steril. 1997;67(1):133–41.
