Vasectomy Reversal vs. IVF (In-Vitro Fertilization + ICSI) in 2023

This article, by internationally recognized vasectomy reversal authority, surgeon and author Sheldon Marks MD, highlights why every study that looks at this question recommends a vas reversal as the most logical, common sense first step approach to fathering children after vasectomy for most couples. The following pros, concerns and risks about IVF were taken from peer-reviewed, published literature and a course on complications of IVF taught by a leading international IVF and female fertility expert.

Dr. Marks was honored to debate this topic of “IVF vs. vasectomy reversals” using published literature and expert opinion at an international meeting of the world’s top reversal and IVF doctors at a 2016 scientific meeting of the American Society for Reproductive Medicine.

The doctors of ICVR believe it is the doctor’s role to provide accurate, unbiased, up-to-date information so that a couple can make an informed, educated, shared decision that is best for them. Couples considering a vas reversal or IVF are encouraged to use this information as a foundation with their own research to speak with fertility specialists about all options for each patient’s and couples’ specific needs, preferences and circumstances (1).

Here’s 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 still healthy. There is no disease or a genetic problem that needs to be overcome or bypassed with IVF. Instead, there is only a small blockage in the vas preventing the flow of normal sperm traveling from the testicle into the semen.

The goals of a vas reversal and IVF + ICSI with sperm retrieval are different.

The goal of a vasectomy reversal after vasectomy is to restore the man’s fertility to allow for natural conception with all of the male and female filters and systems in place.

The goal of IVF + ICSI (intra-cytoplasmic sperm injection) is to bypass all the barriers with the man and woman and make a child. There is no question that for the right couples, IVF may be the best choice and is truly a modern miracle. We regularly refer couples to a reproductive endocrinologist (REI) to discuss possible IVF when indicated or for an opinion before making a decision.

Here is a brief summary of some of the important pros and cons to each of the options, though these 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 for most couples
High success rates (up to 99.5%) for vas-to-vas connections in experienced hands (2)
Very effective at any interval from vasectomy (3)
Well tolerated, safe procedure with very low risks
Allows for natural conception
No increased risks to the mother or to the offspring
Couples can continue to try every month to have children with no additional costs or risks in the future (4).

Research shows that even a redo vasectomy reversal is still more cost-effective than IVF/ICSI (5,6).

Advantages of IVF/ICSI
It allows most couples to have a child faster, which may be important for older women with reduced fertility
IVF makes sense if there are other female or male fertility factors that might interfere with or prevent natural conception
Allows for genetic testing of the embryos if there are risks, concerns or a need for gender selection

Disadvantages of a Vasectomy Reversal
Results depend on the skill and expertise of the surgeon
Pregnancy can take time for natural conception, the same as with healthy couples that have never had a vasectomy and reversal
If an epididymal bypass is needed, the chances for having sperm in the semen are lower, at 70 to 90% with a more variable return (7)
There are rare risks for complications, though this is often surgeon dependent.

There is also a chance the surgical repair can scar up, though this can usually be reversed in most men with close monitoring of sperm counts and oral anti-inflammatory medications.

Disadvantages of IVF/ICSI
Extremely expensive in the US, and not as cost-effective as a vas reversal, ranging from $12,000 to $30,000 or more for the first cycle, with additional costs for every subsequent cycle. We have seen some couples report paying $50,000 to $200,000 with no child before they came to us for a vas reversal (8).

It can take 1 to 3 (or more) cycles for most couples to have a child
We see many couples for a reversal that go through multiple IVF cycles and still don’t have a child.

There are rare but very serious and potentially life-threatening risks to the mother from:
a. Extreme hormone stimulation, which include strokes, blood clots, loss of a limb and child issues (9).
b. Pelvic infection/abscess or hemorrhage from egg retrieval
c. Obstetric and delivery complications and hemorrhage from being pregnant with twins, triplets or more to include ectopic pregnancies, the need for C-sections with all the associated increased risks (10).
d. Risks to the offspring from the IVF process (11,12,13).

The health risks for the babies are more common with multiple gestation births – twins, triplets or more, which can be very serious with lifelong consequences to include brain injury and cerebral palsy and death (14).

IVF/ICSI also requires an invasive procedure for the man to retrieve sperm to inject into the eggs, with associated rare risks for infection, bleeding and injury of his testicle.

For healthy couples where the only problem is the vasectomy, most top experts agree, why would anybody take the rare but serious and potentially fatal risks to the mother and the offspring when there is a much safer, far less expensive and more natural option?

If the couple is not in a hurry or has a fertility or genetic issues, it only makes sense to choose restoration of the flow of sperm so that couples can conceive the way we were designed, rather than go directly to IVF with unnecessary and potentially dangerous risks, not to mention the significantly higher costs, not only for the treatment but for any complications to mother, the man or the child.

Just because it can be done does not mean it should be done.

Please call us to talk about how a microsurgical vasectomy reversal here at ICVR, a full-time, vas reversal only “Center of Excellence” may be the right answer to restore fertility after vasectomy.

This page was reviewed, edited and updated June 13, 2023, by Sheldon H.F. Marks, MD.

References:
1.Shridharani A, Sandlow JI. Vasectomy reversal versus IVF with sperm retrieval: which is better? Curr Opin Urol 2010;20:503-9.
2.Crosnoe LE, Kim ED, Perkins AR, Marks MB, Burrows PJ, Marks SH. Angled vas cutter for vasovasostomy: technique and results. Fertility and Sterility.2014;101(3):636-639.
3.Mui P, Perkins A, Burrows PJ, Marks SF, Turek PJ. The need for epididymostomy at vasectomy reversal plateaus in older vasectomies: a study of 1229 cases. Andrology 2014;2(1):25-9.
4.Silber SJ, Grotjan HE. Microscopic vasectomy reversal 30 years later: a summary of 4010 cases by the same surgeon. J Androl 2004;25(6):845-859).
5.Donovan JF, Jr, DiBaise M, Sparks AE, Kessler J, Sandlow JI. Comparison of microscopic epididymal sperm aspiration and intracytoplasmic sperm injection/in-vitro fertilization with repeat microscopic reconstruction following vasectomy: is second attempt vas reversal worth the effort. Hum Reprod. 1998;13(2):387–93.
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11.Kissin DM, Zhang Y, Boulet SL, Fountain C, Bearman P, Schieve L, Yeargin-Allsopp M, Jamieson DJ. Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children. Human Reproduction. 2015;30(2):454–465.
12. Pontesilli M, Painter RC, Grooten IJ, van der Post JA, Mol BW, Vrijkotte TG, Repping S, Roseboom TJ. Subfertility and assisted reproduction techniques are associated with poorer cardiometabolic profiles in childhood. Reprod Biomed Online. 2015;30(3):258–267.
13.Scherrer U, Rimoldi SF, Rexhaj E, Stuber T, Duplain H, Garcin S, de Marchi SF, Nicod P, Germond M, Allemann Y, Sartori C. Systemic and pulmonary vascular dysfunction in children conceived by assisted reproductive technologies. Circulation. 2012;125(15):1890–1896.
14.Kulkarni AD, Jamieson DJ, Jones HW, Jr, Kissin DM, Gallo MF, Macaluso M, Adashi EY. Fertility treatments and multiple births in the United States. N Engl J Med. 2013;369(23):2218–2225.