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    Sources and Uses of Banked Sperm During a Vasectomy Reversal in 2023 – Part 2

    This article, by international vasectomy reversal authority, lecturer and author Dr. Sheldon Marks, highlights the three sources of sperm that can be banked during a vas reversal and the 5 options couples have to direct the surgeon about the options for retrieval of bankable sperm (1).

    Sources of sperm.
    There are three sources of sperm that can be frozen and banked at the time of the vasectomy reversal. Again, at ICVR there is no additional charge to bank sperm, and this includes the first year of storage, saving our patients up to many thousands of dollars and added risks for future sperm retrieval. Sometimes we do not find enough volume, counts or motility to bank at the time of the vas reversal. The three sources of sperm are from the vas, the epididymis and the testicle.

    Vas. Fluid that flows from the vas, if bankable, can sometimes be used for IUI and/or IVF, depending on the volume of the fluid, the percent of motile sperm and sperm counts (measured as concentration).

    Epididymal window. If we have to perform an epididymal bypass because of deeper epididymal blockage, then if the fluid from the window in the epididymal tubule is bankable (called a MESA or micro-epididymal sperm aspiration), it usually is only good enough for IVF, if at all, because usually we find only a small fluid volume. On very rare occasions we might be able to get IUI quality fluid and volume from a tubule.

    Testicle. If we have to do a micro-biopsy of the testicle, called a TESE (testicular sperm extraction), then the sperm frozen are only usable for IVF. This requires the additional micro-biopsy of the testicle to remove tubules filled with sperm, and because of the added biopsy, with additional but very rare risks to the testicle.

    Patient choices at the time of the vasectomy reversal.

    Prior to the surgery we send patients a review of this information and the various options to consider. Then, the morning of the vas reversal we discuss again and ask each couple to choose one of these five options to guide the surgeon during the vas reversal. Be aware that even if we try, sometimes we cannot find bankable sperm in volume, count or motility. Even when banked, most often the frozen sperm are not needed (2).

    1. Bank sperm, no matter what we find. This directs the doctor to do whatever we can to find and retrieve sperm for banking. This may mean adding on a micro-biopsy of the testicle, with additional exploration and added rare potential risks. If the surgery is a favorable vas-to-vas on both sides then the chances for needing sperm in the future are rare, so most often a biopsy to obtain sperm is not performed. If an epididymal bypass is needed on both sides and IVF is an option, then we can obtain sperm from the testicle for IVF with ICSI, if needed,

    2. Bank IUI quality fluid only. If in-vitro fertilization (IVF) is not an option for personal, financial or religious reasons, then patients can ask us to only bank sperm for IUI.

    3. Bank fluid only with no testicular biopsy. If the fluid is bankable for IUI or IVF, then the sperm will be processed and cryopreserved, and the testicular biopsy will not be performed even if the fluid is not bankable.

    4. Bank sperm using the surgeon’s discretion. The surgeon will bank sperm based on the pre-vas reversal conversation, guidance and preferences before surgery and the findings during the vasectomy reversal. This is the option that many couples choose after talking with the doctor and each other about what each couple will and will not consider.

    5. No banking of sperm. This means that even if the fluid is bankable, the couples requests that no banking is performed for either future IUI or IVF.

    We understand that this is a lot to think about and consider. For any questions about sperm banking or the vasectomy reversal here at ICVR, please call today.

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

    References:
    1.Schrepferman CG, Carson MR, Sparks AE, Sandlow JI. Need for sperm retrieval and cryopreservation at vasectomy reversal. J Urol. 2001; 166:1787–9.
    2.Glazier DB, Marmar JL, Mayer E, Gibbs M, Corson SL. The fate of cryopreserved sperm acquired during vasectomy reversals. J Urol. 1999; 161:463–61.