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Advanced Fertility Center of Chicago
Infertility and In Vitro Fertilization Specialists
Gurnee & Crystal Lake, Illinois

Many men have had a vasectomy for contraception and then later have gotten remarried and regretted the decision to become surgically sterilized. There are 3 general options for attempts at further child bearing in such a situation.

1. Vasectomy reversal surgery

2. Sperm aspiration from the testicle or vas deferens and then in vitro fertilization using the wife’s eggs

3. Donor sperm insemination of the wife

Vasectomy reversal surgery

Vasectomy reversal surgery is more successful if the period of time since the vasectomy has been less than 10 years. At about 10 years out there is a substantial drop in the subsequent pregnancy rates. Therefore, it is not recommended that vasectomy reversal be done when the intervening time has been 10 years or more.

Vasectomy reversal surgery is usually very expensive and is not covered by insurance. This procedure is done by a Urologist. The total cost to the couple from what we have heard from patients that have undergone the procedure is approximately $10,000 to $15,000 including the surgeon and the hospital fees. The obvious advantage to vasectomy reversal surgery is that if it is successful the couple can conceive further children without medical assistance. Disadvantages include the high cost and the fact that if the surgery is not successful the couple is faced with the other 2 options (above) without having improved their fertility at all.

Sometimes couples have a concern regarding future birth control after vasectomy reversal surgery. For example, if they want only 1 more child - once they are successful there will be a need for further birth control or further surgical sterilization. This issues applies to both vasectomy reversals and tubal reversal surgery for the women.

Sperm aspiration from the vas deferens or testicle

Sperm can be aspirated with a needle from the testicle or from the vas deferens (the tube that carries the sperm from the testicle). The man is given some drugs to sedate him and some local anesthesia is also used to numb the area. Then a small needle is inserted and sperm is aspirated. There should be no severe pain. The procedure generally takes about 30 minutes.

Usually millions of sperm are obtained which are of sufficient quantity and quality to use to fertilize the wife’s eggs in the laboratory using in vitro fertilization - IVF. Unfortunately, there is not enough sperm obtained to make is reasonable to proceed with insemination of the wife. Therefore, the woman will have to go through ovarian stimulation and in vitro fertilization in order to have a chance to get pregnant using this sperm. Usually, a special procedure is performed that involves injection of each individual egg with a single sperm using specialized tools and microscopes. This is called intracytoplasmic sperm injection, or ICSI.

ICSI in progress
ICSI needle in inside egg, sperm is being injected
Holding pipette at the far left holds the egg steady

More images demonstrating ICSI

The sperm can be used fresh if it is obtained on the same day that the eggs are obtained from the woman, or it can be frozen and then thawed and used later. Usually enough sperm is aspirated so that it can be split up into several vials and multiple attempts of IVF can be performed if that will be necessary.

The sperm aspiration procedure is performed by a urologist or a reproductive endocrinologist (infertility specialist).

The cost for the procedure depends on several factors including the surgical fees of the physician, charges for sperm freezing, facility fees and anesthesia fees. If it is performed in a hospital or surgicenter, the costs are generally higher than if it is performed in an office setting. The total cost of a sperm aspiration including freezing will generally be somewhere between $1000 and $5000 - depending on the variables mentioned above.

Donor sperm insemination

This is a fairly simple process in which the couple chooses a donor from a major sperm bank, of which there are several, and the frozen donor sperm is thawed and placed into the uterus at the time of her ovulation. This process is described in more detail on the donor insemination page.

So which option is the best?

For many couples with a relatively young female partner and a relatively shorter time since the vasectomy has been performed, vasectomy reversal surgery is probably the best initial option.

If the female partner is close to 40 years of age, it is my opinion that there should always be some evaluation of the fertility status of the female before proceeding with either reversal surgery or sperm aspiration. This female evaluation would be best done by a Reproductive Endocrinology and Infertility specialist. In this age group, the best option may be sperm aspiration and IVF.

If a vasectomy reversal has been performed and it has not been successful, a second surgery is of low yield and should be avoided. Sperm aspiration and IVF will be the best option in this scenario, unless the couple prefers donor insemination.

Couples should be fully informed of the pros and cons of these approaches prior to making their decision. In many cases it is advisable to consult with both a Reproductive Endocrinologist and an Urologist before making the final decision. Most Urologists are not well versed in discussing the options of IVF since that is not part of their training or professional skills. The reproductive endocrinologist does not perform vasectomy reversals and therefore is not the best expert to discuss the details of that option.