Is Vasectomy Reversal The Answer for Infertility?
When couples come to see me for infertility, it is not unusual that one of the contributing factors of them not becoming pregnant is the partner has had a vasectomy. This leads to the vasectomy reversal discussion.
The vasectomy question has different variations on the answer. Most couples ask something along the lines of ‘surely we can just have a vasectomy reversal, then we can go and have normal intercourse and fall pregnant’ and yes, in some cases that is true.
If the vasectomy was less than five years, the best method is to go and have a vasectomy reversal. One piece of advice, you need to see a fully qualified urologist. There are some clinics marketing cheap and effective reversals, but in most cases, the results are not nearly as good. A qualified urologist will give you the results you need.
After five years, it becomes statistically less likely to be successful in reversing a vasectomy. Why is this? Well, it’s all to do with this thing called Anti-sperm antibodies.
What’s an antibody?
You would best know this as your body’s defence when you have the flu or infection. Your body’s defence produces antibodies to immobilise the flu or anything else that is going to lead to infection.
The testes and scrotum are a unique sealed system in the male body. They have no antibody and no immune system because they are unknown to the rest of the body. That is until some form of trauma breaks the barrier and antibodies can get in.
The commonest cause of antibodies is through a vasectomy. During the vasectomy procedure the surgeon takes a small amount of the tube, called the vasa deferens, which leads to the sperm being absorbed by the body instead of ejaculated, so the egg and the sperm cannot get together and cause pregnancy. Once the immune system is exposed to the previously sealed testes and sperm, the body then produces anti-sperm antibodies. With ejaculation, all the antibodies bind to the sperm forming clumps which mean the sperm can’t move or swim freely, making conception unlikely and infertility continues. Even if we get sperm from normal ejaculate, it is unlikely that it will result in pregnancy.
So, what are my other options for becoming pregnant?
My advice for someone greater than 5 years post vasectomy would be to do IVF, with a sperm retrieval procedure. Typically, sperm is recovered by passing a fine needle through the skin of the scrotum, into the testes, and suction is used to pull out some of the tubules containing sperm. They can be successfully injected into eggs to achieve fertilisation using ICSI. We use this procedure frequently, leading to an excellent chance of success.
If you are considering a vasectomy reversal for pregnancy, other factors that may affect your decision are costs (this procedure is not covered by Medicare and can become expensive), possible surgical risks, downtime after surgery and future contraception when your family is complete.
The vasectomy question is well worth discussing with a fertility specialist, as you may find there are other options to meet your needs and which lead to an excellent chance of a successful pregnancy.