Alternatives to vasectomy reversal surgery

The alternative to vasectomy reversal is sperm aspiration from the epididymis or testes, and using this sperm in InVitro Fertilization (IVF) with IntraCytoplasmic Sperm Injection (ICSI).

Usually, sperm production continues in the testes even after vasectomy. This sperm can be harvested from the epididymis by a procedure called Percutaneous Epididymal Sperm Aspiration (PESA). A small needle is introduced into the epididymis through the skin of the scrotum, and fluid is aspirated. This fluid should contain sperms which can be used in IVF (InVitro Fertilization) or ICSI (IntraCytoplasmic Sperm Injection).

The other alternative is to remove sperms directly from the testes. This is called Testicular Sperm Extraction (TESE). Here, a small piece of tissue is removed from the testes using a biopsy needle. Sperms are extracted from this tissue and used in IVF.

In both PESA and TESE the quantity of sperms obtained is low, and the mobility is poor. These sperms therefore can not be used in artificial insemination, and the more complex and expensive technique of IVF with ICSI is required.

Invitro fertilization (IVF) with ICSI

The female partner is treated with a hormone known as FSH (Follicle Stimulating Hormone) to stimulate the growth and release of multiple eggs in her ovaries. These eggs are retrieved vaginally using an ultrasound probe to guide a needle into the ovaries. The PESA (Percutaneous Epididymal Sperm Aspiration) or TESE (Testicular Sperm Extraction) is done on the male partner on the same day.

Invitro fertilization (IVF) is the union of the sperm with the egg ouside the woman's body (in the lab). Since the quality of the sperms obtained through PESA and TESE are low, usually IntraCytoplasmic Sperm Injection (ICSI) is also done. ICSI involves puncturing the egg under a microscope and injecting one sperm into it. After 3-6 days, typically 3-4 embryos are transferred into the uterus of the woman through the cervix.

Vasectomy reversal versus IVF

In most cases, vasectomy reversal is the preferred first option for most couples. The sperms are of better quality and quantity and pregnancy may be achieved in multiple cycles without additional cost.

In certain situations, IVF with ICSI is preferred. An older woman may not want to wait the four months to an year it takes for sperms to appear in the semen after a vasectomy reversal. A woman with blocked fallopian tubes is also a good candidate to choose IVF. In all cases, the female partner should undergo a gynaecological examination to determine her fertility potential before the male partner has vasectomy reversal surgery.

In case of men married to younger women with no known fertility problems, if there are no sperms in the semen 4-12 months after a vasectomy reversal, or if the number of sperms are low, then IVF maybe suggested as an alternative.

Artificial insemination using donor sperm

Here, the husband or the male partner will not be the genetic father of the baby. Donor sperm obtained from a sperm bank is placed within the female reproductive tract to achieve pregnancy.

Glossary of terms used in this page:

Artificial Insemination: Artificial insemination is the injection of seminal fluid into the vagina or cervix or uterus by means other than sexual intercourse.

Epididymis: Epididymis is a tube-like structure which connects the testis and the vas deferens. The sperms are stored and matured in the epididymis.

Fallopian tubes: The fallopian tube is a tube extending from the uterus to the ovary. The union between sperm and egg takes place here.

FSH (Follicle Stimulating Hormone): Follicle Stimulating Hormone. FSH is a hormone produced by the pituitary gland. It stimulates the testes to produce sperms in the male, and stimulates the ovaries to produce eggs in the female.

IVF (InVitro Fertilization): IVF is a treatment for infertility. Here the egg and sperms are incubated in a dish outside the body of the woman. After fertilization occurs, the embryos are transferred into the uterus of the woman.

ICSI (IntraCytoplasmic Sperm Injection): ICSI is a type of invitro fertilization. Here a single sperm is injected directly into the egg in the laboratory, and later the embryo is transfered to the uterus of the woman.

Ovaries: Ovaries are the female gonads. The cells of the ovaries produce eggs and the female hormones, estrogen and progesterone.

PESA (Percutaneous Epididymal Sperm Aspiration): TESE is a procedure in which a small needle is introduced into the epididymis through the skin of the scrotum, and fluid is aspirated. This fluid should contain sperms which can be used in IVF (InVitro Fertilization) or ICSI (IntraCytoplasmic Sperm Injection).

Sperms: Sperms are male reproductive cells. They are produced in the testes. They are carried in fluid called semen. Sperms are capable of fertilising an egg cell to form a zygote.

Testes: Testes (singular=testis) are the male gonads. They are situated in the scrotum. They produce sperms and the male hormone, testosterone.

TESE (Testicular Sperm Extraction): In this procedure, a small piece of tissue is removed from the testes using a biopsy needle. Sperms are extracted from this tissue and used in IVF (InVitro Fertilization).

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