Vasectomy and Vasovasostomy - Assisted Reproductive Technologies

Highlights	Surgery	Reversal Surgery
Introduction	Complications	Assisted Reproductive Technologies
Considerations	Unexpected Pregnancy	Resources
Male Contraception	Long-Term Complications	References

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Assisted Reproductive Technologies

Assisted reproductive technologies (ART) are available for men who want to conceive children after a vasectomy. The shorter the period since the vasectomy the better the chances of success: In one study, success rates after ART were highest (34%) when it was performed within 10 years of their vasectomy and lowest (8%) when ART occurred more than 20 years after vasectomy. Of course, the couples would be older as the duration between procedures increased and so pregnancy rates would be lower in any case. However, in the study time elapsed after vasectomy appeared to have an effect independent of the couples' ages. Debate is ongoing about its advantages versus reversal surgeries for men who have had vasectomies and want children.

Intracytoplasmic Sperm Injection (ICSI)

The best ART procedure at this time for men who have had vasectomies or failed reversal surgery is called intracytoplasmic sperm injection (ICSI). In this procedure, sperm are taken from the epididymis or testes using needles or microsurgical techniques.

The procedure itself injects a single sperm into an egg with the aid of powerful microscopic and robotic instruments. The fertilized egg is then implanted in the woman.

Sperm Retrieval for Assisted Reproductive Technologies After Vasectomy

If a reversal surgery is not successful, sperm may be able to be retrieved from the testes or the epididymis for use in assisted reproductive technologies (ART). Various techniques are now available for retrieval. The procedure may be done under local or general anesthesia, using a spring-loaded biopsy device, a thin needle, incisions, or microsurgical techniques. Rigorous trials on the best technique are lacking, although all can be successful. The choice will depend on the experience of the clinic and any underlying problems.

Testicular Fine Needle Aspiration (TFNA). TFNA employs a fine needle to remove sperm. This can be performed with local anesthetic and by surgeons who do not have to be experienced in microsurgeries.

Microsurgical Epididymal Sperm Aspiration (MESA). MESA uses microsurgical techniques to collect sperm that are close to blocked portions of the epididymis. It involves an open incision and may be done under general or spinal anesthesia in a hospital setting, although the patient can often go home the same day. The doctor accesses the epididymis and retrieves sperm with an extremely fine needle-like device. It has the advantage that it can retrieve the largest number of sperm compared to other procedures. However, as with any invasive procedure, it carries some risk of complications, such as bleeding or infection.