Wednesday, August 12, 2015

Vasectomy reversal vs IVF ( PESA-ICSI)


Life is full of the unexpected , and the only constant is change. Some men who opt for a vasectomy after they feel they have completed their family, sometimes have a change of heart and feel that they want to have another child – for example, if they get married again.

 Is it too late for them to change their mind?  It’s possible for some of these men to father children by reversing their vasectomy.  This is called a VVA - vaso-vasostomy and is best done by a microsurgeon. However, this is technically challenging surgery ( unlike the vasectomy) and the success of surgery is dependent on the length of time between the vasectomy and the reversal as well as the amount of damage to the vas deferens, at the time of the original operation. After 10 to 15 years, there is a significant drop in the chances of success. Even if the reversal surgery is technically successful, there is no guarantee of pregnancy, and that is when IVF comes into the picture.

 Factors affecting success of vasectomy reversal

Some couples we treat feel that once the vasectomy is reversed and sperm are found to be present, the procedure is a success. But it’s important to keep in mind that, that is not the only objective of the procedure and that the aim is to achieve pregnancy. It means we have to look at the couple as a whole, and to take the woman’s fertility  into account as well . There are many other factors that can affect pregnancy such as:

The age of the woman
Her egg reserve
The existence of fertility issues like PCOS or endometriosis

These factors have to be taken into account before the reversal procedure is carried out, and in many instances , ART (Assisted Reproductive Treatment) becomes a much better option.   Instead of opting for vasectomy reversal, some couples ( especially where the woman is older)  choose to do IVF with PESA-ICSI (intracytoplasmic sperm injection), because time is at a premium for them.

The PESA-ICSI Procedure

Even after a man has a vasectomy, he continues producing sperm. In ICSI the sperm will be surgically retrieved  from the epididymis.
Intracytoplasmic sperm injection is actually part of any standard In Vitro fertilization treatment. The difference is that in conventional IVF the egg and sperm are allowed  to fertilize in a Petri dish; while in ICSI, a single sperm will be injected into each egg

The Main Considerations

When you’re trying to decide between reversal of vasectomy, IVF and ICSI, these are the aspects you should be taking into consideration:

How long ago was the vasectomy conducted? This can impact your chances of a natural conception after reversal surgery
The costs of the treatment
Are there any female infertility issues?

Also, if the vasectomy reversal fails, then PESA-ICSI remains your only option.

It’s important that you discuss all these aspects, your medical history and specific situation with an IVF specialist in detail, before you make your final decision. The IVF specialist  will assess you and your partner and tell you which option offers the best chance of a successful pregnancy.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!



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