Vasectomy; Vasectomy Reversal; ICSI
A couple seeking to have a child after the male has had a vasectomy has two excellent options available to them. The traditional approach has been to perform a microsurgical vasectomy reversal. This operation may achieve excellent results if it is performed within the first few years following the vasectomy. When many years have passed since the vasectomy, anti-sperm antibodies may develop leading to decreased success. Another disadvantage of vasectomy reversal is that achieving pregnancy may take 1-2 years because resumption of normal sperm production takes several months once the reversal procedure has been completed. Semen analyses must be repeated during the first year after the procedure to determine if normal sperm production is achieved. In some situations apparently normal sperm production and ejaculation occur, but pregnancy does not, leading to concerns about the fertilizing potential of the ejaculated sperm. In these instances anti-sperm antibodies may play a role, but a complete evaluation of the couple is indicated to rule out other causes.
Advances in assisted reproductive technologies have led to alternative options for these couples. Sperm may be removed from the epididymous (sperm storage and collection tubules above the testes) or from the testes by direct aspiration and used to achieve fertilization of the egg by direct injection into the egg (intra-cytoplasmic sperm injection or ICSI). This technique does not require large numbers of sperm and achieves excellent results. Success of this technique is dependant on the woman’s age with the best results being achieved with women less than 35 years of age, as is the case with most reproductive technologies. One advantage of this approach is that the time required to achieve pregnancy is relatively short compared to microsurgical vasectomy reversal. Sperm may be removed on the same day as the woman’s eggs or at an earlier time if desired, and frozen until they are used for direct injection into the eggs. Another advantage of this technique is that it is unlikely to be adversely affected by the presence of anti-sperm antibodies since a single sperm is directly injected into the egg.