For couples who desire a pregnancy, but the male partner has had a vasectomy, there are two options available: either reverse the vasectomy, or leave the vasectomy but surgically retrieve sperm and use those sperm in an IVF setting to initiate a pregnancy. Which is the better option?
It’s tempting to simply say it depends after all, there are several considerations:
First, the cost: The out of pocket cost is typically less expensive for vasectomy reversal (inclusive of center and or anesthesia fees) when compared to paying for IVF out of pocket. Insurance may not provide coverage for IVF, and, although coverage for vasectomy is almost universal, coverage for vasectomy reversal is uncommon. There is an inherent financial logic for insurance not to cover fertility related services given that pregnancies and more family members represent more cost to those insurance payers. That same logic is consistent with the fact that sterilization procedures such as vasectomy and tubal ligation are typically covered. New Jersey happens to be one of a few IVF coverage mandated states such that IVF is typically covered for businesses with their headquarters in NJ (with some exceptions such as small business or religiously affiliated business).
Another consideration is the goal of conception: Is the couple looking for just one pregnancy? If so, a mechanism by which the male could keep his vasectomy, may make sense. Of course, some couples simply prefer to avoid conception through IVF, whether it is for religious and or spiritual beliefs or simply a lack of comfort with the technology.
Another consideration is the chance of success. With surgical sperm retrieval and IVF, (in the scenario of an otherwise healthy man who has undergone vasectomy after having children) success will depend mainly on the female partner’s fertility, the reproductive endocrinologist (physician who does IVF) and the IVF lab. With reversal, success depends on the skill of the surgeon, the demands of the actual surgery (how difficult, vasovasostomy vs. Vasoepididymostomy) and the fertility of the female partner.
It should come as no surprise therefore that this issue was recently studied and reviewed. Kapadia et al in the June 2018 issue of the journal Fertility an Sterility published a report titled: Reconsidering Vasectomy Reversal Over Assisted Reproduction in Older Couples. The report focused on couples in this situation where the female partner was over thirty-four years of age. The authors looked at the results of 136 men who underwent vasectomy reversal and compared outcomes with age matched controls who underwent IVF. The findings: outcomes were essentially similar.
Finally, there is a hedge your bets approach. I offer my vasectomy reversal patients the option of surgical sperm retrieval with cryopreservation at the same time as reversal. IF the reversal ends up not working out, the patient has a back up option without needing an additional procedure.
Regardless of which decision a couple chooses, the goal is to add a member to their family. With that said, I would be remiss if I did not also include the options of adoption and donor insemination.