Prior to considering a vasectomy reversal (vasovasostomy), you should be evaluated by a practitioner who can discuss both the vasectomy reversal and IVF options and their associated risks, benefits and costs. If the female partner is of advanced age (more than 35 years old) the reduced conception rate, higher chromosome abnormality and miscarriage rate associated with age must also be discussed.

Approximate 60 percent of men develop circulating anti-sperm antibodies after a vasectomy. While controversial, some investigators suggest that the presence of antisperm antibodies may decrease the chance of pregnancy after a reversal. Discuss with your practitioner whether anti-sperm antibody testing is indicated in your case.

After a macrosurgical (no magnification) vasovasostomy, sperm appear in the semen in about 80 percent of men. Thereafter, 20 to 40 percent of their wives become pregnant.

Utilizing a microsurgical (with magnification) vasovasostomy sperm appear in the semen in 85 to 90 percent of men and 50 to 70 percent of their wives become pregnant.

The longer the time from the vasectomy to the reversal, the lower the chances of success. The Vasovasostomy Study Group reported the following:

• If the interval between the vasectomy and reversal was less than three years, 97 percent of men had sperm in their semen and 76 percent obtained a pregnancy.
• If the interval increased to between three and eight years, 88 percent had sperm in their semen and 53 percent obtained a pregnancy.
• If the interval was 9 to 14 years, 79 percent of men undergoing a reversal had sperm in their semen and 44 percent were able to achieve a pregnancy.
• If the reversal occurred 15 years after the vasectomy rates of sperm in the semen were 71 percent with pregnancy rates of 30 percent.

Additionally, it was noted that the quality of sperm in the vas deferens at the time of surgery correlated with overall success rates. If the sperm was of poor quality pregnancy rates were significantly lower.

Occasionally vasectomy reversal fails. A repeat procedure may be offered, but it usually technically more difficult than the first reversal. This is due to the formation of scar tissue. During re-operations particular attention is given to bypassing all scarred portions of the vas deferens.

The option of IVF avoids surgery and allows sperm to be aspirated directly from the vas deferens for use in intracytoplasmic sperm injection. Consultation with your IVF program will allow one to compare pregnancy rates of IVF with ICSI with vasectomy reversal rates.

Reviewed April 17, 2001