Vasectomy Reversal Alternatives & Redo Reversals

What are the Alternatives to Vasectomy Reversal? When is a Reversal Unsuccessful or Not Practical?

By Martin Bastuba, MD, FACS

For some couples the road to parenthood is a little more complicated. In some cases the vasectomy reversal may be unsuccessful, and in others previous medical procedures may preclude the use of a vasectomy reversal. In either case, there are alternatives that can help you build your family.

What if the Vasectomy Reversal Fails?

A failed vasectomy reversal is when sperm is not found in the ejaculate 12 months past the reversal. One in ten men undergoing vasovasostomies and two out of five men having a vasoepididymostomy¹ (Thomas AJ. 1987. Urologic Clinics of North America) have no healthy sperm after surgery. When a vasectomy reversal fails, often times it can be successfully “redone” or other alternatives can be considered. Dr. Bastuba has successfully “redone” many failed vasectomy reversals. In experienced hands, an additional vasectomy reversal procedure may be more cost effective than IVF and other fertility treatments.

Vasovasostomy Vasoepididymostomy

Vasoepididymostomy is a similar procedure to a vasovasostomy and may be performed if a blocked epididymis has been diagnosed or no sperm is found in the fluid of the exposed vas deferens. The epididymis blockage can develop by scar tissue forming after infection or trauma, which may have been caused by the vasectomy.

During vasoepididymostomy the vas is connected to the tubule of the epididymis, which allows healthy sperm to pass through the unblocked vas deferens. This is one of the most demanding procedures in microsurgery due to its technical difficulty. Many surgeons do not offer this procedure. For Dr. Bastuba a vasoepididymostomy is a routine surgery and performed at no extra cost.

Contact MFS about a Previous Vasectomy Reversal Failure

Sperm Retrieval and In Vitro Fertilization (IVF)

A treatment alternative to a vasectomy reversal is to use sperm retrieval combined with in-vitro fertilization (IVF) to start a family. The woman’s eggs and the man’s sperm are retrieved to be combined in the lab via intracytoplasmic sperm injection (ICSI). Sperm retrieval rates are outstanding at approximately 95%, especially if the male has been involved with prior pregnancies. Pregnancy rates are approximately 50% in fertile females depending on their age. There are several different sperm retrieval techniques including MESA (Microscopic Epididymal Sperm Aspiration), TESE (Testicular Sperm Extraction) and PESA (Percutaneous Epididymal Sperm Aspiration))² (Cancer.gov. 2020).

Sperm retrieval and IVF are typically more expensive options. However, it is safe, effective and achieves results almost immediately. When female fertility factor is a major concern or when expediency is demanded, sperm retrieval combined with in-vitro fertilization is a wonderful alternative. Typical IVF cycle treatment costs range from $8,000 to $18,000.