Some older physicians are still performing
testicular biopsies prior to vasectomy reversal. This is no longer
recommended or necessary.
Myth #2: Vasectomy reversals don't work after 10 years.
Fact: This is a common misconception that I have heard told to patients
by both gynecologists and urologists who don’t perform many
vasectomy reversals. This is based on the old studies of vasectomy
reversals prior to the refinement of the vasoepididymostomy surgery.
Back then, all patients who had a vasectomy reversal underwent a
vasovasostomy even if they had a second blockage in the epididymis.
Obviously a vasovasostomy will fail in that situation. Success rates
for older vasectomies have increased dramatically with the advent
of the refined vasoepididymostomy and new microsurgical techniques.
The latest study to look at success rates of vasectomy reversal
performed 15 years or more after vasectomy (published in Fertility
and Sterility, March 2002) shows that the pregnancy rates for intervals
15-19 years, 20-25 years and greater than 25 years are 49%, 39%,
and 25% respectively. The Los Angeles Times Health Section recently
ran an article on the increased success of vasectomy reversal for
vasectomies more than 15 years old. Dr. Werthman has helped a man
father a child 57 years after his vasectomy, the oldest on record.
Myth #3: Even if sperm are present after a vasectomy reversal,
your wife won't get pregnant because of anti-sperm antibodies.
Fact: Antibodies are small molecules that the body produces to fight
off infections and other substances that the body thinks doesn’t
belong. The antibodies stick to the invader and help destroy it.
What does this have to do with sperm, you might ask? Sperm are made
in the testicle and shielded from the immune system so in the normal
situation the body doesn’t even know they are there. When
a man has a vasectomy, the vasa are cut and the sperm may leak out.
This could allow the body to see sperm for the first time. The body’s
natural reaction is to produce antibodies to try and kill the sperm.
If we measured blood of men who underwent vasectomy then we could
detect antibodies to proteins located on sperm in the blood of 70%
of these men. While this number seems very high it is somewhat meaningless.
The reason is that only antibodies measured on the sperm themselves,
not in the blood (there is no sperm in the blood just sperm proteins)
may play a role in hindering pregnancy. Most patients do not have
antibodies present on their sperm after a vasectomy reversal and
most couples don’t have a problem getting pregnant after vasectomy
reversal because of antibodies. A recent study published in the
medical journal Urology showed that it was actually a partial blockage
of the vas after the reversal that was responsible for poor sperm
quality and not anti-sperm antibodies. When the reversal was fixed,
the patients got pregnant in most cases. So, while antibodies can
cause problems for some patients they are clearly not responsible
for most cases of post-vasectomy reversal infertility.
Myth #4: You shouldn't have a vasectomy reversal if your wife is
over 37.
Fact: While female fertility does start to decline when a women
is in her thirties, many women can still conceive into their forties.
The pregnancy rates for any fertility enhancing procedure are related
to the female partner’s age. While in-vitro fertilization
does give the opportunity for the quickest way to conceive in a
given cycle, the success rates per cycle for women over 37 decrease
dramatically to less than ten percent for women over 41. The pregnancy
rates for women ages 36-40 and greater then 40 years old whose husbands
underwent vasectomy reversal are 32% and 28% respectively. (Fertility
and Sterility, March 2002) The oldest woman to conceive whose husband
we had treated with vasectomy reversal was 47 and the oldest women
to deliver a baby was 44 at the time when the reversal was performed.
Myth #5: In-vitro fertilization is a much better alternative to
vasectomy reversal.
Fact: One problem that a patient is faced with when there are two
reasonably good treatments for the same condition is which one to
choose? Both vasectomy reversal and in-vitro fertilization with
sperm harvesting and intracytoplasmic sperm injection yield good
results. In fact, the overall pregnancy rates for IVF and reversal
(taking in to account all patients and female ages) are almost identical
at 40% for IVF and 43% for reversal.
We believe in giving couples all their options and having them choose
what is best for their own unique situation. We frequently here
from patients who see female fertility specialists that they were
told not to have a reversal because it doesn’t work. This
is plain and simple not true. They are then steered into an IVF
cycle based on false information. While there is nothing wrong with
choosing IVF, it should be because you had the opportunity to evaluate
accurate information and make an informed decision. I have performed
many reversals on men whose wives went through IVF and failed and
would have picked reversal to begin with if they were given the
choice. That is not to say that reversal always works or is better
than IVF, but it is your decision as to what to do, not mine or
any other doctor's.
The pros and cons of vasectomy reversal and IVF are the following:
If a vasectomy reversal is successful then it can lead to natural
conception which for most couples is most desirable, cost effective
and fun! It requires only one procedure be done and then most people
are on their way. Reversal is about one half the price of a single
cycle of IVF when all expenses are added up. A study published several
years ago showed that total costs were three times as expensive
to deliver a child conceived with IVF versus a vasectomy reversal.
The cons of reversal are that it doesn’t always work, some
men don’t want to have a reversal and that it may take a fair
amount of time to conceive after a reversal. The mean time to pregnancy
is about 12 months following a reversal but this is distributed
on a bell shaped curve (Gaussian) so some people will get pregnant
sooner and others later then 12 months.
The Pros of IVF are that it offers the quickest way to get pregnant
in a given month but it doesn’t always work, as a matter of
fact most couples will have to go through more than one IVF cycle
to deliver a baby. Remember that pregnancy rates don’t mean
a live baby. IVF is an excellent alternative if a vasectomy reversal
has failed or if there is female factor infertility as well as male
factor problems. Sometimes a vasectomy was performed in a manner
that will make it difficult to reverse. This can sometimes be detected
at the time I examine you which is why the exam prior to surgery
is very important. In this situation I may recommend IVF over reversal
or we may want to harvest sperm to freeze for the future.
The cons of IVF are several fold. IVF is expensive, much more expensive
for the same statistical result as reversal. Many women do not react
well to taking two weeks of fertility injections and the medications
can have side effects ranging from very mild to very severe. Many
couples are hesitant about having a test-tube baby unless it is
the only alternative. The whole process also requires that a man
undergo a procedure to get sperm for IVF although is it not as detailed
as a reversal procedure. Lastly, there is close to a 30% chance
of having multiple births with IVF that can compromise the health
of the babies and complicate the pregnancy in certain circumstances
Myth #6: If you only want one more child then In-vitro is a better
option than vasectomy reversal and than having a vasectomy again.
Fact: Since there is a 30% chance of having twins or triplets with
IVF, vasectomy reversal is usually a better option for couples wanting
only one more child. Couples are often told to have IVF rather than
a reversal and another vasectomy. This is usually very appealing
to the husband but not so for the wife who has to go through the
injections and egg harvesting procedure. The truth is that it is
still way less expensive to have a reversal and a second vasectomy
if needed down the road than IVF. Now with the no-scalpel vasectomy,
vasectomy is a quick and relatively painless 10 -minute office procedure.
Remember that it will take time to conceive and carry the pregnancy
to term so most men won’t need another vasectomy by the time
it is all over.
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