Vasovasostomy is the surgical intervention intended to reverse a previous vasectomy. Although it began to be performed sporadically at the beginning of the last century, it was not until 1977 that it became popular thanks to Silber’s description of his microsurgical technique.
Factors predictive of vasovasostomy success
Generally, there is a tendency for the pregnancy rate to decrease as the number of years since vasectomy increases. Some authors consider that, especially above the age of fifteen years, there was a significant decrease in the pregnancy rate. Nevertheless, rates of about 40% are described. This is at least similar to pregnancy rates per IVF-ICSI (In Vitro Fertilization and Intracytoplasmic Sperm Injection) cycle.
The best results are obtained in men whose vasectomy was performed a few years before, as they can reach 80% if there is no problem in their partner. The surgeon’s experience and the performance of a careful technique are fundamental in this type of intervention.
Alternatives to vasovasotomy: IVF-ICSI
The development of new Assisted Reproduction techniques allows us today to extract sperm from the testicle from a simple biopsy, and these can be used to perform in vitro fertilization and sperm microinjection. Thus, vasectomized men can have children again.
However, this involves ovarian stimulation treatment in the woman by means of hormonal injections, the performance of a lumbar puncture to extract the follicles, the manipulation of the gametes in the laboratory so that they develop the embryo (the so-called baby-probe) and the transfer of the embryos to the mother. Therefore, it is a procedure that involves both partners, there is a risk of multiple pregnancy and the pregnancy rate per IVF-ICSI cycle is lower overall than that of vasovasostomy.
The cost of an IVF-ICSI cycle, which includes the biopsy and ovarian stimulation, usually exceeds that of the procedure and sometimes several cycles are necessary.
Biopsy and IVF-ICSI would be indicated in the following circumstances:
- Males whose partner is over forty years of age and/or has poor ovarian reserve.
- Men who want only temporary fertility, i.e. once they have a child, they will repeat the vasectomy.
- Due to technical difficulties or failure of a previous vasovasostomy.
Fertility recovery
Although the appearance of sperm in the ejaculate may be immediate, it is generally necessary for at least two months to pass before the sperm count and motility are acceptable. However, sometimes this may take longer than six months.
For more information, consult an Andrology specialist.