Many men have had a vasectomy for contraception and then later have gotten remarried and regretted the decision to become surgically sterilized. There are 3 general options for attempts at further child bearing in such a situation.
- Vasectomy Reversal Surgery
- Sperm aspiration from the testicle or vas deferens and then use of the Intracytoplasmic Sperm Injection (ICSI) procedure to fertilize eggs from the female partner and then In Vitro Fertilization (IVF) and Embryo Transfer
Sperm Aspiration from the Epididymis - PESA
Sperm can be aspirated with a needle from the testicle or from the vas deferens (a structure right next to the testicle that also contains sperm). The man is given some drugs to sedate him and some local anesthesia is also used to numb the area. Then a small needle is inserted and sperm is aspirated from the epididymis. There should be no severe pain. The procedure generally takes about 30 minutes.
The different sperm aspiration and extraction procedures have long names and also short names (acronyms):
PESA - Percutaneous Epididymal Sperm Aspiration (can be done in the office)
TESA - Testicular Sperm Aspiration (can be done in the office)
TESE - Testicular Sperm Extraction (involves a small incision and snipping off some tissue from inside the testicle - often done in a hospital or free-standing surgicenter)
With a PESA there will usually be thousands to millions of sperm retrieved. Unfortunately, there is not enough sperm obtained to get any reasonable success rate from Intrauterine Insemination (IUI) of the female partner.
- The sperm should be of sufficient quantity and quality to be able to fertilize the female partners eggs in the laboratory using a procedure that injects each egg with a single sperm. This process is called Intracytoplasmic Sperm Injection (ICSI).
- After fertilization has been accomplished, In Vitro Fertilization (IVF) culture techniques are used to culture the resulting fertilized eggs for 3 to 5 days before Embryo Transfer is performed to the female's uterus.
- Because multiple eggs are needed to have a good chance for success, the woman must go through ovarian stimulation and then an egg retrieval procedure.
The sperm can be used fresh if it is obtained on the same day that the eggs are obtained from the woman, or it can be frozen and then thawed and used later. Usually enough sperm is aspirated so that it can be split up into several vials and multiple attempts of IVF can be performed, if that is necessary.
The success rate will depend very much on the IVF live birth success rates of the particular in vitro fertilization laboratory. IVF success rates are also dependent on the age of the female partner - even in these "male factor" cases after vasectomies.
We would generally expect the success rates to be about the same as (or somewhat higher) the rates for other couples with a female partner of the same age going through IVF.
The female partner's ovarian reserve, which is best measured by the antral follicle count is a good predictor of the chances for successful IVF outcome.