The goal of a vasectomy reversal is to have sperm return to the ejaculate. While the hope is to help couples conceive naturally (“good old-fashioned sex”), some couples may still require assisted reproductive technology (ART) using inseminations or in vitro fertilization (IVF) just like other couples where the man has not had a vasectomy. Is there a way to help couples predict whether their chances are higher for requiring ART after a successful vasectomy reversal?
Hsiao et al. from Cornell Medical College in New York reported their 2011 study on looking at the correlation of FSH and the need for ART after a successful vasectomy reversal. FSH is Follicle Stimulating Hormone and is a blood test that is a crude indicator of how well a man makes sperm. In general, a normal FSH roughly correlates with normal sperm production and a higher FSH correlates with poorer sperm production. (Please note: FSH is not a perfect test and should not be used in isolation. Seek the counsel of your male infertility specialist so they can look at all of your male fertility factors!).
They looked at 206 men who underwent a vasectomy reversal on average of 11-13 years after their vasectomy. The men were divided them up into two groups: 155 men with a normal FSH (average of 5.1 U/l) and 51 men with a high FSH (average 16.2 U/l). They found that the high FSH group used inseminations or IVF more frequently than men with normal FSH (78% vs 55%). It is important to see that couples may choose to use ART (inseminations or IVF) even if they choose to do a vasectomy reversal. Of the couples that they were able to follow, 47.8% got pregnant naturally or by using inseminations (using sperm in the ejaculate after a successful vasectomy reversal) and 40.7% got pregnant with IVF.
Bottomline: Every couple where the man has had a vasectomy must choose the reproductive option that best resonates with their reproductive needs and timetable. Some couples want to try natural conception first and choose to have a vasectomy reversal. Others are very comfortable with artificial conception or may not have the reproductive time to try naturally (advanced female age) and then choose IVF. What is important to realize is that it is NOT a binary decision. It is not just vasectomy reversal OR assisted reproduction like IVF. Some couples have a vasectomy reversal because they want a chance to conceive naturally, but talk to your partner. You may create a hybrid plan where you try to conceive naturally for a certain time period…6, 9 or 12 months…some number you both can agree on and at that time, if you haven’t gotten pregnant, then agree together to pursue inseminations or IVF. Just because you choose IVF or inseminations, doesn’t mean you will not conceive naturally for later kids. My point is that there are many options (vasectomy reversal, inseminations, and IVF). These options can be used in various combinations and various orders to help you build a family. Consult with your male fertility specialist to help you design the best reproductive plan for you and your partner (ideally, someone who does more than just vasectomy reversals, so that you can empower yourself with education about all your options).
<u>Please note: </u>Inseminations (where the sperm are washed and placed inside the woman’s uterus at the time of ovulation) can only be used if the vasectomy reversal is successful and there are enough sperm in the ejaculate! I realize all this stuff is overwhelming and confusing so take the time to visit with a male fertility specialist. It will help to sit down with him or her and hash out all these details.
Reference: Hsiao et al. 2011 Journal of Urology 185: 2266