Just saw a lovely couple the other day where the man had had a vasectomy 7 years ago and wanted to to know if he was a good candidate for vasectomy reversal. Under normal circumstances given his wife's young age, he would have been a great candidate until he mentioned that he had been on testosterone replacement therapy for 5 years by his endocrinologist (a hormone specialist). While testosterone allowed him to function well in his daily life, testosterone therapy confuses the brain who thinks that the testicles are out of control making too much testosterone. As a result, the brain begins to shut down the testicles and sperm production will drop off. To confirm this, we performed a testicular biopsy that revealed only a few sperm. He made it clear that there was no way he could have a vasectomy reversal if it meant not being on testosterone therapy for a long period of time; consequently, he and his wife decided to pursue In Vitro Fertilization. To do this, we wanted to try and boost his sperm production for several months before going into his testicle to retrieve sperm. He stopped the testosterone therapy and started on Human Chorionic Gonadotropin injections which is a hormone that stimulates the testicles. The HCG injections worked well and after two and a half months of injections, we went back into his testicles and found sperm at near normal concentrations. After retrieving and freezing plenty of sperm, he is happy that he can now go back on his testosterone therapy. They will be starting their IVF cycle in several weeks. Just thought this was a unique and interesting situation that I wanted to share with you all. - Dr. K