Many people choose vasectomy as a means of birth control. But what if you later change your mind? You wouldn’t be alone — about 7.4% of people who get a vasectomy eventually regret it.
The good news is that you can still be fertile with a vasectomy reversal or sperm aspiration. Learn more about these sterilization reversal options to determine the best choice for your situation.
First Steps in Determining Your Fertility
Before you decide which option is best for you, you’ll want to have a fertility assessment. We’ll work in conjunction with your urologist, who will conduct a physical exam or hormonal testing to look for signs of male infertility. They may also ask you questions about your medical history, including things like:
After considering all of this information, your urologist can make the best recommendation for your future fertility options. If your male fertility tests show that you’re unlikely to have a full return of your fertility, your doctor may recommend alternative options.
What is a Vasectomy Reversal?
Whether you’ve had a no-scalpel or a traditional vasectomy, you’ll have two options for your sterilization reversal: vasovasostomy and vasoepididymostomy. Which sterilization reversal you need depends on how your urologist performed your original vasectomy procedure.
Either way, your chances of successfully getting your partner pregnant are higher if your vasectomy is more recent. Here’s a look at your chances of having a child through vasectomy reversal based on the time since your initial vasectomy:
Most patients end up having a vasovasostomy. In this procedure, the two severed ends of the vas deferens are stitched back together. The vas deferens is the duct that carries sperm from the testicles to the urethra, so by reconnecting it, you can ejaculate sperm again.
Getting a vasovasostomy is best for patients who’ve had a vasectomy within the last ten years. That’s because, as time passes, the opening of the vas deferens can begin to close up and fill with scar tissue, making it hard to reconnect and restore function.
Sperm motility plays a role in whether or not this is the right procedure for you. Before your procedure, doctors will examine sperm from the testicular end of your vas deferens.
Sperm can be ranked on a scale from Grade 1 to 5, where Grade 1 is mainly normal, motile sperm, and Grade 5 shows no sperm. Generally, doctors will only perform a vasovasostomy if you have sperm between Grades 1 to 3 (sperm with tails that can move around).
A vasoepididymostomy is a little different from a vasovasostomy. It’s slightly more complicated, as instead of just reattaching the severed halves of the vas deferens, your doctor will connect the abdominal half of the vas deferens directly into the epididymis, which is the duct right behind the testes that move sperm.
This procedure is tougher because it involves cutting an opening into the epididymis — one that is much smaller than the original opening of the vas deferens. Because of that, it’s more of a specialty procedure.
Typically, a vasoepididymostomy is chosen in cases where there aren’t healthy sperm coming out of the testicular end of the vas deferens — in other words, if you have sperm Grades 4 to 5. It might also be the best choice if your original vasectomy was more than ten years ago, as the openings of the vas deferens may have sealed shut too much to reattach successfully.
What is Sperm Aspiration or Extraction?
If a vasectomy reversal is not an option for you because of too much damage to the vas deferens, or if you’d like to keep your vasectomy but just want to have one more child, then sperm aspiration or extraction (TESE) could be the right choice for you. In a non-invasive aspiration procedure, your doctor will use a needle to extract sperm directly from your testicles.
If your doctor doesn’t see any sperm from this procedure, they may instead try a more invasive extraction called a TESE or micro-TESE, which involves cutting into the testes to pull out sperm directly.
While both procedures can gather thousands of sperm at once, this won’t be enough to inseminate your partner naturally. That’s because normal ejaculate usually contains tens of millions of sperm — and even then, only very few make it through the vagina and fallopian tubes into the uterus.
Instead, your option will be to pursue in vitro fertilization (IVF). With IVF, sperm and egg are either combined in a dish to facilitate fertilization or through intracytoplasmic sperm injection (ICSI), where a single healthy sperm is isolated and in vitro fertilization injected into a healthy egg using a tiny needle.
With IVF, the fertilized egg (now called an embryo) is transplanted into your partner or surrogate around three to five days after fertilization.
With this procedure, success rates vary depending on your partner’s fertility, but about 48.6% of patients in a study of 40 couples were able to achieve a pregnancy.
Are There Other Fertility Options?
If neither a vasectomy reversal nor sperm aspiration is valid options for you, that doesn’t destroy your chances of having a child. It’s still possible to conceive using donor sperm. We partner with leading sperm banks, including Seattle Sperm Bank, at ORM Fertility to give you the highest quality options. You can learn more about the donor before selecting, including seeing their genetic results, listening to their audio interview, and checking out their baby photos.
Once you make your donor selection, your reproductive physician can perform either in vitro fertilization or intrauterine insemination (IUI) (when sperm is inserted directly into the vagina) with the goal of achieving a successful pregnancy.
No matter which route you choose, there are options for getting pregnant after a vasectomy. When you work with ORM Fertility, we’ll help you with every step, from fertility testing to fertilization. Learn more about our comprehensive fertility treatment today, or contact us with your questions.