How is IVF (In-Vitro Fertilization) Different in 2023 from a Vasectomy Reversal?

Whether to have IVF (in-vitro fertilization) or a vasectomy reversal is a common question among couples that are wondering what the smartest way is to have children together after he’s had a vasectomy. Like all choices, there are pros and cons to each.

This page, compiled by vasectomy reversal authority and expert, Sheldon Marks, MD, will highlight some of the more important aspects of each option to help couples when talking with their own personal doctors, so that they can make an informed, shared decision that fits with their personal needs, resources and wishes (1).

First of all, let’s look at the purpose and goal of IVF versus a vasectomy reversal. IVF is designed to give a couple a baby, whereas a vasectomy reversal’s purpose is to restore the flow of sperm after a vasectomy and give a couple the chance to make a baby together naturally, with all the important hurdles and filters in place.

IVF is designed to override and bypass any of the man’s or woman’s problems and so the doctors then create an embryo outside the body using his sperm and her eggs with hormones to prepare the woman’s body to be able to carry the embryo through full term to deliver a baby. This is truly a modern miracle for so many couples that otherwise could never have had a child of their own. The success of IVF depends on many factors, especially the woman’s age and health and the skill and expertise of the reproductive endocrinologist and the embryologist.

To do this after a vasectomy, sperm must be retrieved by a urologist from the testicle either by removing sperm from the epididymis or by extracting tissue containing sperm from the testicle. The eggs are removed from the ovaries after a cycle of hormones designed to stimulate multiple eggs to move to the surface of the ovary. A single sperm is then selected and microscopically injected into each egg, resulting in an embryo. These embryos then start to grow and are then graded and placed up into the uterus, usually one each month, with the hope that they will implant and grow into a baby.

One downside to IVF is that there are added rare risks and costs to the man to have sperm retrieved as well as rare though potentially serious risks to the mother and offspring from the hormone stimulation, egg retrieval and though this is still being debated, concerns over the genetic health and well-being of the children (2). There are also added risks to the mother and babies for multiple births, such as twins, triplets and more.

A vasectomy reversal, unlike IVF, is a restorative, reconstructive procedure to simply reconnect the damaged ends of the vas microsurgically in 3 to 4 layers to allow for the sperm to once again flow through the vas and out of the body. This then allows for natural conception, the way we were all designed, so there are no added risks to the mother or babies and no added risks for genetic or birth issues.

The cons to a vasectomy reversal are that, like IVF, the success depends on the skill and expertise of the urologic microsurgeon that is chosen as well as the technique needed based on how the man’s body responded to the years of blockage. Though all doctors will have success, the highest level of success, up to 99.5%, will be with that small number of senior, experienced urologists that perform many reversals a year (3). The other issue is that there is a small percent of couples that may not conceive naturally because of some other male or female factors or scarring at the reversal site and so require assisted reproductive techniques to have a child.

Each couple should consider what is important and choose which path is best for them to become a parent after vasectomy.

Our staff of fertility professionals is available to answer questions or discuss a vasectomy reversal at our full-time, vas reversal only center. We can be reached at (888) 722-2929.

This summary was reviewed, edited and updated by Dr. Sheldon Marks, author of the textbook on vasectomy reversals on JJanuary 1, 2023.

References:

1. Shridharani A, Sandlow JI. Vasectomy reversal versus IVF with sperm retrieval: which is better? Curr Opin Urol 2010; 20:503-9).

2.Kissin DM, Zhang Y, Boulet SL, Fountain C, Bearman P, Schieve L, Yeargin-Allsopp M, Jamieson DJ. Association of assisted reproductive technology (ART) treatment and parental infertility diagnosis with autism in ART-conceived children. Human Reproduction. 2015;30(2):454–465).

3.  Crosnoe LE, Kim ED, Perkins AR, Marks MB, Burrows PJ, Marks SH. Angled vas cutter for vasovasostomy: technique and results. Fertility and Sterility. 2014;101(3):636-639).