Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis

Objective: To explore the primary options available to men who desire fertility after a vasectomy. Design: Literature review. Setting: University of Miami Miller School of Medicine. Patient(s): Men with a previous vasectomy now seeking fertility. Intervention(s): The two main options to achieve paternity for men following vasectomy include vasectomy reversal (VR) and surgical sperm retrieval with subsequent in vitro fertilization (IVF). Main Outcome Measure(s): We reviewed and compared the important considerations for men deciding between these 2 options, including: obstructive interval, female partner age, antisperm antibodies, male partner age, female infertility factors, and cost. Result(s): Both VR and IVF represent reasonable options for the couple seeking fertility after vasectomy. Specific circumstances may favor one modality over another, depending on obstructive interval, possible female fertility factors, female partner age, male partner age, and cost. In the absence of insurance coverage, VR is often more cost-effective than IVF. Alternatively, when a female factor may contribute to infertility in addition to vasectomy, IVF is often the better choice. Antisperm antibodies are unlikely to contribute to infertility following a successful VR. Conclusion(s): VR or surgical sperm retrieval with IVF are reasonable options for couples seeking children after vasectomy. Pregnancy rates for both options are overall similar, so prior to pursuing either option, a thorough discussion with a reproductive urologist who possesses microsurgical skills in VR and a reproductive endocrinologist with expertise in IVF is imperative. Making a final choice through shared decision-making while considering these points is ideal.