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Sperm aspiration

Some couples may wish to consider IVF (in vitro fertilization) treatment as either an alternative to vasectomy reversal or if a previous vasectomy reversal has failed. Most commonly this is considered by men who would have a long time interval between their vasectomy and a reversal operation (over 20 years), where the chance of natural conception is reduced. In couples where the woman also has fertility problems, such as tubal blockage which cannot be corrected, IVF may be the only route to pregnancy.

Vasectomy reversal success rates

Time Elapsed Sperm Present Pregnancy Rate
0-3 years 97% 76%
3-10 years Greater than 90% 50%
10-15 years Greater than 80% 45%
More Than 15 Years 70% 30%

Vasectomy reversal comparison with IVF

IVF can be performed with sperm obtained directly from the testicle or epididymis by needle and syringe under local anaesthetic. IVF is expensive, costing at least £5,000 per treatment cycle and, as less than 1 in 3 treatments results in a pregnancy, several treatments may be needed. There are also occasional medical complications from the drug treatments given to women during treatment. There are, of course, some women with gynaecological problems such as blocked fallopian tubes for whom IVF is the only possible treatment. By comparison, microsurgical vasectomy reversal is a very successful and cost effective treatment, it is the preferred option for most couples.


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IVF (the alternative option)

The sperm used in IVF treatments in these situations are normally obtained by sperm aspiration techniques, that is by using a needle and syringe. The sperm may be obtained from the epididymis (the delicate tubing behind the testicle where the sperm mature), the technique is known as Percutaneous Epididymal Sperm Aspiration (PESA). This is done after a sedative and pain killing injection is given intravenously and local anaesthetic has been injected into the scrotum. A fine needle is then advanced into the epididymis where a small amount of fluid usually rich in sperm is obtained by suction with a syringe. The procedure is done in the IVF department where sperm are viewed with a microscope, counted and then stored by freezing in liquid nitrogen until needed for an IVF treatment. For most men this procedure causes only minimal discomfort and they may go home after resting for an hour.

In some men too few sperm are obtained by the PESA technique, in this instance the needle is then advanced into the body of the testicle to obtain a small piece of the tubing in which sperm are formed (seminiferous tubule). This procedure is known as TESA or testicular sperm aspiration, it again causes only minimal discomfort however to extract the sperm from the small specimen is a difficult technical problem for the laboratory staff, often taking several hours to complete.

Sperm obtained by these sperm aspiration techniques are used in a procedure called ICSI which stands for intracytoplasmic sperm aspiration, where each egg obtained from the woman is injected with a single sperm. More details of ICSI and IVF can be obtained from Hull IVF unit.

Couples who wish to be seen by doctors at the IVF clinic need referral by their GP who has to do a number of blood tests and a cervical smear test on the woman prior to referral.

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