Microsurgical Reconstruction

Microsurgical reconstruction of the male reproductive tract is often a successful treatment when an obstruction exists and is performed to reverse a vasectomy. After vasectomy reversal, sperm return to the semen in about 70 to 95% of men and pregnancy without assisted reproductive technology occurs in 30-75% of couples.

The chance for pregnancy following reconstructive surgery depends on many factors, most importantly the age and fertility status of the female partner and the number of years between the vasectomy and its reversal. The longer you wait to reverse a vasectomy, the less the chances are for successful reversal. Still, there is no absolute number of years beyond which a reversal is not an option for consideration. Contrary to what is commonly believed, the chance for success with a vasectomy reversal does not suddenly decline after ten years or after any other specific number of years. Microsurgical reconstruction is a two to four hour operation and can be performed as an ambulatory procedure. Identifying and treating reversible conditions may improve the male partner's fertility and allow for conception through natural intercourse. Many complex factors go into the decision to use microsurgical reconstruction of the male reproductive system versus sperm retrieval with ICSI. Microsurgical reconstruction of the male reproductive system often is more cost effective than sperm retrieval with IVF/ICSI. Microsurgical reconstruction allows couples to have subsequent children without additional medical treatment. On the other hand, there are situations in which sperm retrieval with IVF/ICSI is a better choice. For example, couples in whom there is more male and female factor infertility are usually better treated by sperm retrieval and ICSI. The fertility status of the female partner is another important consideration. For example, the woman's age is important. Although individuals vary greatly, a woman's fertility begins to decline after the age of about 35. This means that the chance for success with both microsurgical reconstruction and sperm retrieval with ICSI decreases with increasing female partner age, especially beyond age 37.

It is important to understand that after a successful microsurgical vasectomy reversal, the average interval until pregnancy is about one year while a successful ICSI cycle pregnancy occurs within one to two months of starting hormonal therapy. The choice of either sperm retrieval with IVF/ICSI or microsurgical reconstruction should also be influenced by the pregnancy rates achieved with ICSI by the IVF laboratory with which you are working in the local community.