Vasectomy Reversal vs. Assisted Reproduction

"IT IS REMARKABLE HOW OFTEN COUPLES CHOOSE VASECTOMY REVERSAL OVER ASSISTED REPRODUCTION SIMPLY BECAUSE THEY WOULD LIKE TO CONCEIVE AT HOME, RATHER THAN IN A LABORATORY OR DOCTOR'S OFFICE. I GUESS THAT DESIRE IS PART OF BEING HUMAN. - DR. PAUL TUREK

Assisted reproduction uses “test tube baby” technology (also called in vitro fertilization, IVF) for the female partner along with sperm retrieval techniques for the male partner to help them build a family. This technology, including intracytoplasmic sperm injection (ICSI) has been available since 1992 and became available as an alternative to vasectomy reversal soon after. In his consultation visit, Dr Turek offers this option to all couples who desire to build a family and want more children; he can explain it in detail.

Dr. Turek has also done cutting edge research to identify the issues that matter most as couples decide between these two very different approaches to family building. He has studied and published on the cost-effectiveness of these approaches to family building. From this published work, Dr. Turek has learned that vasectomy reversal can be the most cost effective way to build a family if: a) the female partner is reproductively healthy, and 2) the surgeon can achieve good outcomes with the vasectomy reversal. Assuming that insurance does not cover either vasectomy reversal or IVF-ICSI, the choice of which one is better for a couple can be difficult to make. IVF-ICSI is usually twice as expensive as a vasectomy reversal procedure, but not necessarily twice as effective.

FIGURE 5. GRAPH OF HOW IVF-ICSI COMPARES WITH VASECTOMY REVERSAL IN DECISION ANALYSIS MODELING. IF THE SURGEON IS EXCELLENT (ACHIEVING HIGH PATENCY RATES), THEN REVERSAL SURGERY CAN BE BETTER THAN IVF-ICSI IN TERMS OF COST/PREGNANCY. ADAPTED FROM: MENG, GREENE AND TUREK. JUROL 2005, 174:1926-1931.

If the surgeon can achieve high “patency” rates (moving sperm in the ejaculate) after the reversal surgery, however, then vasectomy reversal is always as competitive as IVF-ICSI. When Dr. Turek used computer modeling techniques to see what issues mattered the most in cases of advanced maternal age (defined as a female partner > 38 years old), he found that female reproductive health is far more important than: a) the age of the vasectomy, b) the age of the man, or c) the vasectomy reversal patency rate after procedure. This is why Dr. Turek is very interested in learning about the female partner when seeing candidate couples in The Turek Clinic. Ultimately the decision to pursue either option is a personal one for each couple.

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