Six of one, half a dozen of the other. Spoiled for choice. How do you decide which path to take to have children after a vasectomy? Do you do a vasectomy reversal or undergo a sperm retrieval and assisted reproduction (IVF-ICSI). Stuck between a pillow and a soft place now becomes a pillow and a laboratory.
About a decade or so back, we and others published on how vasectomy reversal compares to assisted reproduction for baby making after vasectomy. These were studies of cost and cost-effectiveness, decision analysis and Markov modeling. What they showed was that vasectomy reversal is the cheaper way to go, but there were caveats:
- The age of the female partner matters a lot.
- The skill of the vasectomy reversal surgeon matters a lot.
- How old the vasectomy is also matters.
The bottom line back then was that vasectomy reversal is the cheaper option, but not in every case. It’s all in the details.
A Fresh Look
It’s been ten years now and a lot has changed. Certainly, technology has gotten better, but so have surgeons. I’ve been asked to readdress the state of affairs on this question at our upcoming international fertility meeting. With the help of Dr. Mark Sigman, Chief of Urology at The Warren Alpert Medical School at Brown University, we plan to infuse the issue with new data and examine things anew.
What’s really different in the field? Here’s a list that will figure into any new analysis of this age-old question:
- Vasectomy reversal surgeons are better than they’ve ever been. This means more couples have more opportunities to conceive at home.
- Vasectomy reversals cost about the same as they did 10 years ago. Compare this to the cost of a college education.
- IVF-ICSI is about the same as it was at bringing babies home. The rate of live births/IVF cycle start in 2008 was 30% (n=104,673 cycles) and in 2015 it was 33% (n=186,157 cycles).
- The cost of IVF has increased, probably at the same rate as a college education. Hey, technology costs money–what’s s’matter you?
I’m not at liberty to give things away before the talk, but you might be getting the idea that fixing broken things can make sense. Oh, and that couples prefer having kids at home whenever possible. What is it that Woody Allen said about sex in Annie Hall? “It’s the most fun I’ve ever had without laughing.”