MANday: Fertility After a Vasectomy

Vasectomies are the safest, most effective form of birth control for men to date. The procedure is relatively quick and pain free. Furthermore, vasectomies give men the assurance that birth control is under their control and minimizes risks of future pregnancies. Also, most insurance plans cover the cost of a vasectomy.

We counsel all our male patients that a vasectomy is an effective method for permanent birth control. The likelihood of a future pregnancy after a vasectomy and a zero sperm count is 1/3000.

A vasectomy reversal however is a larger surgical procedure and we must consider other important factors when it comes to differences between a vasectomy and vasectomy reversals.

Unlike a vasectomy, a vasectomy reversal is significantly more surgically challenging, requiring skill that only a minority of urologists are willing to perform (Androl, 2016). Male patients might need to travel to other cities that have urological centers of microsurgery. The procedure is best visualized as attaching two shoelaces from end to end with sutures the size of a human hair…technically challenging.

Furthermore, the procedure is costly and typically not covered by insurance. The cost of the reversal is around $9,000-$10,000 on average. Recovery after a vasectomy reversal is usually 5-7 days of “couch rest” with light activity. Many guys need to take one week off work and refrain from intercourse for 5 weeks.

Although Dr. Russel Williams MD has an 85% success rate of returning sperm into the ejaculate, the sperm counts are not always sufficient to obtain a pregnancy. Some vasectomy reversal patients need intrauterine insemination and occasionally in vitro fertilization to conceive. In vitro fertilization is a process where eggs are retrieved and sperm fertilizes the eggs in a laboratory setting prior to transferring the fertilized egg back into the uterus.

The average fertility rate of a non-vasectomy man is ~85%. Eight five percent of men are able to conceive with timed intercourse alone. However, 15% of the male population will have difficulty conceiving after one year of timed intercourse. The fertility rate (able to create a pregnancy through intercourse) after a vasectomy reversal is around 70%. Thirty percent of men with sperm in the ejaculate after a vasectomy reversal will need additional help to conceive. (These above numbers assume no female fertility problems.)

Alternatively, men that want fertility after a vasectomy may elect to undergo a sperm retrieval. A sperm retrieval is a procedure in which Dr. Williams extracts sperm from the epididymis/testicle (tubes) to be used with in vitro fertilization. The sperm retrieval typically costs about $8000 and requires 4-5 days of light recovery.

The main hesitation to using a sperm retrieval for fertility is that the female partner needs to undergo in vitro fertilization. The surgically retrieved sperm is insufficient to obtain reasonable fertilization rates with intrauterine insemination. In vitro fertilization has an average of 65% successful pregnancy rates (live birth) for women under age 35. In our experience, we have found this alternative to not be the method of choice for the man with a vasectomy and a young female with no fertility problems.

The take home point:
Consider a vasectomy as a PERMANENT form of birth control. We discourage the request for a vasectomy in men with plans of future fertility. All options for fertility after a vasectomy using non donor sperm are difficult, expensive and require a surgical procedure.

Patel AP, Smith RP. Vasectomy reversal: a clinical update. Asian J Androl. 2016 May-Jun;18(3):365-71. doi: 10.4103/1008-682X.175091. PMID: 26975488; PMCID: PMC4854082.

Ahmad Tabbara is a board certified Family Nurse Practitioner (FNP-C) and brings a wealth of knowledge to The Y Factor. Ahmad has a bachelor’s degree in biology from the University of Texas at Austin, A bachelor’s degree in nursing from the University of Houston, and a Masters degree in family nursing practice from Texas Woman’s University.

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We offer fertility after a vasectomy treatment in Houston & Tomball.