Sperm collection without reversal
While a vasectomy is one of the most effective and safest forms of contraception and is intended to be permanent, there will always be situations when fertility is desired after a vasectomy has taken place. The traditional method of producing a pregnancy after a vasectomy has been vasectomy reversal surgery, where the severed ends of the vas are located and put back together under an operating microscope. Unfortunately, it is a much more involved surgery than the original vasectomy. In addition, while vasectomy reversal success rates can be high when measured in terms of re-obtaining sperm in the ejaculate, those same success rates when measured in terms of actually getting pregnant after vasectomy reversal are much lower.
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My husband had a vasectomy 6 years ago before we were ever together. We want to have a baby together but he does not want to have to go through the pain of reversal due to pain meds ineffective and had to feel everything during vasectomy. Is there a relatively inexpensive way to extract the sperm and not have to reverse the vasectomy? The options for you include not only aspiration and IVF extraction of sperm but a reversal as well with or without aspiration and freezing at the same time in case the reversal is not successful. One of the limitations to aspiration and IVF is that if you are not pregnant within that cycle, you have no chance the next month or the next month or the next month until you do another IVF cycle. The real conversation should always be about what maximizes your chances for pregnancy - with a reversal that is successful, you have a chance through natural means each and every single month - if you want to supplement that with an IVF cycle, that would be just fine. A good option for some, but it might not be the best option for most.
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Sperm harvesting is entirely different from a diagnostic testicular biopsy because, in this setting, the goal is not to identify what is happening in the testis but instead it is to find sperm. Only men with no sperm in their ejaculate azoospermia need to have sperm retrieved directly from the testis or epididymis. This may involve a simple aspiration for men who have a blockage or require much more extensive sampling of the testis for men who have a sperm production problem. As a result, there is a significant difference in the amount of time it takes, the need for anesthesia and the equipment utilized. Very few tests allow for an accurate prediction of whether or not sperm will be found in the testes of men with testicular problems.
Depending on when the vasectomy was performed and the age and health of the couple depend on which option is best. TESE is a procedure performed under local anaesthetic where sperm can be extracted from the testis by passing a fine needle into part of the testis. If there are low amounts of sperm in the testis, mico-TESE can be performed under general anaesthetic using a microscope to take samples and seeks live sperm from the testis.