Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis

Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes

“…Despite this cost-effectiveness, it is important to consider all aspects of the couple prior to recommending a vasal reconstruction procedure versus sperm retrieval with IVF/ICSI. Specifically, female factor infertility, female partner age, obstructed interval, cost of care, and insurance coverage should all be considered when determining which option is the best for a particular couple [ 157 ].…”

“…For couples affected by female factor infertility, natural conception may be challenging even if the male partner’s vasectomy reversal is successful. While a vasectomy reversal may still be discussed as a potential option, the couple, reproductive urologist, and reproductive endocrinologist should all participate in shared decision making to create a plan that best aligns with the couple’s overall goals [ 157 ]. For those couples with such significant female factor infertility that both partners would require reconstructive surgery, the choice to proceed with IVF is clear; in other, less severe pathologies, the discussion may be more nuanced [ 45 ].…”

“…However, live birth rates with IVF/ICSI have also been found to drop significantly with maternal age [ 161 , 162 , 163 ]. Given that female age has a negative impact on both natural conception and IVF/ICSI outcomes, there is no definitive age at which one treatment modality must be pursued over the other [ 157 ]. Additional testing (such as ovarian reverse testing) may be helpful in selecting a treatment option when the female partner is at the critical age of 34 to 40 and on the cusp of a precipitous decline in fertility [ 164 ].…”

“…While an obstructive interval (OI) has historically been considered an important prognostic factor in VR success [ 165 ], more recent studies have demonstrated excellent patency, and at least comparable pregnancy rates can be achieved with prolonged (>10–20 year) obstructive intervals [ 157 , 166 , 167 , 168 ]. However, a longer OI has been found to strongly correlate with an increased likelihood of epididymal obstruction and the need for a VE procedure rather than VV [ 167 , 168 ].…”

Erkek İnfertilitesinin Cerrahi Tedavisi

“…Obstruction caused by hernia repair may be correctable, though these repairs are technically challenging. Crossover transseptal procedures (VV or VE) is possible when a normal testis with unreconstructable obstruction is present on one side and an atrophic testis and patent ductal system are present on the contralateral side (42). Vasal obstruction secondary vasectomy can be corrected with microsurgical VV.…”