Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS
Microsurgical Vasectomy Reversal
Robert U. Finnerty M.D. FACS

Alternatives to Vasectomy Reversal

ICSIThe primary alternative to surgery for restoring fertility after vasectomy is an in-vitro technique called IVF with ICSI, combined with sperm aspiration.

IVF with ICSI involves the use of specialized micromanipulation tools and equipment which selects a single sperm in a special needle. The needle is advanced through the outer shell of the egg and the egg membrane – and the sperm is injected into the inner part (cytoplasm) of the egg. The woman must be first have her ovulation stimulated with medications, and have an egg retrieval procedure to obtain several eggs for in vitro fertilization and ICSI.

To obtain the sperm, the man must undergo sperm aspiration. Sperm aspiration is generally performed by one of two means: percutaneous aspiration (PESA or TESA) or open surgical extraction. In percutaneous aspiration, a fine needle is inserted into the testes or the epididymis under local anesthesia.

Open surgical extraction from the testes or epididymis is less common, and is rarely needed in men whose infertility is solely due to vasectomy.

The following charts show the relative costs of vasectomy reversal vs. open epididymal sperm extraction (MESA) and ICSI (intracytoplasmic sperm injection) — the most common and successful alternative to vasectomy reversal. Keep in mind how the costs are calculated: if a reversal costs $5000, and one in two men undergoing vasectomy reversal achieve pregnancy (50% pregnancy rate), the cost per pregnancy will be $10,000. Similarly, if three cycles of ICSI are required on average for pregnancy, at $10,000 a cycle, the cost per pregnancy achieved will be $30,000. Also keep in mind that the surgical costs in this study — estimated at $10,000 — are much higher than Dr. Finnerty’s costs.

As you can see, uncomplicated vasectomy reversal is one-third the cost of aspiration plus ICSI for every pregnancy achieved. But what if you need a more expensive, complicated repair — a vasoepididymostomy?

MESA/ICSI remains nearly twice as expensive in total cost per pregnancy achieved as vasoepididymostomy in such cases. But what if you’ve had a prior reversal which failed, and choose to undergo another surgery?

Even when repeat surgery is required, the costs per pregnancy with reversal are still substantially better than MESA/ICSI.

MESA requires a open surgical procedure to collect sperm from the epididymis, which is substantially more expensive than simpler sperm aspiration techniques such as testicular or epididymal sperm aspiration(TESA). However, even with in-office aspiration procedures, the costs for the aspiration alone are typically between $1500 and $3000 per procedure. But this procedure also collects far fewer sperm than the open procedure –and their fertility is much lower.

Here’s how these compare with vasectomy reversal on total costs per pregnancy achieved:

In the large majority of cases, microsurgical reversal performed by an experienced reversal surgeon will result in better pregnancy rates at lower costs than in-vitro fertilization.

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