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. This difference is owing to a number of issues, such as lower overall sperm counts after the vasectomy reversal, as well as the common finding of men making antibodies against their own sperm once the vasectomy has been performed. These antibodies can attach to the sperm and interfere with its motility or with the ability of the sperm to bind to the egg membrane and initiate fertilization. Because of these issues, some studies indicate that only half of the men who show sperm in the ejaculate after vasectomy reversal surgery will father a child without further medical treatment.
As a result, many couples seek vasectomy reversal alternatives, such as the PESA (Percutaneous Epididymal Sperm Aspiration) procedure.
Near the spot where the seminiferous tubules meet up to form the collecting system, there is a structure called the epididymis. The epididymis is a long, tightly coiled tube where sperm is stored and eventually transported to the vas deferens, which in turn, transports it to the outside world. The tightly coiled epididymis occupies much of the back of the testicle and is usually fairly easy to locate. A urologist can take a small needle and (with some anesthesia, of course) place it into the epididymis and aspirate a few droplets of fluid.
Because the blockage produced by the vasectomy takes place beyond the epididymis, sperm is still being produced in the testicle and stored in the epididymis. These few droplets of sperm will generally contain thousands (even millions) of sperm – enough for several in vitro fertilization procedures. The procedure to obtain sperm is called a percutaneous (through the skin) epididymal sperm aspiration, or PESA for short. It generally takes about 20 minutes to perform and the patient will walk quite normally afterward, with minimal recovery required. PESA is the most commonly performed of the vasectomy reversal alternatives. Sperm can also be obtained directly from the testicle in a similar procedure called TESA (Testicular Epididymal Sperm Aspiration), which is more painful and has a longer recovery time.
While the sperm obtained through these techniques functions well for IVF, it generally has little motility and often lacks the ability to fertilize an egg on its own. For this reason, IVF with direct injection of sperm into the eggs is the method of choice for using sperm from PESA. Pregnancy rates with PESA-obtained sperm are not significantly different from those with normally ejaculated sperm.
Given the advantages of IVF with PESA over vasectomy reversal surgery (no major surgery, retention of contraceptive effectiveness, high pregnancy rates, less time to pregnancy) it is rapidly becoming the more popular method for couples seeking pregnancy after a vasectomy. If you and your partner are considering pregnancy after a vasectomy, talk to your doctor to determine the best treatment option for you.