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Alternatives to Vasectomy Reversals

By Sharon Perkins ; Updated August 14, 2017

Approximately 500,000 vasectomies--male sterilization procedures that block the exit of sperm from the testicles--are performed in the United States each year, the National Institutes of Health reports. One of six men older than 35 has had a vasectomy. Inevitably, some of those men regret having the procedure and want to have children. But vasectomy reversal is expensive, not covered by insurance, and not always successful. There are alternatives to vasectomy reversal, although they also are not guaranteed and aren't covered by insurance.

Percutaneous Epididymal Sperm Aspiration (PESA)

Sperm is still produced normally after a vasectomy, but it isn’t ejaculated out of the body, so pregnancy can’t occur. PESA is used to retrieve sperm that are produced after vasectomy but are unable to be ejaculated because the tube that transports them from the testicle to the urethra, the vas deferens, has been cut or blocked. Sperm are produced in the testes and then travel to the epididymis, a coiled tube that stores sperm before they’re ejaculated. Because men who have had a vasectomy still produce sperm normally, the epididymis usually contains a large number of sperm.

The testicle is numbed with local anesthetic, and the urologist puts a very fine needle through the testicle directly into the epididymis and aspirates a small amount of fluid. Because this is done blindly, without direct visualization, the chance of hitting a blood vessel and causing bruising is higher than with open techniques, says the Center for Male Reproduction (CMRM) and Vasectomy Reversal.

The fluid is checked under the microscope to ascertain whether an adequate number of sperm have been removed. No stitches are necessary; the procedure takes around half an hour. If enough sperm are obtained, some of the aspirate can be frozen for future use. Recovery from sperm aspiration takes just a few days and requires only an ice pack and pain medication for aftercare. Bleeding, severe pain or extensive bruising should be reported to the urologist.

The sperm obtained from PESA and other sperm-removal techniques are not mature and can only be used in conjunction with in vitro fertilization. A single sperm must be injected into each egg removed from the female partner, a procedure known as egg retrieval. Sperm injection into the egg is called ICSI, or intracycloplasmic sperm injection.

Testicular Sperm Extraction (TESE)

TESE is the removal of sperm from the testes, where they’re manufactured. Sperm are removed through a small incision made under local anesthesia or conscious sedation. This allows for direct visualization of the tubules where sperm are produced. Usually enough sperm can be retrieved to freeze for future IVF attempts, if necessary, the James Buchanon Brady Urology Institute says.

Microepididymal Sperm Aspiration (MESA)

MESA is done in the operating room under general anesthesia, or in an office setting under a local anesthesia block and conscious sedation. MESA allows direct visualization of the epididymis through an operating microscope. A small incision is made into the scrotum, the bag of skin that holds the testicle, and the epididymis. Fluid is removed and examined under microscope for live sperm. Excess sperm are removed and frozen for future use. Epididymal sperm freeze and thaw better than sperm removed from the testes, CMRM reports.

Donor Sperm

Donor sperm--sperm obtained either from a sperm bank or from a friend or family member--can be used to achieve pregnancy as an alternative to undergoing sperm aspiration or extraction procedures. The cost for donor sperm is considerably less, and artificial insemination can be done at the time of ovulation without undergoing expensive IVF procedures. The child will not be biologically related to you, unless you use a family member as a sperm donor.

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