Vasectomy Reversal vs In Vitro Fertilization

V asectomy should be seen as a permanent form of contraception. This being said, life does not always turn out the way we predict and a fair number of men will seek to have a reversal of their vasectomy performed.

Before the mid 1970’s vasectomy was considered a permanent form of contraception – a relatively small number of reversals were being performed but the surgical success rate (“Patency Rate”) was less than 20% and subsequent pregnancies (“Pregnancy Rate”) were considered a rare event. The advent of microsurgical techniques changed all of this and today microsurgical vasectomy reversal is successful in more than 90% of patients - even in cases where several years had passed since the vasectomy. (See “Success Rates”)

A vasectomized man wishing to be a biological father again (in other words he does not want to adopt a child), basically has two options:

  • Vasectomy Reversal Surgery
  • Assisted Reproduction Technology (ART)
    (This involves various methods of In Vitro Fertilization (IVF) like Intracytoplasmic Sperm Injection (ICSI))

Experts have still not proven which technique is the “best”: vasectomy reversal or IVF, and they will probably not be able to do so any time soon…

The reason is simple: each couple that wants to have a baby is unique, and has their own dynamics, preferences and fears. There is such a large number of variables, advantages and disadvantages of these procedures to consider and each couple will interpret them differently. That’s what makes us unique.

As a couple, you will have to discuss these options. There is a mass of information available on the internet about vasectomy reversal and ART / IVF.

Here are some of the most important things to consider:

Success Rates


Depending on the area of the world, the success rate of ART is around 35% per cycle.
Depending on the Urologist doing the operation, the patency rate after microsurgical vasectomy reversal is around 90% and the pregnancy rate 50-70%.

Number of children desired


When using ART, every pregnancy will require “starting over” with the fertility treatment cycles and the costs thereof.

Vasectomy reversal is a once off procedure that restores the male reproductive ability – after successful vasectomy reversal there will be no additional intervention or cost if you decide to have more than 1 child.

Risks of twins/triplets


Women who undergo ART have more or less a 10-fold increase in the chance of having twins and a 100-fold increase in the chance of having triplets. Twins or triplets are more commonly born prematurely and are at higher risk to have low birth weights.

Pregnancy after vasectomy reversal is achieved by the “natural” methods and there is no increased risk of twins or triplets or any birth defects.

Costs


It is very difficult to make a direct comparison between the cost of vasectomy reversal vs ART.

The cost of vasectomy reversal is once off, whereas you will pay for every new cycle of ART. When performing ART there is not only the cost of all the procedures being performed on the female partner, but the male partner will also need to undergo harvesting of sperm from the testicle, which will result in an additional fee.

Studies consistently show that, when all variables are taken into consideration, vasectomy reversal is the most cost effective option.

Physical & Psychological Effects


ART usually involves placing of a long needle into the ovary of the female partner to extract the eggs, after she had taken hormone medication to increase the production of eggs. For each of the IVF cycles there is about a 35% chance of success only and most women need multiple cycles. There is also a significant amount of distress involved when expectations of success are not realized and the whole process needs to be repeated. For IVF, sperm also needs to be harvested from the male partner - this involves a small surgical procedure where the sperms are taken directly from the testicle with a needle or surgical blade.

During vasectomy reversal it is only the male partner who is subject to physical discomfort in the form of an operation and anaesthetic.

Your personal/work schedule


ART will in most cases include several cycles and each of these will require a few visits to the fertility specialist: consultations, harvesting of eggs, placing the embryos into the uterus and follow-up to see if it had been successful. The male partner will also need to undergo a procedure where sperms are harvested from his testicles.

For a vasectomy reversal, most male patients will only have to see me 3 times:

  1. A first consultation before the operation where we can discuss the procedure and questions that you may have
  2. The operation itself
  3. A follow-up appointment 6-8 weeks later to discuss the results of your post-operative semen analysis

The semen analysis will require an additional visit to a pathology laboratory. It is not necessary for the female partner to be present at any of these appointments. She is, however, more than welcome! Most men return to work 3 days after vasectomy reversal surgery.

Summary


My personal opinion is that microsurgical vasectomy reversal is superior to ART in couples that desire pregnancy after vasectomy of the male partner.

  • It has higher success rates
  • Costs less
  • Has more predictable outcomes (twins / triplets)
  • Has less impact on your time and professional life
  • Requires only a single intervention in the male partner, no procedures on the female
  • Good day Dr Zarrabi I hope you are keeping well. It has been 10 months since we did the Varicocele repair and a lot has happened since then and obviously it’s been quite a journey. But needless to say it was not all in vein. Hence my e-mail to you today. If you recall we went back to the Aevitas about August for one last Invitro (6th). The result was that we had a better count and better mobility due to the Varicocele repair as what we ever had before with the previous 5 Invitros. And I am very pleased to announce that E had a successful/positive result and she is 3 and half months pregnant now. We would just like to express our Sincere Gratitude to you and your staff for all your assistance and prayers through the whole process. Kind regards,
    JB, Ermelo
  • We want to thank you and Dr Zarrabi for being kind and gentle…. There is such a huge difference in patient care, follow-ups and bruising between the previous Dr and Dr Zarrabi’s offices. I thank God that we went to your practice and I will let you know if there is a little heart beat inside of me… Lots of Love.
    RL, Rustenburg
  • Good day Dr Zarrabi Trust you well. I just wanted to say thanks very much for your professionalism and great help on my husband’s operation. Today I have a very healthy active 9 month old son thanks to you. At one stage we had just given up because nothing happened but then this miracle came along. Keep up the great work. Thanks and regards,
    KW, Cape Town
  • Dear Dr Zarrabi We have the best, if not surprising news, 'M is PREGNANT!!! She been feeling funny in the latter part of August as I was starting my course of prelox. We are overwhelmed and overjoyed. Thank you, thank you so so much.
    PM, Johannesburg
  • Good morning Gillian I just want to send you this email to say a big thank you for all your assistance in making our trip a success. We are safely back home and everything with M is going great so far. Dr Zarrabi really is the best! I will keep you posted on any further developments. Thank you kindly and have a blessed day.
    NL, Johannesburg
  • Hi Doctor Baby girl YP was born on the 12th of April 2017. You do amazing work and she turns 3 months old tomorrow. See pics attached… Regards
    TN, Johannesburg
  • Dear Dr Zarrabi A and I feel truly blessed to have been able to have this reversal done by Dr Zarrabi. The fact that he is able to even perform an operation of this nature is truly amazing and we are fortunate to have somebody in South Africa that has the skillset to perform Micro surgery reversals. I imagine it must be very rewarding to make such a positive difference in people’s lives. In addition to this we found it to be easy and hassle-free to undergo the surgery in spite of the fact that we live more than 1500 kilometres away. Thank you for the professional, efficient and friendly way that you assisted us throughout this process. I will be sure to let you know as soon as A is pregnant (she may already be). Once again thank you.
    CF, Witbank
  • Good day Dr Zarrabi Thank you so much to You and your Staff. We (my Wife) recently did a blood test; and it came out positive - that she is pregnant. Thank you soo much Dr Zarrabi; thank you for helping us in our journey.
    PF, Johannesburg
  • Thank you so much, doc I truly appreciate all your support and valuable information. I hope your stay in the USA is amazing, you have been the most amazing medical professional i have ever dealt with and I'm extremely grateful that you've helped me all along. Kind regards,
    DK, Cape Town
  • Good day Dr Amir / Gillian and Team I hereby would like to thank you all for the excellent and friendly service we received. Everyone on the doctor’s staff was professional and efficient, they made me feel at ease in a stressful situation. I felt that I made a good choice in coming here and, as a group, each of the staff members cared for me and wanted to help me get better. I was thoroughly impressed with the facilities and services at the hospital. Everyone knew what needed to be done, at what time and did it with a smile and compassion. Any questions that myself or wife had was answered quickly and with a friendly disposition. In closing, I would like to thank you for all that you did even after I was dismissed and had a little complication Dr Zarrabi assisted and was ready to take action. It is professionals as yourself and facilities like your hospital that made me decided to use you from the beginning. Regards,
    JH, Pretoria
  • Dear Dr Zarrabi We are not sure you will remember us, amongst all your clients! D and I came to see you in November 2013 for a vasectomy reversal procedure. You were a little concerned that his vasectomy was 15 years in the past and he was 55 at the time. We visited your practice this month while in Cape Town for the first scan of our expected little one - we wanted to share the good news with you! We did conceive within 3 months of the procedure but had an early miscarriage and what with the ups and downs of life over the last 2 years didn't get this far until now. SO - D is in peak condition and our baby is due on Christmas day this year. Thank you so very much for all the microsurgery and D says please send him 1000 business cards to hand out wherever he goes! We will send you a picture of the three of us for your collection when baby is born. With heartfelt gratitude and deepest thanks.
    SD, Johannesburg
  • Dear Dr Zarrabi We are writing to you to thank you for your amazing care, concern and professionalism. Since meeting you we have has such a wonderful experience working with you. Thank you for everything!! It is greatly appreciated. Wishing you a good evening. With gratitude,
    NC, Johannesburg
  • Hi Amir Hope all's well on your side. I am pleased to announce that L is pregnant - exactly 1 year to the day of the reversal! We had it confirmed with a blood test today. We just thank you for your skill and optimism. Just interested to know... Have we set a new record for length of time between vasectomy and reversal: 18 years ;-) thanks again to you and your team. Cheers D.
    DO, Port Elizabeth
  • Liewe Dr Zarrabi Ons wil u net graag in kennis stel dat die prosedure wat u gedoen het suksesvol was. Ons moes nog gaan vir die sperm analise, maar ons het vroeër uitgevind ons is swanger. Ons is nou 6 weke swanger, en wil u net baie hartlik bedank vir die suksesvolle operasie. Baie Dankie
    GH, Cape Town
  • Hallo Dok, Lyk my jou operasie was ‘n reuse sukses. My vrou is nou 11 weke swanger. Dit het ons dus so 1 jaar en 3 maande geneem om swanger te raak. Groete,
    JD, Pretoria
  • Hi Amir Weereens baie dankie vir jou hulp! Dit was n great ervaring! Baie profesioneel! World Class!! Groete
    JS, Cape Town
  • Dear Dr. Zarrabi, Hope you are well. I just want to say thank you for a fantastic service and care I received. It was nice to chat with you first and it made me feel like I am in the right hands. The staff in the clinic were also great. Warm and kind and understanding. A service that stands out compared to other clinics or hospitals where nobody comes to check on you and you never see anybody around.  
    OF, Hermanus
  • Hallo Dokter Zarrabi Ekt gister met my sussie en swear ‘n koffietjie gedrink en hierdie ‘great’ storie gehoor van hoe u hulle hanteer en versorg het. (eintlik gebless het!) My mond het oopgehang, want mens hoor dit min. Dankie Dokter, ek eer en respekteer jou daarvoor. Alle sukses met jou praktyk en drome vorentoe. Vriendelike groete  
    BB, Johannesburg
  • Hello Dr. Zarrabi, It has been a hectic couple of months. I have great news, M is 11 weeks pregnant and to top it off I didn’t even go for the sperm test. We found out the week that the test was scheduled. Thank you! You have worked miracles we never in our wildest dreams thought that it would happen so soon. We will keep you updated as the pregnancy progresses and might even come introduce the little one next time we are in Cape Town. Regards
    LB, Botswana 
    (Vasectomy 8 years previously)
  • Dear Dr Zarrabi, Many thanks to you and the gift that you have given to me. I really wish that I were in Cape Town to celebrate with you. Thanks once again for your great skill and miraculous hands.  
    PN, Durban
    (Vasectomy 14 years ago, 2 cycles IVF / ICSI unsuccessful)
  • Hi Doc, Just a quick email to share our wonderful news - we are pregnant!!! We can't thank you enough for all you have done, and not giving up when most doctors probably would have just shrugged their shoulders. I know you were a tool in the Great Healer's hands, but nonetheless, a BIG thank you!! Can't wait to send our updated family picture. Have a wonderful, blessed day!  
    MH, Swakopmund
  • Dear all, After much soul searching, S and I decided to reverse his vasectomy and try naturally before resorting to other options. S had his vasectomy reversal done by Dr Amir Zarrabi. We never got to do the 6 month sperm test as I had fallen pregnant. The pregnancy was uneventful and our son was delivered at 39 weeks.  
    GL, Cape Town
    (Vasectomy 13 years ago, 4 cycles IVF / ICSI unsuccessful)
  • Hi Dr, Thank you so much for this report!! I am in tears right now, I did not even realize how much I was stressing about this until I got your e-mail!! You really have made this year the best one ever and we will highly recommend you to anyone we can. Your support and complete handling of our case including your after service has been so amazing! We are both so grateful to you. Kind regards,
    MS, Plettenberg Bay
    (Vasectomy 17 years ago, 3 cycles IUI with donor sperm unsuccessful)
  • Dear Dr Zarrabi This letter is long overdue…but for a very happy reason. My wife and I would like to express our heartfelt appreciation for the efforts you made and the application of your considerable skill in reversing my previous vasectomy done 13 years ago. Before proceeding with the surgery you fully explained what we could expect in terms of a timeline, and we complied with all the steps along the post-surgical way. As per your instruction we were supposed to have a sperm analysis done 3 months after the operation but when my wife missed her date we knew something was going on and I didn’t even have to go for the sperm test. We were ecstatic to learn that the surgery was successful and that I was once again delivering viable “swimmers”! We are now 12 weeks pregnant and all thanks goes to you. Doctor we are so blessed to came across your information on the website just when we were at our lowest. We have been through ICSI twice, as we thought it would have a better chance of success. With even everything as normal and positive as could be both sessions was unsuccessful. It costed us a fortune and we didn’t realize that if we did our homework properly the first time, we could had our baby in our arms right now. That is why we are extremely thankful that you have done such a great job. We never doubted you once…we just knew this was it. Words are a poor conveyance of the gratitude we feel, but please accept them with the knowledge that you have made us very happy as a result of your outstanding skill and diligence. Warmest regards,  
    GH, Cape Town
    (Vasectomy 13 years ago, 2 cycles IVF / ICSI unsuccessful)
  • Hi Doctor Amir, We hope that you and your family had a wonderful Christmas and new year. We have some wonderful news, D is pregnant!! This miracle was conceived naturally!! She is just over five weeks today and we are both over the moon. We would like to thank you again for all that you have done for us to make this miracle happen! We will keep you updated. Kind regards,
    CD, Phalaborwa
    (Vasectomy 10 years previously)
  • Dear Dr Zarrabi, As you can see from the attached pics, our 2015 started off extremely well, all thanks to you... KL was delivered via c-section at 08:31am on Friday the 2nd Jan 2015. Weighing 3.22kg and measuring 51cm. She is gorgeous! I'd like to extend a very big thank you to you and your staff for making our dream come true. A is thrilled to be a big sister. Take care and best regards,
    MD, Namibia
    (Vasectomy 8 years previously)
  • Good day Dr Zarrabi We are happy to announce the birth of our baby girl TH. She was born on the 4th of February 2015 weighing 3.350kg. This was a miracle to us. We would like to thank you for making our dream come true by resulting in a successful vasectomy reversal on my husband G in October 2013. Thank you so much doctor!
    SH, Cape Town
    (Vasectomy 13 years previously)