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Vasectomy reversal versus IVF with sperm retrieval: which is better?

Shridharani, Anand; Sandlow, Jay I

doi: 10.1097/MOU.0b013e32833f1b35
Andrology, sexual dysfunction and infertility: Edited by Peter N. Schlegel

Purpose of review: This paper will describe why this review is timely and relevant. Over the past two decades, treatment options for couples with reconstructible obstructive azoospermia have improved tremendously. Advances in assisted reproductive technologies (ART), specifically sperm retrieval techniques for intracytoplasmic sperm injection coupled with in-vitro fertilization, as well as refinements in microsurgical reconstruction have led to improved outcomes and cost-effectiveness. Providing the most up-to-date care based on the most recent data allows for better patient outcomes and satisfaction.

Recent findings: Microsurgical reconstruction of the vas has remained a cost-effective, reliable and effective means of restoring fertility in the majority of men who have previously undergone vasectomy when the reconstruction is performed by an experienced microsurgeon. However, there are specific instances in which sperm retrieval/IVF/ICSI may be a more appropriate treatment modality as ART techniques continue to improve.

Summary: Data comparing surgical reconstruction versus sperm retrieval/ICSI/IVF are neither randomized nor homogenous. Therefore, a comprehensive understanding of the factors that can affect outcomes, overall cost, and the morbidity associated with each treatment modality, respective of the institution providing the treatment, is strongly recommended.

Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Correspondence to Jay I. Sandlow, MD, Vice Chair, Department of Urology, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA Tel: +1 414 805 0805; fax: +1 414 805 0771; e-mail: jsandlow@mcw.edu

© 2010 Lippincott Williams & Wilkins, Inc.