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Research eyes vasectomy impact on sperm production
While family planning clinicians counsel on the permanency of vasectomy, more men are seeking reversals of the sterilization method. In the United States, approximately 500,000 vasectomies are performed each year.1 It is estimated that up to 6% of men who undergo voluntary sterilization eventually will request reversal.2
Research from a small study indicates that men who have had a vasectomy, even if it has been reversed, produce less sperm and have poorer success rates when their partners have fertility treatments.3
"Men should consider having a vasectomy carefully, as it can be very difficult to have a child again, even with reversal or fertility treatment," says Carmel McVicar, PhD, lead author and a research fellow in the department of obstetrics and gynecology at Queen’s University in Belfast, Northern Ireland.
Scientists at Queen’s University decided to examine vasectomized men following two studies indicating a decrease in the pregnancy rate of the partners of men who have had a vasectomy, McVicar reports.4,5 The researchers tested 21 men who had vasectomies and found their sperm count was about three times lower than that of the 39 nonvasectomized fertile men assessed. A further analysis of Sertoli cells, which nourish sperm development in the testis, revealed normal numbers in the vasectomized individuals; however, the amount of spermatids (developing sperm ) were reduced. Success rate after intracytoplasmic sperm injection (ICSI), an assisted reproductive technology procedure for achieving pregnancy, was about 50% lower in the vasectomized men.
Findings from the small study suggest that one long-term outcome of vasectomy may be a significant reduction in sperm production, which could lower the chances of fertility following reversal or assisted reproductive technology (such as ICSI), says Amy Pollack, MD, MPH, president of EngenderHealth in New York City. This study alone, given the small size and design limitations, does not warrant a change in practice, she contends.
Other studies have shown that pregnancy rates decrease as the interval between vasectomy and reversal increases6; reduced sperm production could be a contributing factor, Pollack notes. High levels of antisperm antibodies following reversal also have been shown to negatively affect fertility, she observes.7
Counsel on permanency
A vasectomy reversal involves a surgical procedure that restores the flow of sperm through the vas deferens, the tubular structures that allow sperm to travel from the testicles. It usually is performed by an experienced microsurgeon using specialized instruments, including an operating microscope.8
Vasectomy reversal costs, including the surgeon’s fee, the hospital’s charge for use of the operating room and ambulatory care facility, and the anesthesia fee, can range from approximately $5,000 to $15,000.8
In comparison, ICSI adds about $2,500 to the cost of in vitro fertilization, which can range from $8,000 to $10,000.9 "Men should continue to be counseled that the intention of vasectomy is to provide permanent protection against pregnancy and that there is no guarantee of returned fertility after vasectomy reversal or fertility treatment," states Pollack.
1. National Institute of Child Health and Human Development. Facts About Vasectomy Safety. Bethesda, MD; 1996.
2. Potts JM, Pasqualotto FF, Nelson D, et al. Patient characteristics associated with vasectomy reversal. J Urol 1999; 161:1,835-1,839.
3. McVicar CM, O’Neill DA, McClure N, et al. The effects of obstruction on spermatogenesis. Presented at the annual meeting of the British Fertility Society. Cheltenham, UK; March 2004.
4. Abdelmassih V, Balmaceda JP, Tesarik J, et al. Relationship between time period after vasectomy and the reproductive capacity of sperm obtained by epididymal aspiration. Hum Reprod 2002; 17:736-740.
5. Borges Jr. E, Rossi-Ferragut LM, Pasqualotto FF, et al. Testicular sperm results in elevated miscarriage rates compared to epididymal sperm in azoospermic patients. Sao Paulo Med J 2002; 120:122-126.
6. Fuchs EF, Burt RA. Vasectomy reversal performed 15 years or more after vasectomy: Correlation of pregnancy outcome with partner age and with pregnancy results of in vitro fertilization with intracytoplasmic sperm injection. Fertil Steril 2002; 77:516-519.
7. Meinertz H, Linnet L, Fogh-Andersen P, et al. Anti-sperm antibodies and fertility after vasovasostomy: A follow-up study of 216 men. Fertil Steril 1990; 54:315-321.
8. Fisch H. The Patient’s Guide to Vasectomy Reversal. New York City: Center for Biomedical Communications Columbia Presbyterian Medical Center; 1995.
9. "Paying the Price for Infertility." Accessed at www.drkoop.com/hcr/insurance/library/health/basics/infertility3.asp.