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    Is vasectomy always permanent?

     

    Questions often arise regarding the success of vasal reconstruction with respect to the obstructive interval (OI). Men with an OI less than 10 years are more likely to achieve anastomotic patency and achieve pregnancy post-operatively compared to OIs greater than 10 years (Urology 2015; 85:819-25). However, some studies including both VV and VEs suggest that the patency rate does not change with OIs even at 15 years (89%), but pregnancy rates are reported to be lower (44%) among OIs greater than 15 years (J Urol 2004; 171:304-6).

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    Thus, among couples wishing to pursue natural pregnancy, vasal reconstruction is a successful management option in couples even with a long OI, with mean natural pregnancy rates of 73% for VV and 31% for VE. Additionally, if natural pregnancy is not achieved, ejaculated sperm can be used for IUI or IVF/ICSI. Sperm retrieved at the time of vasal reconstruction can be used only for IVF/ICSI. Among couples wishing to pursue immediate attempts for fertility and desire multiple children, we recommend considering combined sperm retrieval cryopreserved at the time of vasal reconstruction for immediate IVF/ICSI, allowing potential natural conception for subsequent children, particularly in the setting of advanced maternal age. If only one child is desired, then either vasal reconstruction, or sperm retrieval for IVF/ICSI may be offered. Vasectomy counselling should focus on the permanency of the procedure. However, among vasectomized men now pursuing fertility, vasal reconstruction and/or sperm retrieval and ICSI are viable and successful options. If the couple is willing to pursue all possible options, a majority will be able to have children after prior vasectomy.

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