After A Vasectomy

Dr. K, I had a vasectomy and can I still use the sperm in my testicles to have my own kids?

Definitely! But let’s first give you a little more information on how the sperm are retrieved and how it can be used.

Sperm can be retrieved from either the testicle (the main factory for sperm production) and/or from the epididymis (the small refinery that sits behind the testicle where sperm get their last minute tune-ups before heading out towards the penis). The procedure takes about 30 minutes or less and can be done where you are most comfortable. If it is done in the office, your doc will use a lot of local anesthetic to numb everything up before the procedure. For the very small percentage of men who say “Just wake me up when it is all done and I don’t want to feel a single thing”, the operating room may be a better choice for them where you can work with an anesthesiologist to achieve your desired level of comfort.

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There are a multitude of techniques that can be used to retreive the sperm. The technique used is determined by what your male fertility and IVF doctors are most comfortable with. When a very tiny catheter or very tiny needle are used to “suck” out sperm, it is called a TESA (TEsticular Sperm Aspiration) if it is from the testicle or a PESA (Percutaneous Epididymal Sperm Aspiration) if it is from the epididymis (the refinery behind the testicle). This is the simplest approach and the most minimally invasive since it does not require any incision of the skin. While simple and straightforward, some men do not have the anatomy to allow for a successful aspiration. Additionally, the amount of retrieved sperm may not be enough for your IVF doctors. As a result, it is important that your doctor, hopefully a male fertilit specialist, is comfortable to go ahead right there and then to also do a TSEC or Testicular Sperm Extraction.

A TSEC is where a tiny skin incision (a couple millimeters) is made and taken down to the surface of the testicle. A small window (just a couple millimeters) is made in the testicle and then small rice-kernal sized samples of the testicular tissue are removed. The small “window” in the testicle is closed and the skin is brought together using threads that your body will absorb (that way you don’t have to come back to have any sutures taken out). While this is slightly more involved then the aspirations (TESA/PESA), it allows you to definitely get all the sperm that your docs need for multiple IVF cycels so that you more than likely never have to come back for another procedure.

Some words of advice:

1. See a male fertility specialist (fellowship-trained, etc.), they will be well-versed in all these techniques and will be able to retrieve sperm in the most minimally invasive way possible in the most comfortable way for you.
2. Some doctors will offer what is called a MESA or Microsurgical Epididymal Sperm Aspiration. This can be a little confusing for patients. “Aspiration” makes it sound very minimally invasive; however, it actually requires using an operating microscope and a larger skin incision to actually deliver your testicle and epididymis out of the scrotal sac. Using the microscope, the epididymis is incised and the fluid is then aspirated. Most male fertility specialists no longer use this technique, since the TSEC/TESA/PESA are all less invasive. Moreover, MESA may preclude your ability to have a vasectomy reversal down the road if you ever decide to go down that reproductive path.
3. One common misperception that often needs to be clarified is that the retrieved sperm retrieved are used for In Vitro Fertilization with Intracytoplasmic Sperm Injection (where a single sperm is injected into single eggs and then the developing embryos are monitored in a laboratory before being placed in a woman’s uterus). It is important to point out that the retrieved sperm cannot be used for IntraUterine Inseminations (IUI) where the millions of sperm from a man’s ejaculate are placed in a woman’s cervix/uterus at the time of ovulation. The sperm retrieved from a TSEC/TESA/PESA are not in high enough numbers tu do inseminations.

Dr. K, I have cystic fibrosis and don’t have any sperm in my ejaculate? Is it true that my situation is similar to patients who have had a vasectomy?

Cystic fibrosis patients may be missing the main pipes that deliver sperm (vas deferens) out to the penis or if they have pipes, then they may be blocked. In most of these individuals, sperm are being produced but have no where to go. Similar to vasectomy patients, this is called obstructive azoospermia. Fortunately, TSEC, TESA and PESA techniques can be used to also retrieve sperm from the testicle or epididymis to be used for IVF.

If you have questions or want help finding a specialist near you, feel free to give us a call. You can either reach your Fertility Guide on the Fertility Fone at 855 4 VR CONSULT (855) 487-2667 or feel free to reach me on my personal cell phone at 505-353-1961. If you are reading this, then you are probably thinking about starting or growing your family which is awesome. If we can help out in any way, just let us know.

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