Factors impacting couples’ decision making between vasectomy reversal versus sperm retrieval/IVF/ICSI
500,000 men in the US undergo vasectomy annually. About 6% will change their mind. 2 options to conceive are vasectomy reversal (VR) or sperm retrieval (SR) with in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Often the male partner is only evaluated by a urologist and counseled and treated with a VR without an evaluation or counseling of the female, or the female is evaluated by a reproductive endocrinologist (RE) on the option of IVF/ICSI, and the male partner is referred to a urologist to perform SR for use with IVF/ICSI. Our objective was to identify factors which impact a couples decision making between VR versus SR/IVF/ICSI when counseled both by a reproductive urologist (RU) and a RE.
Retrospective chart review was performed. Between 1/11 to 2/17, all male patients seen by a RU for VR consult as well as all female patients who were seen by a RE for IVF/ICSI with SR consult, were offered evaluation of their respective partner by the other respective specialist. IRB exemption was obtained. Statistical analyses were performed via Students t-test with p value of <0.05 considered significant.</p>
Of all patients presenting, 175 elected to have their partners evaluated. Mean age of males was 40.5 (SD 6.5, range 26-62) and mean age of females was 33 (SD 4.8, range 19-46). Mean obstructed interval was 9.7 years (SD 6.1, range 1-29). 137/175 (78.3%) of couples opted for VR and 38/175 (21.7%) elected SR/IVF/ICSI. Diminished ovarian reserve (DOR) defined as day 3 follicle stimulating hormone (FSH) > 10 mIU/mL, until 1/13, at which time anti-mullerian hormone (AMH) < 1 ng/mL was used as the criterion for DOR. 25% of females were categorized as having DOR. 23% of couples selecting VR had female partners with DOR, and 31.6% of couples who selected SR/IVF/ICSI had female partners with DOR, 2 of whom opted for donor oocyte IVF/ICSI. There was no statistically significant difference in male or female partner ages between those that selected VR vs SR/IVF/ICSI. There was a significantly longer mean obstructed interval since vasectomy in couples who selected SR/IVF/ICSI versus VR. There was not a significant difference in choosing VR versus SR/IVF/ICSI when the female partner was found to have DOR (p-value 0.3041).
Of couples counseled on VR versus SR/IVF/ICSI by a RU and a RE, respectively, the majority selected VR. Male age, female age, and ovarian reserve status did not seem to play a significant role in this decision making; however, a longer obstructed interval since vasectomy was a factor that drove the decision making of couples towards SR/IVF/ICSI.