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Age should not rule out visectomy reversal

For couples who want to have a baby after the man has had a vasectomy, reversing the vasectomy offers a reasonable chance for pregnancy even when the woman is 35 or older, according to a new study. In this scenario, the chance for success is comparable to that of one cycle of a type of in vitro fertilization (IVF) in which sperm is directly injected into an egg.
Besides reversing a vasectomy, another option for men who have gone under the knife is to have sperm extracted and then used to perform in vitro fertilization.// But Kolettis and his colleagues note that vasectomy reversal is less expensive than IVF. And by making it possible for couples to conceive naturally, it avoids the increased risk of multiple births that comes with IVF.

The findings, which are published in the June issue of The Journal of Urology, are based on a study of 46 couples that were trying to conceive. In each couple, the male partner had undergone vasectomy reversal and the female partner was at least 35. The average time between vasectomy and reversal was 10 years. Of the 40 couples with adequate follow-up, pregnancy occurred in 14 (35 percent). Thirteen of these pregnancies were still ongoing or had been delivered by the end of the study.

Nearly half of women in their late 30s became pregnant after their male partner had his vasectomy reversed. But women in their 40s were much less likely to conceive. Just 14 percent became pregnant, according to the report. The results suggest that "couples should not be eliminated from consideration for reversal simply because the female partner is 35 years old or older," the authors note.

However, "in our series there was only one live delivery for a women older than 40 years and, therefore, careful preoperative counseling is required for these couples," they add. During a vasectomy, a surgeon cuts a small section out of each vas deferens, the tubes that carry sperm from the testes. The open ends of the tubes are then closed. The procedure can be reversed through a surgical procedure that restores the flow of sperm through the vas deferens. SOURCE: The Journal of Urology 2003;169:2250-2252.

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