IVF in lieu of vasectomy reversal

[Anonymous]

My husband recently discussed getting a vasectomy reversal with his doc (this is DH's 2nd marriage) and the doctor actually told him we should consider IVF instead. As far as we know, we would not have any problems conceiving naturally, although we are getting a little older - me in my mid 30's, he in his mid 40's.

On one hand, I like the idea of IVF because we could have genetic testing performed on the embryo before implantation. On the other hand, I've never heard of IVF used in lieu of a vasectomy reversal.

Has anyone else heard of this?

[Anonymous]

There are a lot of pros and cons to genetic testing (if you search this forum for PGD you'll see the posts...) so if that would be a big factor in your decision, I'd look into it before going forward (assuming you aren't a carrier for a genetic disease like CF or Huntington's, in which case the PDG issue may be more straightforward). Good luck!

[Anonymous]

Yes, I'm not sure where you will do useful genetic testing around here. Shady Grove is supposedly going to be doing it, but I don't know if they will be doing vitrification (a quick freeze of the embryos); if not, you're looking at a 25-30% loss rate for your embryos. Plus, even when they do the full testing it is only 90% accurate so you have to consider doing additional testing when you get pregnant.

But in any event, I would check out ivfconnections.net, which is a great board with all kinds of information. I'm sure they have a male factor board that can answer a lot of your questions.

[Anonymous]

FWIW, my situation was similar and we spent $10k out of pocket for a reversal that didn't work, so ended up going with IVF anyway. Post-surgery, DH had an analysis done every 6 months and while some sperm were getting through and the numbers were rebounding, 2 years later it was still just thousands, not millions, so IVF was our only chance. IThe drawbacks of course are that you will have to have a much more invasive process than natural conception, and you'll have to repeat IVF if it doesn't work and/or you want additional kids. If the reversal works, on the other hand, "trying" as often as you want is free. That thinking swayed us into doing the reversal, though now I really wish we had just cut right to IVF instead of wasting time and money on the reversal.

[Anonymous]

I just wanted to offer a little insight into PGD because we've done it multiple times with Shady Grove (we've done 9 IVF cycles with them and thankfully have 3 children as a result). You need to have a reason to do PGD - I would find it highly unlikely that they would add it to your IVF cycle just because you wanted it to improve your odds. We did it b/c my husband has a chromosome abnormality which causes miscarriages and a higher rate of Trisomy 13 babies. You need to have a chromosome issue, reoccuring failed IVF cycles, multiple miscarriages. PGD is not something that you just start with.

PGD is expensive and the cost will vary based on how many tests you have done and what tests you have done to your embryos. For us, it cost another $3,200 PER IVF cycle ontop of all the other costs.

When we cycled with Shady Grove, we were quoted that PGD was 95% accurate so we still did a CVS with all of our kids to ensure with more accuracy that they were chromosomally normal because we had a higher chance of having kids with fatal chromosome combinations.

PGD can be hard on your embryos because they are removing a cell on Day 3 of your embryo development. Although I have a daughter as a result of IVF PGD - we started to wonder if PGD was too hard on my embryos because we kept putting back PGD normal Day 5 beautiful blasts and miscarrying so on our final cycle we decided to forgo PGD and put back our remaining 3 embryos and thankfully ended up with twins. So just because you end up with PGD normal embryos - don't assume it's a fail proof method to achieve a pregnancy. I still had miscarriages as a result of even using IVF PGD. PGD is not able to test all of the chromosomes which is a big reason why you can still miscarry after doing it - it can test for the "sex" chromosome, 13, 18 and 21 trisomies and then if you have a specific issue - like for us it was a translocation between 13 and 14. If you wanted to test all of the chromosomes - you would want to do a process called CGH which I don't believe is offered by any clinics in this area - you would need to look at other clinics like SIRM.

Best of luck to you in whatever you decide to do!

[Anonymous]

OP here....Yes, I realize PGD is rather expensive, but I reason its cheaper than providing medical care fora child with Downs or other chromosomal abnormality ...which is a concern because of our ages.

[Anonymous]

Another thing to consider is that many insurance companies who do cover IVF (or a portion of it) will not pay if a tubal ligation is the reason IVF is needed.
I know our insurance (MDIPA) had this stipulation.

[Anonymous]

My DH had a reversal (2nd marriage here too) that failed. He was about 42 at the time and had had the initial vas around age 30. Time elapsed is a factor in success. My suggestion if you do go with the reversal is to have the urologist collect sperm when he is in doing the procedure. That way, if it doesn't work, you will have sperm for an IVF round. Otherwise your DH will have to do TESA or MESA to get testicular or epididymal (sp?) sperm, respectively, down the road. For us, the TESA procedure was a disaster.....RE told us we'd have to use donor sperm if I wanted to conceive. Well, we wouldn't accept this answer and found an awesome urologist (DR Shin out of GW) and he performed the MESA procedure. We got 6 vials of sperm and have a 15 month old daughter as a result. We also kept tons of sperm frozen from that procedure. I got a BFN on a cycle yesterday trying for number 2, but we have 10 blasts frozen and will try again soon. My advice is to skip the uncertainly of the vas and do the IVF. Or, at a minimum make sure you use a urologist that is equipped to work with your RE to freeze sperm as a back-up. Best of luck to you!