Vasectomy Reversal must be the first step for a man who had a vasectomy and wants a children from a new marriage? Opinion: Yes.

Decision on which is the best treatment for a problem that has more than one way to be dealt with goes much further from exclusively looking to the final results. Decision must include which are the final results you are looking for, how many variables are present in both options, money expenditure to reach the result and finally, how much resources are available for it. The beginning of 90’s brought consolidation of vasectomy reversal as the treatment for man who had a vasectomy and want to become a father again. With the paper publishing with published paper from Belker and cols. that established time from vasectomy as a main variable for patency rate and pregnancy after surgery (1). In 1992 the first pregnancy obtained from an injection of a single sperm into a oocyte was published by Palerno et al. (Intracitoplasmic Sperm Injection – ICSI) (2) and two years later Shrivrastav and cols. published the technique for sperm retrieval from epididymis by a percutaneous puncture (Percutaenous Epididymal Sperm Aspiration – PESA) (3), introducing a second option for man with vasectomy to become a father and new variables that may alter the results. ICSI/PESA introduced variables that come from the female partner, mainly age, and laboratory variables as the number of metaphase oocytes manipulated, fertilization rate and embryo classification (4-7). The final objective of infertile couples seeking for treatment is having a healthy baby and not only getting pregnant, so, papers objecting the comparison between vasectomy reversal and ICSI with sperm retrieval (SR) must also look for live birth rate. Silber and cols., in 1995 published the results of 72 cycles of Microsurgical Sperm Aspiration (MESA) and ICSI showing a 42% ongoing pregnancy rate. Since then the literature shows pregnancy rates ranging from 28 to 42% and live birth from 27 to 32% (7-13). Data from Society for Assisted Reproductive Technology (SART) shows that live birth rate for male factor was 34.5 % in 2003 and raised to 37.3% in 2008 and the use of ICSI for male factor raised from 84% to 87%, but those numbers are for all male factors (14). Lee and cols. published a literature review comparing vasectomy reversal and DIffERENCE Of OpINION