Vasectomy Reversal must be the first step for a man who had a vasectomy and wants a children from a new marriage? Opinion: No.

The evaluation of any couple with infertility for any reason, including known post-vasectomy obstructive azoospermia, involves simultaneous evaluation of the female for her fertility potential with male evaluation. The goal of vasectomy reversal is to allow a couple to have a healthy child. In this overview, we will clarify that sperm retrieval with IVF is the most effective means for a couple to achieve their goal of having at least one healthy child. The limiting factor for natural conception and live birth after vasectomy is not typically the male partner’s obstructive azoospermia, however, it is directly related to the female partner’s fertility. The Practice Committee of the American Society for Reproductive Medicine clearly state in their guideline for management of obstructive azoospermia using reconstruction: “Before vasectomy reversal is performed to restore fertility, evaluation of the female partner’s reproductive potential is prudent and recommended...” (1). Women have a decline in reproductive potential that becomes significant by age 32-35 with a subsequent rapid decline (2). Age is not the only reason for impaired female fertility, and there is no age below which normal female reproductive potential can be guaranteed. Hormonal and congenital abnormalities as well as endometriosis are a few examples of common issues that greatly decrease the chance a couple has for a successful natural conception; all can be issues for women of any age. The observation that men are less likely to have a pregnancy with a new partner after vasectomy reversal than with same female partners, emphasize the role that the female plays in success rates of vasectomy reversal (3). These increased risks underscore the importance of the female evaluation because her fertility potential will frame the conversation regarding the risks, benefits, and likely outcomes of all reproductive possibilities, including natural conception. Vasectomy reversal is an option for couples interested in fertility after vasectomy reversal. Vasectomy reversal has been reported to have some cost-benefits related to use of ART (4, 5). However, the “costs” associated with ART are overestimated by low pregnancy rates in historical published literature and excessive frequency of multiple gestations. Original cost-effectiveness studies with vasectomy reversal assumed a pregnancy DIffERENCE Of OpINION