Condition
Post-vasectomy infertility
Infertility following elective vasectomy, where restoration of fertility is desired.
ICD-10Z98.52
Treatable7 options
Treatment options
1Vasectomy reversalMicrosurgical reconnection of the vas deferens to restore fertility after vasectomy.2PESA — Percutaneous Epididymal S perm AspirationPercutaneous epididymal sperm aspiration (PESA) is a minimally invasive sperm retrieval procedure used mainly in men with obstructive azoospermia who produce sperm normally but cannot release sperm into the ejaculate because of a blockage or congenital absence of part of the reproductive tract. A fine needle is passed through the scrotal skin into the epididymis to aspirate sperm, which can then be used fresh or frozen for intracytoplasmic sperm injection (ICSI).3MESA — Microsurgical Epididymal Sperm AspirationMicrosurgical epididymal sperm aspiration (MESA) is a surgical sperm retrieval procedure for men with obstructive azoospermia in whom sperm production is preserved but sperm cannot reach the ejaculate because of a blockage or absent reproductive ducts. The surgeon exposes the epididymis under magnification, opens selected epididymal tubules and aspirates sperm-rich fluid for use with intracytoplasmic sperm injection (ICSI), often obtaining enough sperm for cryopreservation and future treatment cycles.4TESA — Testicular Sperm AspirationTesticular sperm aspiration (TESA) is a minimally invasive sperm retrieval procedure in which a needle is inserted through the scrotal skin directly into the testicle to aspirate seminiferous tissue and sperm for use with intracytoplasmic sperm injection (ICSI). It is most commonly used in men with obstructive azoospermia when sperm production is preserved but sperm cannot reach the ejaculate, and it may also be used as a backup when epididymal sperm retrieval is unsuccessful.5TESE — Testicular Sperm ExtractionTesticular sperm extraction (TESE) is a surgical sperm retrieval procedure in which a small incision is made in the testicle and testicular tissue containing seminiferous tubules is removed and examined for viable sperm. Retrieved sperm can be used fresh or cryopreserved for intracytoplasmic sperm injection (ICSI), and TESE may be used for obstructive azoospermia and selected cases of non-obstructive azoospermia, although Micro-TESE is generally preferred when sperm production is severely impaired.6Vasoepididymostomy — Microsurgical Epididymal BypassVasoepididymostomy is a complex microsurgical fertility procedure that connects the vas deferens directly to an epididymal tubule to bypass an epididymal blockage and restore the passage of sperm into the ejaculate. It is used for selected men with obstructive azoospermia, including some men undergoing vasectomy reversal when secondary epididymal obstruction prevents a standard vasovasostomy.7Vasovasostomy (Vasectomy Reversal)Vasovasostomy is the microsurgical reconstruction of the vas deferens after a vasectomy. Working under an operating microscope, the surgeon removes the blocked segment on each side and rejoins the two cut ends, restoring the channel that carries sperm from the testicle into the ejaculate so that natural conception becomes possible again. It is usually a day-case operation under general or spinal anaesthesia, takes around two to four hours for both sides, and its success depends more on how many years have passed since the vasectomy than on any other single factor.