Vasectomy Reversal or IVF with PESA or MESA
Patients with a prior vasectomy that wish to have another child have several options. Vasectomy reversal is surgery to reconnect the vas deferens, the structure that carries sperm from the epididymis to the urethra. This procedure is done in the hospital under general anesthesia. The couple may have intercourse to hopefully get pregnant. A vasectomy reversal may fail because of scar tissue formation causing the vas deferens to re-occlude or partially occlude (i.e. low sperm count), or the presence of anti-sperm antibodies (ASA). The other option is IVF (In Vitro Fertilization) with Percutaneous Epididymal Sperm Aspiration (PESA) or Microsurgical Epididymal Sperm Aspiration (MESA). These are forms of Assisted Reproductive Technology. These procedures involve using a small needle to aspirate the sperm under local anesthesia (PESA) or a slightly larger incision to use a microscope for isolation of sperm from the epididymis (MESA). Because the numbers of sperm are typically low and there may be anti-sperm antibodies, IVF with ICSI (intra-cytoplasmic sperm injection) is used to assure fertilization.
Anti-sperm antibodies are important factors that may influence the final outcome when a man has had a prior vasectomy. The testes are an immunologically privileged, which means that the immune system does not have access to the very immunogenic sperm cells normally. However, when the vas deferens is occluded with the vasectomy and sperm production continues pressure may build up and cause the gap junctions between the basement membrane cells to separate allowing the immune cells access to the testes. When the immune cells have access, they produce antibodies to various parts of the sperm cell. The sperm cell has 3 components; the head, mid-piece, and tail. Antibodies to the head may inhibit sperm and egg fusion at fertilization. Antibodies to the tail may decrease sperm motility. Thus, a man that was previously fertile may now be infertile.
It is uncommon for most insurance companies to cover sterilization reversal or fertility procedures. Because we offer the most advanced therapies in a cost effective office based IVF facility we can provide IVF with MESA or PESA to many more couples. Below is an approximation of the costs for the various procedures.
Estimated Costs for Various Procedures
Because our IVF lab is so cost effective we can offer the ART based procedures much more affordably than hospital based IVF labs. Costs were obtained from Urology of Indiana, PC and phone conversations with hospital billing department and will be verified again prior to actual procedure.
When IVF-ICSI is done in the hospital setting, an additional $12,000 would be added to the MESA and PESA costs for the procedure.
Family Beginnings, PC costs for MESA and PESA
We charge no cost for facility fee for the male procedure and our IVF-ICSI is much less.
We are able to offer our patients IVF/MESA and IVF/PESA in an
affordable fashion. Please call our office or
email Dr. Donahue for more
information. We are able to coordinate treatment with local providers so
the patient will have minimal travel commitments and can have initial