Dealing with a Diagnosis

Removing one testicle does not impair fertility or sexual function. The remaining testicle can produce sperm and hormones adequate for reproduction. But that doesn't exclude a man from having other unrelated fertility concerns. Or, if the loss of the testicle was from cancer, there are related fertility complications. Sometimes the disease will have curtailed sperm production, but if not, doctors frequently advise banking some sperm before undergoing invasive procedures, including surgery, radiation, or chemotherapy.

Tubal Ligation

What are your chances of getting pregnant if you have a tubal ligation, and later decide that you want it reversed?

Reversing a tubal ligation is not as simple an operation as "untying tubes" sounds. It requires exquisite surgical technique and is also very expensive; insurance rarely pays for it. "Even if you do get the tubes reconnected," points out Dr. DiLeo, who is not a fan of tubal ligation, "there's scarring at the junction where they were repaired, enough of a rough spot where a fertilized egg can get hung up on its way to your uterus." This means an increased risk of an ectopic pregnancy, which may end up being a surgical emergency leading to loss of the tube, blood, and even life.

He also cites "post tubal syndrome," in which some but not all doctors believe, where the blood supply to the ovaries is damaged, leading to faulty hormonal regulation and therefore faulty ovulation. Fixing the continuity of the tubes later won't help the ovaries work better; the best tubes in the world don't benefit from bad cycles.

With the advent of assisted reproductive technologies, such as intrauterine insemination (IUI), GIFT, and ZIFT, you can bypass the uncertainty of the tubes for the more controlled uncertainty of the laboratory. Before reversing the tubal ligation, check with your doctor for a referral to an infertility specialist. If your tubes have been ligated and you really want a baby badly, then it's a bargain at any price. And the results are getting better and better, says Dr. DiLeo.

Vasectomy

Reversing male sterilization (vasectomy) is a bit less problematic. A vasectomy reversal rejoins the vas deferens, which has been snipped and cauterized. It is performed under light sedation with the aid of a microscope. Pregnancy rates following a vasectomy reversal are generally over 50 percent, says Dr. Michael M. Alper, of Boston IVF. A major factor that impacts fertility following the reversal is the time elapsed since the vasectomy was performed (the less time the better).

At the time of the surgery a sperm sample can be aspirated near the testes and then frozen. If the surgery turns out to be unsuccessful, the sperm sample can be used as part of IVF treatment later on.