Vasectomy reversal: new techniques and role in the era of intracytoplasmic sperm injection.

The growing popularity of vasectomy as a primary form of birth control has also created an increasing demand for vasectomy reversal (VR). The advent of IVF with intracytoplasmic sperm injection after sperm retrieval has given couples an alternative to traditional VR. Although VR remains the most cost-effective and natural way to conceive after vasectomy, competing interests and market pressures have encouraged the development of this assisted reproductive technique (ART). The success of VR is dependent on several variables. The length of time since vasectomy and an individual surgeon's experience appear to be the most significant factors and are equally important. The success of this procedure is highly contingent on adherence to strict surgical principles of creating a water-tight, tension-free anastomosis, along with the appropriate decision whether to perform either a vasovasostomy or epididymovasostomy at the time of VR.