Post-op Pregnancy

When should we try to get pregnant?

You should begin trying to get pregnant beginning in your first month post reversal. Ideally, you should have intercourse the day before ovulation, day of ovulation, and day after ovulation. If you are not sure when ovulation occurs, you may wish to purchase an over the counter ovulation predictor kit. If you are within the first few months after surgery, you should be very careful during intercourse to avoid any pushing on the scrotum, as this may damage the repair.

Once you are several months out from surgery, we recommend increasing how often you have intercourse. You should have daily intercourse beginning 5 days prior to ovulation and then continuing until 1 day after ovulation.

How can we optimize fertility on the female side?

There are several things you can do to optimize fertility on the female side:

Consider going on a fertility aid (such as Clomid) for the first few months after the vasectomy reversal. Although there are not any published studies on whether or not this makes a difference, it likely would increase your chances for pregnancy. It also likely would increase your risk for multiples (i.e. twins).
If you have not done so yet, you may wish to visit with a female fertility specialist (Reproductive Endocrinology and Infertility - REI) or Ob/Gyn to see if there are any factors which may reduce your fertility
Maintain a healthy diet and weight
Exercise regularly
Take a daily multivitamin
Maintain a good sleep schedule

Is Clomid helpful to improve sperm counts?

This is a great question, and the answer is, "probably not." Clomid works by partially blocking estradiol so that the brain releases more FSH and LH. This then increases testosterone production and theoretically increases sperm production. It has largely been used in the past 10-15 years to treat men with infertility due to sperm production issues or what's known as idiopathic infertility (which means, the male and female have no abnormalities on testing, but they still can't get pregnant). However, in the case of men who are post vasectomy reversal, the main issue is getting sperm across the area of repair, and not necessarily due to production issues.

But the question is more complicated because of a few other reasons. First, a percentage of men who go on Clomid will experience tachyphylaxis. This means that they end up getting a paradoxical response, where Clomid actually decreases sperm production. The problem post reversal is that you don't know if the lower sperm count is due to the Clomid or due to an issue with the repair (narrowing/scarring down). The longer someone is on Clomid, the more likely they experience tachyphylaxis as well. A second issue is that in nearly all cases, we don't know the man's underlying fertility prior to the vasectomy. He could have had low sperm counts at baseline, but he was still able to achieve a pregnancy. The reason this is an issue is because once the patient has had a vasectomy and vasectomy reversal, there isn't a way to know if they had sperm production issues previously. You can obtain an FSH test, which gives some indication of sperm production issues. However, if this is elevated (meaning that there are some underlying sperm production issues), Clomid won't work any ways (since FSH is already elevated).

So, for the above reasons, we typically don't recommend Clomid post vasectomy reversal. If patients ever request it, we're happy to prescribe it (relatively low likelihood of harm), but it likely does not have any benefit and may actually hurt sperm counts unknowingly (if tachyphylaxis occurs).

What is the average time it takes to achieve a pregnancy?

Surprisingly, the average or median times to achieve a pregnancy are 12-17 months. This means that about half of the pregnancies which will occur will do so before the 12-17 month time point, whereas the other half will occur after this time point. In our experience, we tend to see an 'early' group, which achieves a pregnancy in the first 4-5 months, and then a later group which is 12+ months. Although no one knows why this may occur, we hypothesize that this is because of the natural healing process, whereby the vasa will narrow down for a period of time (remodeling) and then open up again later on.

Should I take multivitamins?

There is likely no harm in taking multivitamins post-op. There is a small amount of data which show that multivitamins may improve male infertility. However, there is currently no data in men post vasectomy reversal which have examined whether multivitamins improve key outcomes (pregnancy, long-term sperm counts).

So, in the absence of good data, we generally try to look at the risks versus the benefits. Since there are very few risks, and there may be benefits, we would encourage them. However, we would not recommend spending a significant amount of money on 'specialty' vitamins or ones that are 'proven' to improve fertility. Often times (most times), those are simply advertising claims and do not merit spending excessive amounts of money. Rather, a standard multivitamin likely has just as many benefits as the more expensive ones. If you wanted to go further, you could add Co-enzyme Q10 and L-carnitine (updated and accurate as of Mar 18th, 2020). But there is no proven value in using specific vitamins (which heavily market to infertile couples) over generic alternatives.