Vasectomy reveral versus IVF is a complex question and one that you will need to discuss with your physician before making the right decision for you and your partner.  There are several factors to consider when making this choice: the number of pregnancies desired, the age of the female partner, and personal preferences. 

One scenario where IVF is probably the best option is one in which the couple is trying to achieve a single pregnancy and the female partner is over the age of 33-35 years old.  This is due to the fact that a woman's fertility potential drastically declines by the age of 35-37 and it can take 6-12 months to have a good result after a vasectomy reversal.  So when the female partner is nearing 35 years of age, the additional lead time that a vasectomy reversal requires argues in favor of IVF.  Additionally, cases in which the couple desires one pregnancy, rather than several, will probably favor IVF.

If the female partner is less than 33-35 years old, and especially if the couple wishes to get pregnant more than once, vasectomy reversal is a good option.  Assuming the vasectomy was done less than 15 years prior, and the reversal is done by a skilled urologic microsurgeon, then reversal has over a 95% chance of returning sperm to the ejaculate.  Pregnancy rates after reversal range from 50-70% depending upon the woman's age and if any female factor infertility is present.  So, the argument can be made for vasectomy reversal in cases where the female partner is younger (less than 33-35) and the couple would like to achieve multiple pregnancies.  Especially since vasectomy reversal can provide sperm that is useable for IVF, reversal is a very reasonable option in most cases.

Generally speaking, the number of pregnancies desired and the age of the female partner are the main factors to consider when choosing which option is right for you.  Of course, the personal preferences of the couple are also of paramount importance, so you should be sure to make your doctor aware of your viewpoint.  Some people have an overwhelming desire to conceive naturally, and as responsible physicians, we try to respect this wish whenever it is feasible.     

 Answered by Dr. Jonathan Schiff, M.D.