Fertility after sterilisation

Reversal of sterilisation is not usually available on the NHS and the operation costs about £2,500-£3,500. IVF costs about £1,500-£2,000, and again is rarely available to women on the NHS if they already have children and have been sterilised.

Some fertility clinics offer 'egg-share' IVF which is a way in which women may have free or subsidised IVF in return for giving up half their eggs to a couple who need donated eggs.

Male sterilisation
There is a reasonable chance of a reversal of vasectomy producing a good result as long as the original operation was performed less than 10 years beforehand and there were no complications (infection or scarring) at the time.

However, reversals are rarely available on the NHS and usually cost £1,500-2,000 when done privately. Success rates are 50-80 per cent, but the sperm quality is often not as good as before the original vasectomy because of anti-sperm antibodies.

Anti-sperm antibodies are formed when a man's immune system comes into contact with his sperm. Normally the immune cells (the white cells in the blood) are kept away from the sperm by the 'blood-testis' barrier. But if the man has surgery in the scrotal area (vasectomy, reversal or trauma/infection) the barrier is breached and anti-sperm antibodies can form. These have the effect of coating the sperm tails and sticking them together so the 'swimming ability' of the sperm is severely reduced.

Even when the operation is initially successful, the delicate tubes (the vas deferens) may block off again quite soon, and the man should have sperm cryopreserved (frozen) just in case.

If the vasectomy reversal fails, sperm can be obtained directly from the testes by a minor outpatient operation called PESA (percutaneous epididymal sperm aspiration) or TESE (testicular sperm extraction).

Since the quantities of sperm obtained at PESA or TESE are very small, and the sperm is immature, it is necessary to use the ICSI technique to ensure that the woman's eggs are fertilised. This involves the woman undergoing an IVF cycle and her eggs being retrieved as in the 'test-tube baby' technique.

PESA/TESE costs £800-1,000 and ICSI costs an additional £2,500-3,500, so it is an expensive option. However, it is a very successful treatment and does offer the couple the chance of having their own genetic baby.

The other option, the use of donor sperm, is much cheaper (£200-350 per cycle), but many men have reservations about 'raising another man's child.'