My husband had a vasectomy reversal about a year ago. He had a basic semen analysis done that showed a good count of sperm and a fair "upward progression" count. He is going to be retested for antibodies. If he has developed antibodies, is IUI still an option, or do we have to do IVF? We are concerned because of the cost difference. I am 37 and so far, all of my tests have come back good or at least normal (FSH, HSG, ultrasound). I am currently on a low dosage of Clomid, and we've been trying to conceive for about 11 months.

Patty

The longer the time interval from vasectomy to reversal, the greater the likelihood that your husband developed sperm antibodies. Antibodies are one of the immune system's methods of attacking foreign substances. Surprisingly, sperm and eggs are both recognized as foreign by our own immune system. Infection, gonadal surgery or vasectomy can induce the production of antibodies. When antibodies are directed against a man's own sperm, they may cause the sperm to clump or decrease their ability to move. They may also interfere with the sperm's ability to pass through the cervical mucus or to bind to the egg.

Previously, doctors tried using steroid therapy to lower sperm antibody levels. The risks of this treatment appear to be significant, while the hoped-for benefit has not materialized. So, alternatives using the sperm specimen as it exists must be considered. If motility (movement) is good, then ovulation induction with injectable medication and intrauterine insemination for two or three cycles would seem to be a reasonable option to discuss with your physician. If motility is significantly compromised or if you do not conceive after the above treatment, then in vitro fertilization may be the best approach.