Cedric Shields, 35, married, had children and divorced. Then he met Theresa. They fell in love, got married and realized they wanted a baby.

        Bud Roland, 40, had children from a previous marriage when he married Tonya, and they decided they, too, wanted a baby together.

        But both couples faced the same issue: The husbands had vasectomies before their second marriages.

        Surgery could have reversed their vasectomies. But the two men chose a lesser-known and less invasive option: epididymal sperm aspiration, or ESA, in which a man's sperm is harvested and combined with his wife's egg through in vitro fertilization.

        Now the Shieldses are the proud parents of Isaiah, born Dec. 11 And the Rolands are expecting triplets this spring.

        Like anyone with a new baby, sometimes Mr. Shields, 35, of Mount Auburn, just likes to look at his son. “It's truly a dream come true. It's almost like a miracle,” he says

        Fertility procedures are often uncomfortable — sometimes painful — and they can be expensive, depending on insurance coverage. Nevertheless, they have increased by 27 percent from 1996 to 1998, according to the Centers for Disease Control and Prevention — an increase that has some doctors worried about mothers' and babies' health because of the increased risk for multiple births and premature delivery.
       

A newer option

        A woman who has undergone tubal ligation is still making eggs (unless she's gone through menopause), and a man who's had a vasectomy is still making sperm, says Dr. Jared Robins, a reproductive endocrinologist at the Alliance Center for reproductive Health. But the egg or sperm can't get together for conception because the surgery has blocked the delivery route.

        ESA is a newer option for men who have undergone vasectomy or who have infertility issues such as low sperm count or poor sperm quality.

        In the procedure, available in the U.S. since the 1990s, a very thin needle is inserted into the man's epididymis — a structure in the scrotum where sperm are stored — and sperm are retrieved.

        The sperm are then used to fertilize eggs harvested from the woman, and the fertilized eggs are implanted in the woman's womb.

        The procedure is uncomfortable, but not unbearable, says Mr. Shields, a Cincinnati firefighter. “My ordeal only lasted maybe three, four days of discomfort,” he says. “No pain. Just discomfort. It was well worth it.”

        And, he's quick to add, it was nothing compared with his wife's half of the bargain: two weeks of hormone shots to make her hyper-ovulate; a long, thin needle inserted into the ovaries to harvest the eggs; nine months of pregnancy and five hours of labor.

        “The thing that really fascinated me was two weeks after they placed the eggs back in Theresa, we went to the hospital and we could see the baby's heart beating on the ultrasound,” he says.

        Mr. Shields considered having surgery to reverse the vasectomy, but neither his nor his wife's health insurance would cover it. Mrs. Shields' insurance would cover the ESA and in vitro fertilization.

        Mrs. Shields heard about ESA from some of the nurses she works with.

        “We had talked to a couple of doctors and they said, "Get a reversal,' but there were some risks involved and infection, and he could have this ESA, and that was just a better option,” said Mrs. Shields, 23, who is a nurse aide at University Hospital.

        When the Rolands got married three years ago, they already had five children between them: She had two, and he had three.

        But, deep down, Mrs. Roland, 32, of Dayton, Ky., wanted a son to go along with her two daughters.

        So they started reviewing their options. Like the Shieldses, the Rolands' insurance would pay for in vitro fertilization and the ESA procedure, but not for reversing the vasectomy.

        Mrs. Roland, a health care worker who spends a lot of time drawing blood from patients, had worked in a fertility clinic, so she knew what to expect. But that didn't make the fertility treatments any easier.

        “I'm deathly afraid of needles,” says the woman who sticks patients with needles every day.

        She is due to deliver a son — and two more daughters — in April. If she were to go full-term, the babies would be born at the beginning of June. But multiple births are one of the risks of in vitro fertilization, and pre-term delivery is a risk with multiple births. The Rolands were aware of the risks, and were willing to live with them.
       

Other options and factors

        ESA isn't the only option for parents who want a second chance at parenthood, says Dr. Glen Hofmann, a fertility specialist at the Bethesda Center for Reproductive Health and Fertility. Men and women who've been surgically sterilized can undergo surgical reversal of those procedures. Some couples may opt to use donated sperm or eggs for conception, and others will choose adoption.

        Couples who choose reversal have to think about birth control, Dr. Hofmann points out. If that's a problem, or a couple wants only one or two children, ESA with in vitro fertilization might be a better option.

        If couples choose ESA, they can always go through the procedure a second time for a second baby. Alternatively, retrieved sperm and fertilized eggs can be frozen and stored for future use.

        Cost is also a factor that has to be considered. If the Shieldses had opted for a reversal, the cost would have been $8,000. Having a baby after vasectomy reversal costs about $15,000 to $20,000. Having a baby with ESA and in vitro fertilization can cost $45,000 to $80,000, factoring in the additional costs for multiple births, high-risk deliveries and fertility treatments. Because the Shieldses' insurance covered ESA and in vitro fertilization, the cost was minimal, Mr. Shields said.

        Time is also a factor, urologists say. Reversing a vasectomy is less successful if the procedure took place more than 15 years ago, says Dr. Youssef Costandi, a Mount Airy urologist.

        Furthermore, vasectomy reversal results in pregnancies only 35 percent of the time, Dr. Costandi says. After vasectomy, a man's body might produce antibodies against his own sperm, which reduces their viability, he says, “so the quantity might be the same, but the quality is not.”

        The woman's age also has to be considered, Dr. Hofmann says. The older she is, the more difficult it will be for her to get pregnant without in vitro fertilization because a woman's eggs become less viable as she ages.

        There's no data on how many in vitro fertilizations result from ESA. The sperm recovery procedure is becoming more common, Dr. Robins says, but it's still fairly rare.
       

One more time?
       

        The Shieldses are considering having a second child through ESA and in vitro fertilization, but they plan to wait a year or two.

        The Rolands know they don't want any more children. Eight — the three on the way plus the five from their previous marriages — are enough, Mrs. Roland says.

        “I was just asking God for one. That's all I wanted,” she says. But with five other children, she adds, “I'll have plenty of baby sitters.”

Web sites

        Check out these Web sites for more information on treating infertility:

        • The International Council on Infertility Information Dissemination: www.inciid.org

        • www.westcoastinfertility.com

        • www.rscbayarea.com

        • www.infertile.com

        • www.vasectomy.com

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