Hi Ange, so sorry to hear things still haven't worked out, it's very unfair this process. Is there no sperm in the ejaculate at all? I'm guessing so as that's why you needed TESE.
I guess the question that needs to be asked is what will stop another VR closing over.
I'm going to be honest, not to be blunt or hurtful, but because I wish I had of known instead of living in false hope. I really think regardless of a second VR or not, you will need ivf. I know how nice it is to imagine conceiving naturally - but to be realistic the odds aren't in your favour. Many men (my DH included) struggle to produce enough quality sperm even a year post VR to naturally conceive. Given that your DH has already had 1 unsuccessful VR, what are the chances this time it will be different. And even still, it would have to be leaps and bounds different because then you will be a 42 year old TTC naturally with recovering/building or even decreasing sperm count.
I would seek a second opinion in the IVF route. There are some other methods like PICSI or IMSI that could prove helpful - i can't recall exactly which one uses the high powered microscope for sperm selection but it was my next step.
In the grand scheme of things, if you will most likely end up back in the ivf clinic, Id be using the 10k Dr leckich charges to throw everything at a decent ivf cycle.
My story - I sat in Dr Leckich's clinic thinking we would be successful straight away. DH had a daughter AFTER his vasectomy, and on our consult, Dr L found a sperm in the ejaculate prior to VR. I was 25 and conceived my 2 children in my first marriage from one baby dance! So we were a sure success story right? A year of ttc naturally, return of sperm only the minimum for ivf and declining plus morphology/motility issues and then another 18 months and 5 ivf ICSI cycles - we have only just welcomed our precious boy 2 weeks ago! 3 years after our VR.
Whilst I am so grateful and he was worth every heartache, year and cost (and we are in debt now and struggling) I can't say if our journey could have been different. Should we have gone straight to ivf or did the reversal help? I'm not sure, but if I knew then what I know now, I'd probably try the IVF first. Or at least a lot sooner after VR. I too was holding onto falling naturally. It took a long time to accept it wasn't going to happen.
I am so sorry that you are in this boat. I know all too well the feeling of trying VR and IVF and them both not working! And both sides will try to convince you that their procedure is the way to go. But factoring in age and previous results, I would be sticking to ivf but with a different approach as you may just end up in their clinic anyway another 10k down and a year older.
I wish you all the best in whatever decision you make and hope success comes soon. Xoxo