Treatment of failed vasectomy reversal using a microsurgical two-layer anastomosis technique

Prognostic Factors for Pregnancy and Patency Rates After Microsurgery for Obstruction of the Upper Seminal Tract: A Retrospective Single-surgeon Series of 336 Cases

Background and objective

To achieve optimal results in treating vasal obstruction, microsurgery is the standard of care. However, not all vasovasostomy (VV) or vasoepididymostomy (VE) procedures lead to subsequent pregnancy. Identification of parameters that can predict success in restoring fertility is clinically relevant. We evaluated various parameters in relation to patency and pregnancy outcomes in a retrospective single-surgeon series.

Methods

We analysed data for 336 men with azoospermia due to vasal obstruction who underwent microsurgery to restore fertility. Seminal fluid was harvested intraoperatively from the testicular stump for analysis of gross quality. Intraoperative parameters, time to conception, patency rate, age of the female partner, and time from vasectomy to reconstruction were assessed in relation to pregnancy outcomes. Multivariable logistic regression was performed to identify independent prognostic parameters.

Key findings and limitations

The median age at surgery was 42 (range 27-70) yr for the men and 33 (range 19-46) yr for their female partners. The overall patency rate after surgery was 86.8% (236/272). Secondary obstruction occurred in 14/272 men (5.1%). Pregnancy was achieved in 127/258 couples (49.2%). The most significant predictor of successful treatment was the obstruction time (p < 0.01), with significantly lower success rates for longer times since vasectomy. None of the intraoperative parameters we analysed was associated with subsequent pregnancy. The primary limitation of our study is its retrospective design.

Conclusions and clinical implications

Patency and pregnancy rates in our series are similar to rates reported in the literature. Pregnancy success after vasectomy reversal mainly depends on the time since vasectomy. Additional biomarkers are needed to predict postoperative pregnancy outcomes.

Patient summary

In our study, nearly 87% of men were fertile again after surgery to reverse a vasectomy, and about half of the couples were then able to get pregnant. The key factor for success was the time since vasectomy, with better results for shorter times. More research is needed to find reliable ways to predict if a couple will get pregnant after this surgery.

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade

BACKGROUND

In the era of improving assisted reproductive technology (ART), patients with obstructive azoospermia (OA) have 2 options: vasal repair or testicular sperm extraction with intracytoplasmic sperm injection. Vasal repair, including vasovasostomy (VV) and vasoepididymostomy (VE), is the only option that leads to natural conception.

METHODS

This article reviews the surgical techniques, outcomes, and predictors of postoperative patency and pregnancy, with a focus on articles that have reported over the last 10 years, using PubMed database searches.

MAIN FINDINGS

The reported mean patency rate was 87% and the mean pregnancy rate was 49% for a patient following microscopic VV and/or VE for vasectomy reversal. Recently, robot-assisted techniques were introduced and have achieved a high rate of success. The predictors and predictive models of postoperative patency and pregnancy also have been reported. The obstructive interval, presence of a granuloma, and intraoperative sperm findings predict postoperative patency. These factors also predict postoperative fertility. In addition, the female partner's age and the same female partner correlate with pregnancy after surgery.

CONCLUSION

In the era of ART, the physician should present and discuss with both the patient with OA and his partner the most appropriate procedure to conceive by using these predictors.