Impact of obstructive interval and sperm granuloma on patency and pregnancy after vasectomy reversal

Abstract

The objective of this study was to determine the effect of the obstructive interval and the presence of a sperm granuloma on vas patency and pregnancy rate following vasectomy reversal. We identified 334 patients with complete follow-up who met the inclusion criteria. There were significant associations between the obstructive interval and procedure performed as well as with patient age. Patients with longer obstructive intervals were more often older (p < 0.001) and more likely to have a vaseoepididymostomy performed (p < 0.001). There was no association between the presence of a sperm granuloma or the length of the obstructive interval with post-operative vas patency and pregnancy rates. The only independent predictor of post-operative fertility was age of the female partner (p = 0.015). Our data clearly demonstrates that when state of the art surgical techniques are used, neither the presence of a sperm granuloma nor the obstructive interval serve as prognosticators of post-operative vas patency and pregnancy rates. However, when counselling patients and their female partners, it is of utmost importance to stress that the age of the female partner is an independent predictor of successful vasectomy reversal.

The need for epididymovasostomy at vasectomy reversal plateaus in older vasectomies: a study of 1229 cases

“…2). In fact, this finding supports previous observations that sperm counts among patent reversal cases are preserved across all vasectomy obstructive intervals (Magheli et al , 2010a,b). We acknowledge that this does not exclude the possibility that some men can have dramatic impairments to sperm production after vasectomy (as these men may in fact may not have shown patency in this series), but it suggests that the majority of men who have vasectomies do not have impaired sperm output after prolonged obstruction.…”

“…The term vasectomy ‘interval’ used here is identical to vasectomy ‘obstructive interval’ in the literature. For this analysis, and based on published experience, vasectomies of various intervals were arbitrarily divided into two cohorts: ‘younger’ (vasectomy interval 0–15 years) and ‘older’ (vasectomy interval 16 years and higher) (Magheli et al , 2010a). Pregnancy as a separate outcome was not assessed.…”

Vasovasostomy and predictors of vasal patency: A systematic review

“…Moreover, Yang et al followed up 80 patients for more than 2 years following microsurgical two-layer vasovasostomies after different periods of obstructive interval and demonstrated an insignificant difference in the rates of VP at the end of the study [100% (0-8 years), 91% (9-16 years) and 88% ( ‡16 years)] [33]; however, the number of men in each group was not given in these two studies. Furthermore, Magheli et al did not find significant difference in the rates of patency after different obstructive intervals among 242 patients who underwent bilateral microsurgical two-layer vasovasostomies and were followed up for at least 3 months [99% (<5 years, n = 81), 98% (5-10 years, n = 87), 95% (11-15 years, n = 53) and 97% (>15 years, n = 21)], with an overall patency rate of 97% [34]. The procedures were performed by the same experienced surgeons in all studies.…”

Obstructive azoospermia: reconstructive techniques and results

“…Pregnancy rates, however, decreased dramatically from 85% for obstructive intervals of 15 years or less to 44% for intervals of more than 15 years ( p <0.05) (40). Magheli reviewed a single surgeon's series of 334 vasectomy reversals and reported that patency and pregnancy rates were not influenced by the length of obstructive interval, although multivariate analysis revealed that longer obstructive intervals were associated with an increased tendency to perform VE (41). Kolettis found favorable patency and pregnancy rates in 74 patients with obstructive intervals of 10 years or longer drawn from the experiences of three surgeons.…”

“…Age of the female partner significantly impacts postoperative pregnancy rates, as female fertility potential drops profoundly in women over 40 years of age (41,43). Gerrard demonstrated a precipitous decline in postoperative pregnancy rates after age 40 in a series of 249 vasal reconstructions.…”