The Effect of Male Age Over 50 Years on Vasectomy Reversal Outcomes

Nusbaum, David J.; Marks, Sheldon; Marks, Matthew B. F.; Burrows, Peter; Zollman, Robert; Samplaski, Mary K.

doi:10.1016/j.urology.2020.04.141

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…Additionally, a larger series found older age was not predictive of pregnancy rates after vasectomy reversals. 11 While this series included far fewer EVs than ours, the principle of age affecting anastomotic success does not seem to have a significant effect on success after accounting for other variables.…”

Section: Cuaj -Original Researchmentioning

confidence: 58%

“…Men need an EV when there is epididymal obstruction as evidenced by absence of sperm or sperm parts in the vasal fluid in conjunction with thick, pasty vasal fluid, 6 and is more likely to be required if there is a prolonged obstructive interval. 7,8 While multiple nomograms and prediction tools have been developed to predict the success of vasovasotomy, [9][10][11] and some of these studies include men who underwent EV, 12 no models have looked specifically at men undergoing bilateral epididymovasostomy at time of vasectomy reversal.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of success after bilateral epididymovasostomy performed during vasectomy reversal: A multi-institutional analysis

Ory

Nackeeran²,

Blankstein³

et al. 2021

CUAJ

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Introduction: Vasectomy reversal (VR) represents an excellent option for paternity in men who desire to expand their family following vasectomy. Traditional VR via vasovasostomy has a success rate upwards of 90%1,2 but when sperm or sperm parts are not present in vasal fluid, epididymovasostomy (EV) must be performed instead. Our objective was to determine which factors influence success after bilateral EV. Methods: A prospectively maintained database with data from the U.S. and Canada was used to identify men who underwent bilateral EV at time of VR. Success was defined as motile sperm in any postoperative semen analyses. Multivariable logistic regression was used to identify predictors of success. Results: A total of 200 men had at least one postoperative semen analysis, and 171 men were included in the analysis. Average age was 44.7 years, with average followup of seven months. Median time elapsed between vasectomy and EV was 15 years (interquartile ramge [IQR] 10–18). Overall success rate was 50%. Despite the study being adequately powered, factors such as years since vasectomy (odds ratio [OR] 1.01, confidence interval [CI] 0.95–1.06), age (OR 0.96, 0.91–1.01), intraoperative presence of motile sperm (OR 0.81, CI 0.41–1.62), and epidydimal fluid characteristics did not predict success. Conclusions: Bilateral EV at time of VR is successful in 50% of cases in a multi-institutional, North American cohort. Microsurgeons can be reassured that neither time elapsed nor epididymal fluid characteristics negatively impact success rates as long as sperm or sperm parts are present. Surgeons performing VR should be comfortable and prepared to perform EV if indicated.

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Section: Cuaj -Original Researchmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Predictors of success after bilateral epididymovasostomy performed during vasectomy reversal: A multi-institutional analysis

Ory

Nackeeran²,

Blankstein³

et al. 2021

CUAJ

View full text Add to dashboard Cite

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“…Finally, there is some literature analysing the effect of tobacco use on VR outcomes. While some data does show that tobacco use decreased post‐VR pregnancy rates (Nusbaum et al, 2020), although other data did not identify this correlation (van Dongen et al, 2012). None of the available studies included smoking status and the presence of granuloma.…”

Section: Discussionmentioning

confidence: 99%

Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal

Samplaski

Rodman

Perry³

et al. 2022

Andrologia

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The objective of this study was to identify factors that predict for sperm granuloma formation and the impact of sperm granuloma presence and quantity on vasectomy reversal (VR) outcomes. A cross sectional retrospective review of prospectively collected data, on the impact of granuloma on VR outcomes from a single academic center was performed. The impact of age, obstructive interval, intraoperative vasal fluid findings, anastomosis type, body mass index, tobacco use and total motile count (TMC) was determined. A total of 1550 men underwent VR between January 2000 and August 2019. Granulomas were present unilaterally in 23.3% (n = 361) and bilaterally in 14.2% (n = 220). On univariate analysis, increasing patient age negatively correlated with a larger number of granulomas (p = .011). Granuloma presence was associated with finding intact and motile sperm from the vasal stump intraoperatively (p = .001), and vasoepididymostomy anastomosis (p < .001). However, granuloma presence (and quantity) did not correlate with obstructive interval or maximum TMC. Tobacco use and body mass index (BMI) were not associated with granuloma presence. On multivariate analysis, granuloma quantity was not associated with TMC. Obstructive interval and vasovasostomy anastomosis were associated with higher TMC, while BMI was negatively associated with TMC. In conclusion, increasing age was negatively correlated with granuloma formation. Granuloma presence was associated with more favourable intraoperative fluid findings and anastomosis type, but not post‐VR TMC, suggesting men with and without granulomas undergoing skilled microsurgery will have similar patency rates. Heavier men should be encouraged for weight loss prior to vasectomy reversal as increasing BMI was associated with lower TMC.

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“…In assessing outcomes of VR, however, a recent study by Nusbaum et al (32) demonstrated similar pregnancy rates for men >50 years old who underwent VR compared with that of men <50 years old. Younger female partners were associated with higher pregnancy rates (32). In addition, embryo aneuploidy rates are not affected by advanced paternal age, providing further evidence that older men are still good candidates for VR (33).…”

Section: Advanced Paternal Agementioning

confidence: 99%

“…This overall trend in older men seeking paternity may be an issue for patients, as increasing paternal age is associated with several fertility concerns, including worsening semen parameters, prolonged time to pregnancy, and declining conception rates (30,31). In assessing outcomes of VR, however, a recent study by Nusbaum et al (32) demonstrated similar pregnancy rates for men >50 years old who underwent VR compared with that of men <50 years old. Younger female partners were associated with higher pregnancy rates (32).…”

Section: Advanced Paternal Agementioning

confidence: 99%

Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis

Dubin

White

Ory

et al. 2021

Fertility and Sterility

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The Effect of Male Age Over 50 Years on Vasectomy Reversal Outcomes

Cited by 6 publications

References 21 publications

Predictors of success after bilateral epididymovasostomy performed during vasectomy reversal: A multi-institutional analysis

Predictors of success after bilateral epididymovasostomy performed during vasectomy reversal: A multi-institutional analysis

Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal

Vasectomy reversal vs. sperm retrieval with in vitro fertilization: a contemporary, comparative analysis

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