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

Abstract

BackgroundIn 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.MethodsThis 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 findingsThe 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.ConclusionIn 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.

Successful unilateral vasectomy reversal in a lion (<i>Panthera leo</i>)

“…Although only one side could be reversed due to prolonged surgical time, the procedure was extremely successful for two reasons: first, motile sperm were observed in the vassal fluid, and second, during the microsurgical phase of surgery, we could see the epididymal fluid flow through the vas while performing the anastomosis. In humans, surgical success is determined by the presence of motile sperm in semen analyses during follow-up (Namekawa et al, 2018). In our case, patency could be demonstrated with a semen analysis by electroejaculation, requiring general anesthesia, or by the lion's attempt to copulate with an artificial vagina.…”

“…In these patients, the preferred method to restore fertility is vasectomy reversal (Shridharani and Sandlow, 2010), given that the success rate, meaning the presence of motile sperm in the semen analysis after surgery is extremely high (Dickey et al, 2015). The most important factors impacting the success rate of vasectomy reversal are: (1) time elapsed since the original vasectomy was performed, (2) experience of the surgeon, and (3) intraoperative findings, such as the presence of a sperm granuloma as well as the presence of sperm in the vas fluid (Namekawa et al, 2018). If the vasectomy was performed less than 10 years ago, the success rate for an experienced surgeon is approximately 90%.…”

Outcomes of partial intussusception and endo‐to‐side vasoepididymostomy in men with epididymal obstructive azoospermia

“…Obstructive interval, patient age, presence of granuloma and magnetic resonance imaging findings of the epididymis have been reported to be preoperative predictors for patency after VE. 25 A meta-analysis has shown that patients with motile sperm in epididymal fluid exhibit high patency. 20 The site of anastomosis might also be associated with surgical outcomes.…”

Human Contraceptives: Current Status, Sperm Antigen Inhibitors and an Insight into PCSK4

“…One advantage of vasectomy is, that it can be reversed by vasovasostomy surgery to restore fertility with the rate of pregnancy after the reversal was between of 30-60% but, the rate decreased when the vasovasostomy was performed 8 years after vasectomy was conducted [3]. Fertility restoration and pregnancy rate after vasectomy reversal are influenced by, among others, the interval of vasectomy to reversal surgery, the presence of azoospermia, presence of sperm granuloma, the age of female partner and the same female partner [15].…”