NEW ORLEANS, LA (UroToday.com) - American Society of Reproductive Medicine (ASRM) New Orleans - 2006
The authors investigate the factors that predict not success of vasectomy reversal but the time course or the "kinetics" of the return of sperm to the ejaculate.

They point out that that previously, success was judged is patency or return of sperm to the ejaculate. Time of return is an important variable that may affect treatment choices. They hypothesized that there are clinical and intraoperative predictors of time to success.

A retrospective cohort study was performed assessing patient demographics, semen analyses, and intraoperative surgical findings. "Patency" was defined as the presence of motile sperm in the ejaculate. 152 patients were included in the study. Eighty-four patients had bilateral vasovasostomy (VV), 23 had bilateral epididymovasostomy (EV), and 34 had a VV/EV combination.

The presence of motile sperm at both vasa at time of reconstruction predicted significantly faster patency rates postoperatively. 95% of those patients with motile sperm at reconstruction achieved patency by 6 months, whereas 76% of patients without motile sperm achieved patency within 6 months (p=0.04). By 6 months, 81% of patients with bilateral VV or mixed VV/EV achieved patency, compared to 31% of patients with bilateral EV (p less than 0.01). Age did not predict outcomes..

The authors conclude that intraoperative finding of motile sperm at either vas deferens predicts the shortest time to patency following vasectomy reversal, with virtually all patients achieving patency by 6 months. Less than one-third of patients with bilateral EV showed patency within 6 months

Editorial Comment:
The authors explore an important concept in the debate between reconstruction and testicular sperm acquisition and ART for the post vasectomy patient. The time to sperm return to the ejaculate appears to be greater when no motile sperm is found in the testicular vas. This information may important to the older couple under going reconstruction and may significantly affect fecundibility rates. Perhaps if no motile sperm is observed at time of reconstruction in such a couple, one should consider testicular sperm acquisition at the time of reconstruction so that ART may be accessed more quickly without the need for another procedure.

G. Yang, S. Shefi, P. J. Turek. University of California, San Francisco, San Francisco, CA

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Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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