The need for epididymovasostomy at vasectomy reversal plateaus in older vasectomies, "Beyond the Abstract," by Paul Turek, MD, FACS, FRSM

BERKELEY, CA (UroToday.com) - There are many published papers over the last 25 years that confirm that vasectomy reversal can be very effective in overcoming vasectomy-related male infertility. Very few, however, have examined the ability of vasectomy reversal to overcome infertility in the OLDER vasectomy (i.e. vasectomies that are 15 years or older). Most research simply clumps all vasectomies over 12 years or 15 years together and provides lump-sum success rates in these groups, which has been relatively uninformative for many.

In addition, the prevailing thought from published research to date, mainly described in algorithms and logarithms, is that the older the vasectomy, the more likely that the more complicated epididymovasostomy is needed at the time of reversal. This procedure is associated with less success that vasovasostomy and so many men with “older” vasectomies have been informed that it is not worth reversing the vasectomy simply due to the vasectomy age.

Nothing could be further from the truth. By examining a very large number of “older” vasectomy reversals in this paper, we found that even 40-year old vasectomies can be reversed successfully. Remarkably enough, as vasectomies age, they don’t necessarily require an epididymovasostomy to reverse successfully. In fact, fully 30% of vasectomies will never require an epididymovasostomy to reverse, at ANY age.

What we also found was that although total ejaculated sperm “output” remains constant regardless of vasectomy age after reversal, the motility of ejaculated sperm declines. And this decline is more rapid than that which one would expect to see given the age-related changes to semen quality that occur as men get older. We surmise that this is due to changes to epididymal function (confirmed by prior gene expression studies) that occur with prolonged blockage from vasectomy. And it is precisely the lower motility that we believe is the real culprit for the general observation of decreased fertility observed after the reversal of older versus younger vasectomies. So, as our microsurgical technique for vasectomy reversal improves, the underlying changes in biology due to the vasectomy itself have become more obvious.

Written by:
Paul Turek, MD, FACS, FRSM as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

The Turek Clinic, San Francisco, CA 94133 USA

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

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