PURPOSE: To compare fertility outcomes with gross and microscopic fluid findings at the time of vasectomy reversal at a high volume vasectomy reversal center.
MATERIALS & METHODS: A retrospective study of a prospective database was performed. All vasectomy reversals were performed by a single surgeon (EFF) between 1978-2011. Clinical pregnancy rate was either self-reported or via patient mailers. Patient and operative findings were determined through database review. We classified vasal fluid as opalescent, creamy, pasty, or clear. Intraoperative light microscopy was used to determine if sperm or sperm parts were present and if they motile. Multivariate analysis was performed evaluating patient age, partner age, years after vasectomy, type of surgery, gross and microscopic fluid analysis.
RESULTS: A total of 2,947 microsurgical vasectomy reversals were reviewed after we excluded reversals done for post-vasectomy pain. We determined the pregnancy status of 902 (31%). On univariate analysis with respect to pregnancy, motile sperm found at the time of vasovasostomy (VV) neared statistical significance (p=0.075) and there was no difference between bilateral versus unilateral motile sperm. Gross fluid appearance was not statistically significant but we found the following order of pregnancy success: opalescent, creamy, clear, and pasty fluid. Using multivariate analysis, only female partner age and sperm heads only or no sperm seen on light microscopy had statistical significance (p< 0.05).
CONCLUSIONS: Motile sperm at the time of vasectomy reversal approaches statistical significance on univariate analysis as factors that affect clinical pregnancy rates. In multivariate analysis, female partner age and microscopic findings of either sperm heads only or no sperm are inversely related to pregnancy rates. This data will help counsel couples after reversal and reinforces the importance of female partner age.
Ostrowski KA, Polackwich AS, Conlin MJ, Hedges JC, Fuchs EF. Are you the author?
Department of Urology, Oregon Health & Science University, Portland, OR, USA.
Reference: J Urol. 2015 Jan 13. pii: S0022-5347(15)00030-0.