What are the success rates with Dr. Turek’s vasectomy reversals?

Dr. Turek has written and published on the success rates of men who have had vasectomy reversal surgery. With vasectomy reversal surgery, there are two success rates to consider: patency rate, or return of moving sperm to the ejaculate after vasectomy reversal and pregnancy rates. The patency success rate is the success rate that reflects the surgical decision-making and skill during vasectomy reversal, and should be considered carefully when evaluating a microsurgeon. Figure 1 illustrates the fraction of men who achieved motile sperm in the ejaculate (the strictest patency success rate measure) in Dr. Turek’s recent vasectomy reversal case series. Notably, 95% of men with a vasovasostomy show motile sperm in the ejaculate within 1 year after vasectomy reversal. Interestingly, almost 80% of these men achieve motile within 3 months of vasectomy reversal. The vasectomy reversal rate for epididymovasostomy is different, however, for several reasons. First, fewer men with eventually achieve motile sperm counts (62%) and the time to achieve motile sperm counts after epididymovasostomy takes longer than it does for vasovasostomy. This vasectomy reversal rate likely reflects the natural biology of recovery from long term obstruction after vasectomy reversal.

FIGURE 2. PERCENT OF PATIENTS ACHIEVING MOVING SPERM IN THE EJACULATE (PATENCY) AFTER DR. TUREK'S VASECTOMY REVERSAL (N=120 CASES). VV = VASOVASOSTOMY ON BOTH SIDES; VV/EV=ONE SIDE VASOVASOSTOMY AND ONE SIDE EPIDIDYMOVASOSTOMY AND EV/EV=BOTH SIDES EPIDIDYMOVASOSTOMY. DATA FROM YANG ET AL. J UROL. 177: 2272-6, 2007.

To get a better sense of the true quality of Dr. Turek’s procedural skills, it helps to look at the success rates in the best possible setting—when moving sperm are found at the testis vas deferens during vasectomy reversal. Dr. Turek’s vasectomy reversal rates in this setting are illustrated in Figure 3. Notably, when moving sperm are found at the vas deferens during vasectomy reversal, 100% of Dr. Turek’s patients have successful patency (motile sperm) within one year after vasectomy reversal. When non-motile sperm are found, Dr. Turek’s patency success rate is 94% at 1 year after vasectomy reversal. Dr. Turek has also published that:

FIGURE 3. PERCENT OF PATIENTS ACHIEVING MOVING SPERM IN THE EJACULATE (PATENCY) AFTER DR. TUREK'S VASOVASOSTOMY (N=150 CASES). DATA FROM: YANG ET AL. J UROL. 177: 2272-6, 2007.

Another issue to consider is the likelihood of epididymovasostomy during reverse vasectomy, as this technique is generally associated with lower patency success and pregnancy rates than vasovasostomy. From Dr. Turek’s experience the chance of needing an epididymovasostomy is 3%/year for every year after 5 years of vasectomy age. Thus, a 10 year old vasectomy has a 5 x 3%=15% chance of needing an epididymovastomy. A 20 year old vasectomy has a 15 x 3%= 45% chance of epididymovasostomy. This likelihood does not differ with men’s age, as is illustrated in Figure 4 below (n=174 patients):

FIGURE 4. PERCENT OF PATIENTS NEEDING AN EPIDIDYMOVASOSTOMY IN DR. TUREK'S SERIES (N=174 CASES). EV=EPIDIDYMOVASOSTOMY; BLUE BARS INDICATE MEN <45 YEARS OLD; RED BARS ARE MEN > 45 YEARS OLD.

The pregnancy success rates after vasectomy reversal depend not only on the patency rate, but also on known or unknown female factor issues, including female age. Among Dr. Turek’s couples, the average female age in a case series analysis was 35.5 years and the average interval from vasectomy to vasectomy reversal was 13.5 years. Among men with vasovasostomies on both sides, 48% of partners became pregnant within 1 year of vasectomy reversal. Among men with a vasovasostomy on one side and epididymovasostomy on the other side, 50% achieved a pregnancy within 1 year, and among men with epididymovasostomy on both sides, 38% achieved a pregnancy by 1 year after vasectomy reversal. These pregnancy success rates are impressive given the age of the vasectomies in Dr. Turek’s published series and the relatively advanced maternal age of the female partners.

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