Is There a Role for Medical Therapy After Vasectomy Reversal?
S Cayan, A Hernandez, and PJ Turek,
Department of Urology, University of California San Francisco
Objective
Semen quality can vary widely after vasectomy reversal surgery. Often, the reason for such variation is not clear, but may result in the empirical use of adjunctive medical therapy in the form of steroids, non-steroidal antiinflammatory drugs (NSAIDS) or clomiphene citrate. We assess the seminal response to empirical medical therapy in a cohort of men after vasectomy reversal surgery.
Design
Retrospective study of two cohorts of men after vasectomy reversal by a single surgeon.
“…it appears [empirical medical therapy is] more effective when used after motile sperm counts decrease after surgery instead of with an initial finding of no motile sperm.”
– Dr. Paul Turek
Materials and Methods
We identified 23 men who underwent vasectomy reversal and who had received adjunctive medical therapy after surgery. These were divided into two groups based on the indication for adjunctive treatment. Group 1 (n=10) received medical therapy because of a lack of motile sperm in the ejaculate since surgery, and Group 2 (n=13) received therapy because of a decrease in sperm motility to zero at some point after surgery. The response to therapy was assessed through an examination of semen parameters after initiation of adjunctive therapy.
Results
Patient age did not differ between the two groups. Medical therapy included methylprednisolone (n=7 patients), NSAIDS (n=2), clomiphene citrate (n=7) and combination therapy (n=7). Results of treatment are found below. There were no complications from medical treatment. Comparisons were made by unpaired t test (see graph in downloadable PDF).
Conclusion
The role of empirical medical therapy after vasectomy reversal is not well defined. However, it appears to be more effective when used after motile sperm counts decrease following surgery instead of with an initial finding of no motile sperm.
