The Kinetics of the Return of Motile Sperm to the
Ejaculate After Vasectomy Reversal

In prior analyses, we observed that the achievable patency rate after vasectomy reversal is a key factor in whether reversal surgery is more cost-effective than IVF-ICSI for fertility after vasectomy. Since pregnancies will occur sooner with an earlier time to patency, this clinical parameter becomes important with advanced maternal age. We hypothesize that there are predictors of time to patency after reversal that are valuable for patient counseling and intraoperative decision-making in cases of advanced maternal age.

We retrospectively reviewed a cohort of consecutive men who underwent vasectomy reversal. Data obtained included patient demographics, semen analyses, intraoperative findings, patency rates, and time to achieve patency.

Results

One-hundred-fifty patients met inclusion criteria. Mean age was 42.9 years (range 27-61), and mean follow-up was 12.5 months (range 1-90). The presence of motile sperm in both vasa predicted faster patency rates postoperatively. In patients with motile sperm, 95% achieved patency by 6 months, whereas 76% of patients without motile sperm achieved patency within 6 months (p=0.04). Obstructive interval of < 8 years and undergoing vasovasostomy instead of epididymovasostomy predicted faster time to patency within the first 3 months after reversal. Patient age was not associated with time to patency after bilateral vasovasostomy.

Conclusions

Motile sperm found intraoperatively at the testicular vas, undergoing vasovasostomy, and obstructive interval < 8 years predict shorter time to patency after vasectomy reversal. Patient age does not appear to affect patency kinetics after reversal. Patients counseled about fertility after vasectomy may benefit from this information, especially when advanced maternal age is a concern.