Female partner demographics of men seeking vasectomy reversal
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Vasectomy
Vasectomy reversal
Demographics
Vasovasostomy
To evaluate the postoperative patency rates of microsurgical vasovasostomy and vasoepididymostomy at various vasectomy reversal time intervals, and to assess the implications of anti-sperm antibodies on results.Three hundred and eighty-two patients underwent unilateral or bilateral vasectomy reversal between January 1997 and April 2001 at the Health Clinic, Highgate and Manor House Hospitals, London, United Kingdom. Patients were divided into 4 groups according to the time interval between vasectomy and reversal; less than 5 years, 5-10 years, 10-15 years, and more than 15 years. Data collected included patient's age at time of vasectomy reversal, seminal fluid analysis at 3, 6 and 12 months after surgery, and the presence or absence of anti-sperm antibodies before vasectomy reversal.Mean patient age at the time of reversal was 44.6 years. The mean vasectomy reversal time interval was 12.8 years. Overall patency rate of the patients groups was 62.9% with positive sperm in the ejaculate in 85.3% in the less than 5 years group, 75.3% in the 5-10 years group, 50.3% in the 10-15 years group and 26.9% in the more than 15 years group. Anti-sperm antibodies were positive in 31 patients (9.1%), of whom 12 patients (38.7%) were positive for sperm in the ejaculate.Microsurgical vasectomy reversal produces satisfactory patency rates to couples that consider reestablishing their fertility even more than 15 years after vasectomy. The presence of anti-sperm antibodies is associated with negative effects on sperm count, motility, and percentage of abnormal forms.
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Objectives To examine trends in vasectomy and vasovasostomy, and the surgical complications and factors associated with reversal after vasectomy, and paternity after vasovasostomy. Patients and methods Procedure rates were estimated from 1980 to 1996 in the population of Western Australia. Linked hospital morbidity records were used in the follow‐up of men after vasectomy to estimate the risks of complications and reversals. Records of vasovasostomies were linked to the paternity field on birth registrations. Independent effects of the study factors were examined using Cox regression. Results There was little net change in vasectomy rates, whereas vasovasostomy rates increased in men aged 30–49 years. Risks of surgical complications were low and decreased for vasovasostomy. At 12–15 years after vasectomy, the risk of reversal levelled at 2.4% in the total cohort and at 11.1% in men aged 20–24 years. The risk of vasovasostomy was 69% greater after vasectomy performed in 1994–96 than in 1980–84 ( P = 0.011). The factors strongly associated with reversal were age < 30 years and being single, divorced or separated at the time of vasectomy. Paternity was achieved after an estimated 53% of vasovasostomies. Successful reversal was more likely if the man was younger at vasectomy and the time elapsed was comparatively short. Compared with vasovasostomies performed in 1980–84, the success rate of those in 1994–96 was almost four times higher. Conclusion Population rates of vasectomy are stable but the risk of seeking a reversal has increased. Outcomes after vasovasostomy have improved. Care should be taken during the counselling of men before vasectomy, and especially in those aged <30 years.
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Vasovasostomy
Vasectomy
Vasectomy reversal
Epididymitis
Nephrology
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Vasovasostomy
Vasectomy
Vasectomy reversal
Male Sterilization
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Vasectomy
Sterilization
Demographics
Vasovasostomy
Vasectomy reversal
Male Sterilization
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Although a wide array of interventions exist for men seeking fertility after vasectomy, up to 6% of them will elect for a vasectomy reversal. While the widespread adoption of telemedicine promises convenience and improved access, lack of ability to do a physical examination may hinder appropriate counselling. Although vasectomy reversal is successfully completed in most of the men either with a vasovasostomy or a vasoepididymostomy, there could be various reasons for the inability to successfully complete the operation. Our commentary outlines the reasons why a vasectomy reversal is not possible or successful. We also discuss a pre-operative management algorithm in men seeking vasectomy reversal to ensure appropriate counselling with a thorough pre-operative history, physical examination and on occasion, hormonal evaluation.
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The absence of sperm in the ejaculate after vasectomy reversal is commonly caused by failure to recognize and subsequently bypass epididymal or proximal vasal obstruction at the time of vasectomy reversal. If intra-operative proximal obstruction is suspected, vasoepididymostomy (VE) is recommended rather than vasovasostomy (VV). We sought to calculate the associated risk of needing VE, rather than VV with time from original vasectomy (obstructive interval) using a large cohort of vasectomy reversal patients. We reviewed the electronic and paper vasectomy reversal database by a single surgeon from 1978 through 2012. We performed univariate analysis to identify variables that predicted the need for VE rather than VV, and then combined only significant univariates into our multi-variable analysis. 2697 total men underwent vasectomy reversal, and 239 were repeat procedures. Of the 5296 individual testes operated on, 1029 were VE. Significant variables that predicted the need for VE on univariate analysis included: age, obstructive time interval, vasectomy reversal after previous VV (repeat vasectomy reversal), and year the procedure was performed. On multi-variable analysis significant risk factors for VE were age above 50 (OR 1.36), repeat vasectomy reversal (OR 5.78), and greater obstructive time interval (OR 1.56). For every 3 years since original vasectomy, the risk of needing VE increases by 56%. There is a linear relationship between obstructive interval and need for VE. Men undergoing repeat vasectomy reversal have five times greater risk of requiring VE and men greater than 50 years of age are also at higher risk. Using these pre-operative predictors is helpful in identifying patients who will benefit from referral to an experienced surgeon who can perform VE.
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Excellent results of vasectomy reversal have been reported by Silber and Owen in 1977 using microsurgical technique without splints. Herein, we report two cases of male sterility due to previous voluntary vasectomy in which fertility was restored by microsurgical vasovasostomy. The reason for vasectomy reversal in these cases was a subsequent marriage. Case 1: A 36-year-old male who had had vasectomy 3 years earlier, underwent vasovasostomy on September 20th 1976. The sperm granuloma was not found, but sperm was observed in the fluid from the proximal cut-end of the vas deferens at the time of operation. He fathered a baby on October 2, 1977. Case 2: A 43-year-old male who had had vasectomy 10 years ago underwent vasovasostomy on February 5th 1980. Sperm granuloma was observed at the time of operation. He fathered a baby on February 25th 1981. The important factors that determine the success of vasectomy reversal are the method and time of reversal. 1) Microsurgical two-layer vasovasostomy is the most reliable method among the various operations for vasectomy reversal. 2) A shorter duration between vasectomy and it's reversal, and the existence of sperm granuloma after previous vasectomy increase the possibility to restore fertility.
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Vasectomy
Vasectomy reversal
Male Sterilization
Granuloma formation
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