Post-vasectomy reversal patency possible at 38 years

Contrary to popular belief and scientific predictions, a man’s patency after vasectomy reversal is possible almost 40 years after the original vasectomy, according to a study of more than 1,200 reversals that the authors say is the largest such study ever published.

The findings suggest that a vasectomy can be used as temporary male contraception, according to the authors from The Turek Clinic, San Francisco and the International Center for Vasectomy Reversal in Tucson, AZ. Data were published online in Andrology (Nov. 14, 2013).

For decades, conventional wisdom has been that the older the vasectomy, the less likely that a vasectomy reversal will work. But researchers now say this is simply not true. This assumption has led many physicians to encourage couples to choose in vitro fertilization instead of vasectomy reversal to build families.

“Reversals performed even 38 years after vasectomy did not have worse outcomes after reversal,” said senior author Paul Turek, MD, of The Turek Clinic. “In fact, the patency rate after reversal plateaus after 21 years and doesn’t decrease much after that.”

The retrospective review examined consecutive reversals performed by three surgeons over a 10-year period. Among 1,229 patients, 406 had either unilateral (252) or bilateral epididymovasostomy (154), which constituted 33% of reversals.

The chance of achieving live sperm counts after reversal in men with older vasectomies (more than 15 years of obstruction) was 75% compared to 93% in men with younger vasectomies (less than 15 years), a difference that was not statistically different. In addition, Dr. Turek said excellent sperm counts are achievable after reversing older vasectomies: the average total sperm count in men with older vasectomies was 84 million per ejaculate.

The researchers also noted that the motility of ejaculated sperm after reversal trends down as vasectomy age increases.

“This is probably where the effects of time play a role on the outcomes after reversing older vasectomies,” Dr. Turek said.

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