Vasectomy reversal outcomes not dependent on time

San Francisco-Two recent studies appear to deal a serious blow to the commonly held belief that the success of a vasectomy reversal and subsequent pregnancy weakens to futility as the interval between the vasectomy and its reversal lengthens.

The separate studies reported patency rates of 65% to better than 90% in men with vasectomy durations of 10 years or longer. These led to pregnancies in 25% to 39%, rates comparable to those seen with in vitro fertilization and intracytoplasmic sperm injection among women of a comparable age.

“Vasectomies are reversible regardless of the age of the patient, and given the recent studies associating elevated birth defects in children and breast cancer incidence in young mothers undergoing [in vitro fertilization] and [intracytoplasmic sperm injection], it may make more sense for couples to pursue pregnancy via vasectomy reversal,” said Paul Turek, MD, director of the Turek Clinic in San Francisco, and a co-author of one of the studies.

Ethan D. Grober, MD, co-author of the second study, said favorable outcomes are possible with experienced surgeons.

“While the time since vasectomy has a significant impact on the type of vasectomy reversal required, a surgeon who is proficient in vasovasostomy (VV) and epididymovasostomy (EV) can achieve favorable semen parameters, patency, and pregnancy in men more than 10 years after their vasectomy. Couples should not be discouraged from considering vasectomy reversal simply based on the vasal obstructive interval,” said Dr. Grober, assistant professor of urology at Mount Sinai Hospital & Women’s College Hospital, Toronto.

Both studies, which were presented at the 2012 AUA annual meeting in Atlanta, sought to examine the veracity of information being given to couples that as the age of the vasectomy increases, the likelihood of a successful reversal decreases, and that at a certain point, perhaps as early as 10 years post-vasectomy, reversals are for the most part futile and should not be pursued.

“Couples are frequently discouraged from considering a vasectomy reversal based on the time from vasectomy. Those of us who perform these operations have all spoken with couples who have been told very strongly by professionals that they should not consider a reversal procedure,” said Dr. Grober.

Dr. Turek conducted a review of consecutive reversals he had conducted and identified 343 patients who had adequate follow-up. Some 40% of these men had either a unilateral (n=84) or bilateral (n=43) EV. The need for the more challenging VV procedure appeared to reach a plateau around 21 years post vasectomy. Dr. Turek found that the chance of successful reversal (achieving moving ejaculated sperm counts) was 65% in men with older vasectomies (>15 years) compared to 88% in men with younger vasectomies. The difference was not significant, he reported.

Dr. Grober, in collaboration with Edward Karpman, MD, of El Camino Urology Medical Group, Mountain View, CA, looked at 535 consecutive reversals conducted by two fellowship-trained surgeons between 2006 and 2011. Of these, 33% (n=177) had a vasectomy duration of 10 or more years. Patency rates were 95% for patients <10 years post vasectomy (PV), 87% for patients 10-15 years PV, 94% for patients >15-20 years PV, and 92% for patients >20 years PV.

Pregnancy rates were 40% for patients <10 years post vasectomy (PV), 26% for patients 10-15 years PV, 39% for patients >15-20 years PV, and 24% for patients >20 years PV.

Dr. Grober concluded his presentation saying that while the age of a vasectomy may be a factor in determining the most appropriate reversal procedure, high success rates can be achieved by an experienced surgeon and couples can be offered a chance at natural ­conception.UT