Vasectomy Reversal Success Rate – Overview
With approximately 6% of men who underwent vasectomy seeking a vasectomy reversal, it is important to understand what factors affect the success rate of a vasectomy reversal.
Vasectomy is an elective surgical procedure that involves obstructing or removing a part of both vas deferens to prevent the movement of sperm from the testes to the ejaculatory ducts. About 6% to 8% of couples prefer vasectomy as a means of contraception. (1)
This contraceptive method is used by 42 to 60 million men globally. (1) However, approximately 6% (3) of these men who undergo a vasectomy end up seeking a vasectomy reversal due to various reasons. These reasons could be marital status or changes in reproductive goals.
Vasectomy reversal is a surgical reconstruction of the vas deferens permitting the sperm to move from the testes to the ejaculatory ducts. A vasectomy reversal is a very technically demanding urological surgery that requires precision. There are two surgical procedures by which a vasectomy can be reversed.
In a Vasovasostomy both ends of the vas deferens that were cut during the vasectomy procedure are joined by anastomosis. In this procedure, the abdominal and testicular ends of the vas deferens are first excised.
Afterward, the abdominal end is examined for patency using sterile saline solution while the testicular end is examined for the presence of sperm in the vasal fluid. After both ends have been confirmed viable, anastomosis is performed.
Studies show that Vasovasostomy has an overall > 95% patency and > 70% pregnancy rate. (10)
In this procedure, the abdominal end of the vas deferens is surgically connected to the epididymal tubule. In the first place, the epididymal tubule has to be examined for dilated spots, after which an incision is made on the side of the epididymal tubule.
The epididymal fluid is tested for the presence of sperm before being anastomosed to the abdominal end of the vas deferens. Vasoepididymostomy has a patency rate of > 70% and a pregnancy rate of > 50%. (10)
The success rate of a vasectomy reversal depends largely on various factors and it is important for the surgeon to communicate these factors and the degree to which they affect the success of the vasectomy reversal to the patient and their partner.
We discuss some of these factors that determine the success rate of a vasectomy reversal below:
A vasectomy reversal surgery is the most demanding microsurgery in urology, requiring great precision and technical know-how. The very small diameters of the vas deferens and the epididymal tubule make a vasectomy reversal very delicate requiring a surgeon with adequate skill and experience.
Studies show that surgeons who do 15 or more vasectomy reversals annually have higher success rates (87%) compared to those who do less than 6 vasectomy reversals in a year (56%). (4)
Findings at surgery
The decision on the surgical technique to adopt depends on certain findings during the surgery. After the vas deferens are cut, vasal fluid is examined macroscopically and microscopically for the presence of sperm.
If clear fluid with the presence of sperm is found, a vasovasostomy technique will be performed. However, if a pasty fluid without sperm is found, a vasoepididymostomy will be performed. According to studies, vasovasostomy has a higher success rate than vasoepididymostomy.
The time interval between vasectomy and reversal
The period between vasectomy and a vasectomy reversal plays a role in the success rate of the vasectomy reversal. Many studies have been carried out to understand how this time interval affects patency and pregnancy rate. Patients who had a vasectomy for over 15 years before a vasectomy reversal experienced decreased chances of fertility as compared to those with lesser time intervals. (11,12)
Over time, epididymal obstruction can occur causing the patient to require a vasoepididymostomy in place of a vasovasostomy. The patency and pregnancy rate of a vasoepididymostomy is low and therefore reduces the success rate. That being the case, the success rate decreases as the interval between vasectomy and vasectomy reversal increases.
Age of the female partner
This is probably the most important factor affecting the success rate of a vasectomy reversal. This is an important factor to be considered by the couple. Women over the age of 40 showed a lower pregnancy rate compared to women less than 40 years of age. Studies show that even with a similar patency rate, the pregnancy rate varied due to the age of the woman. (13,14)
As women age, their ovarian reserve diminishes affecting their chances of getting pregnant.
Quality of vasal fluid
The quality of the vasal fluid obtained from the testicular end of the vas deferens determines the success rate of the vasectomy reversal. A clear vasal fluid with the presence of full, live and motile sperm increases the chances of fertility post vasectomy reversal than when compared to thick creamy vasal fluid.
Also, a vasovasostomy is performed when vasal fluid contains sperm and as we know, this technique has a higher patency and pregnancy rate.
The surgical technique will either increase or decrease the success rate of a vasectomy reversal. Vasectomy reversals done through vasovasostomy showed higher success rates with a 95% patency rate and a 70% pregnancy rate compared to vasoepididymostomy with only a 70% patency rate and a 50% pregnancy rate. (4)
The microsurgical technique when compared to macroscopic loupes-assisted surgery showed more success rates in a study carried out by Jee and Hong. Loupe-assisted surgery had a patency rate of 72% and a pregnancy rate of 28% while microscopic surgery had a patency rate of 96% and a pregnancy rate of 40%. (15)
After the vas deferens are cut during a vasectomy, the testicular end of the vas continues to leak out sperm. This causes the body to produce an inflammatory response around this site. A mass (sperm granuloma) made up of macrophages, sperm, and other immune cells forms around the vasal stump reducing the pressure within the vas.
This allows for sperm production to continue, increasing the fertility rate after a vasectomy reversal. A study showed 95% versus 78% patency rate in the patients with sperm granuloma as compared to those without it. (16)
Vasectomy reversal success rate is influenced by a variety of factors that determine patency and pregnancy rates. The most important determinants of vasectomy reversal success rates are the surgeon’s skill, the interval between vasectomy and vasectomy reversal, and vasal fluid quality. However, many authors argue that the most important factor is the age of the female partner.
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16. Mary K. Samplaski,John C. S. Rodman,Jessica Michelle Perry,Matthew B. F. Marks,Robert Zollman,Kian Asanad, F. Sperm granulomas: Predictive factors and impacts on patency post vasectomy reversal https://doi.org/10.1111/and.14439.