Background
Microsurgical vasectomy reversal is an effective and cost-effective method of reinstating fertility in a man who has previously had a vasectomy.
The current literature indicates that the success rate (i.e. patency and pregnancy rates) is dependent primarily on the time elapsed since vasectomy and the age of the female partner.
Postoperative semen parameters have not been shown to be important prognostic factors for pregnancy.
Aim
To determine the influence of smoking, postoperative semen characteristics and the use of assisted reproductive technologies (ART) on pregnancy rate in a contemporary series of men undergoing vasectomy reversal in a single hospital in the Netherlands.
Methods
Between January 2002 and January 2009, 186 vasectomy reversals were performed. Of the 171 patients who could be contacted for follow-up, 162 attempted pregnancy and constitute the study group.
Semen analysis was performed 3 months after the procedure and at subsequent 3-monthly intervals. Patient characteristics and surgical information were obtained from a computerised database, and follow-up data were collected by telephone interview.
A multivariate Cox regression model was used to discern possible prognosticators with respect to pregnancy outcome.
Results
The overall patency rate (presence of any sperm with tails, with or without motility) was 91.4%.
The natural pregnancy rate was 44.4% and a subsequent 14.2% of patients conceived using ART, resulting in a total pregnancy rate of 58.6%.More than one pregnancy was obtained by 20.4% of couples.
Smoking of the male or female partner did not influence the probability of conception.
In a multivariate model that included, among other factors, time since vasectomy, female age and semen characteristics, only sperm motility was significantly related to natural pregnancy outcome.
The probability of obtaining a natural pregnancy within 2 years after surgery is 53% for men with sperm motility >20% (WHO a+b) compared to 19% for men with sperm motility <5% (P= 0.003).
Conclusion
A clear and significant association between sperm motility and the probability of conception was found, whereas smoking, female age and time since vasectomy appeared to have no influence on pregnancy outcome in this patient cohort.
The use of ART accounted for an absolute increase in pregnancy rate of 14.2%.
