Patency following vasectomy reversal. Temporal and immunological considerations.

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.