St Elisabeth Hospital - Urology, Tilburg, Noord Brabant, the Netherlands.
BJU Int. 2012 Aug;110(4):562-7. doi: 10.1111/j.1464-410X.2011.10781.x. Epub 2012 Jan 5.
Study Type - Outcomes (cohort series). Level of Evidence 2b What's known on the subject? and What does the study add? 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. potency and pregnancy rates) are dependent primarily on the time elapsed since vasectomy and the age of the female partner. Using a multivariate Cox regression model, evaluation of the influence of preoperative data (including smoking) and semen parameters indicates a significant influence of post-surgical sperm motility only, on time to first pregnancy. The use of assisted reproductive techniques, when natural pregnancy failed, was successful in ≈50% of couples who attempted this procedure and accounted for an absolute increase in pregnancy rate of 14%.
• To determine the influence of smoking, postoperative semen characteristics and the use of an assisted reproductive technique (ART) on pregnancy rate in a contemporary series of men undergoing vasectomy reversal.
• 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 computerized 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.
• The overall patency rate was 91.4%, with a natural pregnancy rate of 44.4% and a subsequent 14.2% of patients conceiving using a ARTs resulting in a total pregnancy rate of 58.6%. Multiple pregnancies were 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).
• 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 ARTs accounted for an absolute increase in pregnancy rate of 14.2%.
• 确定吸烟、术后精液特征和辅助生殖技术（ART）的使用对接受输精管复通术的男性妊娠率的影响。
• 2002 年 1 月至 2009 年 1 月期间，共进行了 186 例输精管复通术。在 171 名可联系到随访的患者中，有 162 名尝试了妊娠，构成了研究组。• 术后 3 个月及随后每 3 个月进行精液分析。• 从计算机数据库中获取患者特征和手术信息，并通过电话访谈收集随访数据。• 使用多变量 Cox 回归模型来辨别与妊娠结局相关的可能预后因素。
• 总体通畅率为 91.4%，自然妊娠率为 44.4%，随后有 14.2%的患者使用辅助生殖技术怀孕，总妊娠率为 58.6%。20.4%的夫妇怀有多胞胎。• 男性或女性伴侣吸烟并不影响受孕的可能性。• 在一个包括其他因素（如输精管结扎时间、女性年龄和精液特征）的多变量模型中，只有精子活力与自然妊娠结局显著相关。• 在术后 2 年内，精子活力>20%（世界卫生组织 a+b）的男性自然妊娠的概率为 53%，而精子活力<5%的男性为 19%（P=0.003）。
• 在该患者队列中，发现精子活力与受孕概率之间存在明显的关联，而吸烟、女性年龄和输精管结扎时间似乎对妊娠结局没有影响。• 使用辅助生殖技术使妊娠率绝对增加了 14.2%。
