Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, MI.
Department of Urology, University of California Los Angeles, Los Angeles, CA.
Urology. 2024 Apr;186:154-161. doi: 10.1016/j.urology.2024.02.028. Epub 2024 Feb 27.
To examine the relationship between antisperm antibody (ASA), pregnancy rates, and method of conception following vasectomy reversal, given that before and after vasectomy reversal, patients wonder if ASAs will prevent them from achieving pregnancy and American Urological Association vasectomy guidelines call for additional research to answer this question.
We performed retrospective chart review and phone interview of patients who underwent vasectomy reversal at our institution from 1/1/2000 to 12/31/2018. We excluded patients who underwent vasectomy reversal for pain, or without postoperative semen analysis with ASA. We categorized patients as having low (<50%) or high (≥50%) ASA levels using the first postoperative semen analysis. Our primary outcome was pregnancy rate, including method of conception. Differences in pregnancy rates were tested using Fisher exact test.
Two hundred and four patients were chart reviewed. Median age at time of surgery was 40years and median obstruction interval was 7.3years. Median partner age was 32years. One hundred sixty-four (80%) patients underwent bilateral vasovasostomy. Eighty-five patients (42%) had low (<50%) ASA levels and 119 (58%) had high (≥50%) ASA levels. Sixty-seven patients completed phone interviews. Of 27 men with low ASA levels, 19 (70%) achieved a pregnancy with 16 (59%) spontaneous pregnancy. Of 40 men with high ASA levels, 30 (75%) achieved a pregnancy with 16 (40%) spontaneous pregnancy. The Fisher exact test P-value was .2.
ASA levels are not associated with pregnancy rate or method of conception after vasectomy reversal. These findings can improve patient counseling before and after vasectomy reversal.
研究抗精子抗体（ASA）、妊娠率与输精管复通术后受孕方式之间的关系。由于在输精管复通术前和术后，患者会担心 ASA 是否会影响受孕，并且美国泌尿外科学会（American Urological Association）的输精管复通术指南也呼吁开展更多研究来解答这个问题。
我们对 2000 年 1 月 1 日至 2018 年 12 月 31 日期间在我院行输精管复通术的患者进行了回顾性图表审查和电话访谈。我们排除了因疼痛而接受输精管复通术或术后未行抗精子抗体精液分析的患者。我们根据首次术后精液分析中抗精子抗体的水平，将患者分为低（<50%）和高（≥50%）两种。我们的主要结局指标是妊娠率，包括受孕方式。使用 Fisher 确切检验比较妊娠率的差异。
共有 204 例患者的图表被审查。手术时的中位年龄为 40 岁，中位梗阻时间为 7.3 年。中位配偶年龄为 32 岁。164 例（80%）患者接受了双侧输精管吻合术。85 例（42%）患者的抗精子抗体水平较低（<50%），119 例（58%）患者的抗精子抗体水平较高（≥50%）。67 例患者完成了电话访谈。在 27 名抗精子抗体水平较低的男性中，有 19 名（70%）成功怀孕，其中 16 名（59%）为自然妊娠。在 40 名抗精子抗体水平较高的男性中，有 30 名（75%）成功怀孕，其中 16 名（40%）为自然妊娠。Fisher 确切检验 P 值为.2。
抗精子抗体水平与输精管复通术后的妊娠率或受孕方式无关。这些发现可以改善输精管复通术前和术后的患者咨询。
