ICSI vs. Vasectomy Reversal in men with prolonged interval since vasectomy?

Even after prolonged obstructive intervals of 15 to 20 years, vasectomy reversal offers better or comparable success rates to intracytoplasmic sperm injection.

Article Reviewed: Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years. Kolettis PN, Sabanegh ES, et al: Urology 2002; 60 (November): 885-888.

Outcomes for Vasectomy Reversal Performed After Obstructive Intervals of at Least 10 Years.

Kolettis PN, Sabanegh ES, et al:
Urology 2002; 60 (November): 885-888Objective: To determine the outcomes for vasectomy reversal performed after at least 10 years of obstruction. Methods: 74 vasectomy reversal procedures were performed in 70 patients after obstructive intervals of 10 to 24 years (mean, 14.5 years). These patients were retrospectively reviewed for patency and pregnancy rates. Results: The overall pregnancy rate was 37%. Patency rates for an obstructive interval of 10 to 15 years, 16 to 19 years, and >=20 years were 74%, 87%, and 75%, respectively. Pregnancy rates for these same periods were 40%, 36%, and 27%, respectively. Assuming a live delivery rate per cycle of 25% for intracytoplasmic sperm injection (ICSI), the delivery rate for vasectomy reversal would not be exceeded until an obstructive interval of at least 20 years.

Conclusions: The authors believe that even after prolonged obstructed intervals, vasectomy reversal offers better or comparable success rates to ICSI. Depending on their success rates at various medical centers, a threshold obstructive interval probably exists at which ICSI surpasses vasectomy reversal.

Reviewer’s Comments: This is, in my opinion, a clinically worthwhile paper. It clearly shows the pregnancy and delivery rates in patients who have undergone vasectomy reversal surpass the historical success rates of ICSI even after prolonged obstructive intervals. In addition, vasectomy reversal avoids the complication associated with multiple births, which is commonly seen after ICSI and is cheaper. In summary, even in patients with prolonged obstructive intervals after vasectomy, vasectomy reversal is probably more effective, cheaper, and less complicated than is ICSI. (Reviewer-George S. Benson, MD).

Additional Keywords: 10 infertility interval reversal vasectomy

Reprints: Division of Urology; University of Alabama at Birmingham; 1530 3rd Ave S, MEB 606; Birmingham, AL 35294-3296 (Peter N. Kolettis, MD).

 

Vasectomy Reversal success rates depend on several factors…and yes a little luck!

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From VasectomyMedical.com

Vasectomy Reversal Failure Rates and Success Rates Vary With:

  • The vasectomy reversal technique used.
  • The years between the vasectomy and the reversal attempt.
  • The experience and skill of the vasectomy reversal doctor.

Some of the best vasectomy reversal success rates reported in the literature for vasovasotomy are a patency rate of 99% with a pregnancy rate of 64%, not including couples where the woman was infertile. This means that in the hands of the surgeon who quoted these rates, he was able to restore sperm flow in the vas tube 99% of the time, and this allowed a pregnancy rate of 64%.

Not every time that sperm flow returns to the vas is pregnancy guaranteed. The expected vasectomy reversal success rates results for vasoepididymostomy in the hands of the same surgeon are lower, reportedly at 65% patency rate and a 41% pregnancy rate.

Factors influencing the success rate of reversal surgery include the following:

  • Time interval since vasectomy-The length of time passed since the vasectomy greatly impacts vasectomy reversal failure, as seen on this chart:
Years Between Vasectomy Sperm Return Pregnancy Rate
Under 3 years 97% 76%
3-8 years 88% 53%
9-14 years 79% 44%
Greater than 15 years 71% 30%

As previously noted, with longer intervals between vasectomy and reversal, there is an increased vasectomy reversal failure rate due to epididymal blockage as well as rupture and obstruction of the epididymal tubules.

  • Sperm granuloma-Sperm granulomas at the vasectomy site are a favorable prognostic sign and increase the likelihood of vasectomy reversal success.
  • Anti-sperm antibodies-Post-operative, sperm-bound antibodies result in a lower pregnancy rate or higher likelihood of vasectomy reversal failure.
  • Quality of vasal fluid-The vasal fluid quality is checked before a decision is made whether to proceed with a vasovasostomy versus vasoepididymostomy when reversing the vasectomy. If no sperm are present in the vasal fluid the gross appearance of the vasal fluid can help in determining between a vasovasostomy versus vasoepididymostomy. Cloudy, water soluble fluid indicates the best case for eventual return of sperm to the semen (higher vasectomy reversal success rate). Thick white greasy toothpaste-like material indicates the worst prognosis (a higher vasectomy reversal failure rate).
  • Microsurgical Vasectomy Reversal Technique-The vasectomy reversal technique and the doctor`s judgment and experience are important factors for success. Given that choosing the vasectomy reversal doctor is one of the few choices controlled by the patient, it may become an important factor in determining the vasectomy reversal success rate.
  • Associated conditions-Any condition that impairs sperm production for example a varicocele may lower postoperative pregnancy rates (increase vasectomy reversal failure rate).

A vasectomy reversal consult is free and easy to schedule 24/7. Leave your number below and we’ll call with an appointment.

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The Nitty Gritty…

  • The cost is all-inclusive-$6,500.
  • The pre reversal consultation is free.
  • Performed in a practice owned and accredited surgery center.
  • General anesthesia performed by board certified anesthesiologist.
  • 200 reversals have been performed.
  • Overnight accommodations is free.
  • Usually takes two and half hours or less to perform.
  • Out patient.
  • Operating microscope and microscopic sutures and instruments utilized.
  • Success rates mirror national studies. (See success rates page.)

Vasectomy 101 Podcast by Dr. McHugh

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