Category Archives: Microscopic Vasectomy Reversal

What does the vasectomy site look like at the time of a reversal?

img_4584

There are several things about the picture above. First of all, the vas deferens has been isolated and is ready to begin the vasectomy reversal procedure proper. There are basically three parts to a vasectomy reversal.

  1. First you have to dissect out the  vas deferens and identify the vasectomy site. In the case above this was easy. You see in the middle of the picture a conglomeration of clips which were used to do the vasectomy. I like it when clips have been used. The area is much easier to find and there is less damage to the vas deferens.
  2. Secondly, the vasectomy site is excised and fresh vascularized vas deferens are delineated and prepared to reconnect.
  3. Finally the actual reversal. The microscope is brought into the operative field and after having approximated the two ends…the reversal is performed under the microscope using microscopic suture, usually 12-14 on each side.

Another interesting finding in the above picture is the sperm granuloma. On the right side of the clips you see a bulge before the vas narrows. This finding is a positive sign of success and that the fluid will be favorable. In this case the vasectomy had been done 5 years previously and the fluid noted upon transection showed a mildly cloudy fluid which with microscopic evaluation showed whole sperm.

So even before the reversal procedure with the microscope even started there where several positive findings the will contribute to a reversal success and pregnancy.

Considering a vasectomy reversal? We do them all the time and the consultation is free. Make an appointment 24/7 by just leaving your number and we’ll contact you. 

Save

What is the effect of a vasectomy on the male? All you’d ever want to know.

135449-004-F2AB0A3F

From: Spermatogenesis. 2012 Oct 1; 2(4): 273–278.

Effects of Vasectomy and Vasectomy Reversal in Humans

Vasectomy is performed by transection of the vas deferens with suture, clips, cautery or a combination of these in the scrotal portion of the vas. This transection disrupts the mucosal, muscular, and adventitial components of the vas deferens, including the autonomic nerves that mediate vasal secretory function and peristalsis. Vasal obstruction results in increased intraluminal pressures within the testicular remnant of the vas deferens. The increased pressure may have physiologic effects on epithelial cell morphology, cellular ultrastructure, and gene expression in the vas deferens and epididymis. Moreover, sperm cannot traverse the intentionally obstructed vasal lumen, and as such they accumulate and die within the testicular remnant of the vas deferens and the epididymis. A resultant local inflammatory response occurs in reaction to dying sperm, which has significant downstream sequelae, including a systemic cellular and humoral immunologic response that may impair testicular and sperm function.The clinical importance of this response is not clear in humans. Vasal transection and occlusion cause significant, independent pathophysiologic sequelae that may or may not be reversible by microsurgical bypass of vasal and/or epididymal obstruction during vasectomy reversal in humans.

Perhaps the most relevant study on the effects of vasal transection during vasectomy on vasal innervation was conducted by Dixon et al. in 1987.8 This group utilized immunohistochemical staining and electron microscopy to evaluate the intramural autonomic innervation of the human vas deferens after vasectomy. Vasal segments were harvested during vasectomy reversal and compared with nonobstructed vasal segments acquired at the time of initial vasectomy. They found that there were marked decreases in the noradrenergic innervation of the testicular vasal remnants in previously vasectomized men. These findings imply that vasal peristalsis, which is mediated by sympathetic autonomic activity, may be irreversibly impaired after vasectomy unless significant regeneration of autonomic nerve fibers occurs in the months and years following vasectomy reversal. Unfortunately, no studies have adequately assessed the regenerative capacity of vasal intramural nerves in humans after vasovasostomy or vasoepididymostomy.

Despite the paucity of anatomic and histologic data in the literature concerning vasal nerve recovery after vasectomy reversal, a study by Shafik et al. did provide further insight regarding vasal autonomic nerve function after vasectomy and vasectomy reversal.9 Shafik utilized transcutaneous electrovasography (EVG) to record the velocity, frequency and amplitude of nerve conduction in the vas deferens in 22 healthy men, 20 vasectomized men, and 18 men after vasectomy reversal. In normal, fertile men there was minimal temporal or individual variability in vasal conduction frequency, amplitude and velocity. In contrast, vasectomized patients exhibited lower conduction frequency and amplitude in the testicular vasal remnant and irregular, described as aberrant “vasoarrhythmic” conduction patterns. One to seven years after vasectomy reversal 7 of 22 patients had successfully conceived. Interestingly, 4 of these 7 patients had a normal electrovasographic evaluation during follow-up while 3 had decreased conduction frequencies and amplitudes but did not exhibit any vasoarrhythmia. This is in contrast to the 11 patients who failed to conceive, all of whom demonstrated electrovasographic evidence of vasoarrhythmia. Notably, the likelihood of abnormal vasal conduction studies was correlated with the interval of vasal obstruction prior to vasectomy reversal. This study suggests that nerve conduction recovery may be variable after vasectomy reversal, and seems to depend upon the interval of vasal obstruction.

Significant changes also occur in epithelial cell ultra-structure within the vas deferens after vasectomy, most of which are thought to result from changes in the intraluminal pressure after vasal ligation (increased pressure in the testicular vasal remnant and decreased pressure in the abdominal vasal remnant). Andonian et al. documented this phenomenon by comparing the ultra-structural features of the abdominal and testicular vasal remnants after vasectomy (harvested at the time of vasectomy reversal) to vasal segments harvested from fertile men undergoing vasectomy.10 Transmission electron microscopic analysis of vasal segments from healthy fertile men revealed the presence of many apical cytoplasmic protrusions from epithelial principle cells into the vasal lumen. Some of these protrusions remained attached to the principle cells by a stalk, whereas others were self-contained within the lumen of the vas deferens, suggesting a secretory process. The cytoplasmic protrusions, termed “apical blebs,” contain ribosomes and endoplasmic reticulum. Interestingly, these investigators observed a marked reduction in the number of apical blebs within the testicular remnants of the vas deferens in vasectomized patients undergoing vasectomy reversal. In addition, they observed dramatic luminal narrowing, epithelial cell flattening, reduction in organelle density, and absence of apical blebs on the abdominal vasal remnant. These findings are suggestive of de-differentiation of vasal epithelium within the abdominal vasal remnant in the absence of contact with seminal plasma. Whether or not these ultra-structural changes are clinically relevant and reversible with vasovasostomy or vasoepididymostomy remains to be determined.

Morphological changes are also apparent in the human epididymides after vasectomy. Older studies of cellular morphology and ultra-structure in the epididymides of vasectomized animals have demonstrated vacuolization and increases in the number and size of lysosomes within epididymal epithelial cells11,12 as well as segmental thinning of the epithelial lining of the vas deferens and epididymis near sites of luminal distension.13 In humans, dilatation of the entire epididymal tubule has been documented, with the most pronounced increase in luminal diameter noted in the cauda. Moreover, the height of the epididymal epithelium is altered by vasectomy. In normal men, maximal epididymal height occurs in the corpus of the epididymis. After vasectomy, however, the maximal height of the epididymal epithelium occurs in the caput.14 Alternations in the height of the epithelial cell layer in the epididymis after vasectomy suggest the presence of complex molecular biological effects of vasectomy on gene expression, as epithelial cellular volume and height are thought to be indicative of underlying RNA translational and protein secretory activities.

Indeed, recent analyses of the human epididymal transcriptome using microarrays have confirmed that vasectomy causes significant alterations in epididymal gene expression. Sullivan et al. characterized the epididymal transcriptomes within each region of the epididymis in both normal and vasectomized men.15Cluster analysis of nearly 3000 genes demonstrated that expression of 1363 genes did not differ based on vasectomy status, whereas 911 genes were expressed only in normal epididymides, and 660 genes were only expressed after vasectomy. Interestingly, three of the differentially expressed genes have well-established roles in sperm maturation during epididymal transit (NPC2, CRISP1, and DCXL).

Unfortunately, no studies have directly examined the impact of vasectomy reversal on gene expression in epididymal fluid or tissue, as the only candidates for such a study would be the rare patients who desire a vasectomy subsequent to successful vasectomy reversal. However, RNA and protein detection studies in semen after vasectomy reversals have suggested that some of the alterations in epididymal gene expression that result from vasectomy may not be reversible.15 The clinical significance of such studies remains to be determined.

Vasectomy with subsequent vasectomy reversal may also be associated with detectable alterations in sperm DNA integrity. Sperm DNA integrity testing has emerged as a valuable measure of sperm quality that is predictive of natural conception, pregnancy outcomes after intrauterine insemination, and pregnancy loss after in vitro fertilization cycles.16,17 The most commonly utilized assay is the sperm chromatin structure assay (SCSA), which is a flow cytometric method that sorts sperm according to their susceptibility to DNA strand breaks upon exposure to a denaturant.

A study by Smit et al. sperm looked at DNA fragmentation with the SCSA in ejaculated semen after vasectomy reversal in 70 men. They demonstrated that sperm DNA fragmentation was increased in the vasectomy reversal patients when compared with proven fertile controls (30% vs. 15%, p < 0.001). The increase in sperm DNA fragmentation was correlated with lower sperm concentrations, lower sperm motility, and a lower percentage of morphologically normal sperm.18 Interestingly, however, there was no relationship between sperm DNA fragmentation and the likelihood of pregnancy after vasectomy reversal. Though the clinical significance of sperm DNA integrity testing after vasectomy reversal remains unclear, this supports the notion that vasectomy likely causes a myriad of molecular biological sequelae, including sperm DNA damage, which may be irreversible in some cases.

Other factors have been isolated and suggested to be associated with infertility after vasectomy reversal, including antisperm antibodies,19,20 granuloma formation21and persistent mechanical partial obstruction,22which may occur despite partial patency and sperm in the ejaculate. Epididymal function, as discussed above, has been widely studied, as has epididymal dysfunction, which is believed by many to be one of the major factors contributing to infertility after vasectomy reversal when post-surgical patency has been established by demonstrating sperm in the ejaculate. Proteins isolated in epididymal fluid harvested at the time of vasectomy reversal, such as GTPase proteins in the Ras/RAB family and Syntenins, likely play a critical in sperm maturation23 and irreversible changes in protein synthesis despite microsurgical vasovasostomy or vasoepididymostomy may play a large role in infertility despite patency after vasectomy reversal.24,25

FAQ-Vasectomy Reversal 101

39bb6928e1c930a935046397f62ef6f5

 

Articles addressing common questions regarding a vasectomy reversal.

A Microscopic Vasectomy Reversal Podcast by Dr. McHugh

If you prefer to read a PDF of Reversal 101

You can schedule your free reversal consultation 24/7 by giving us your phone number and our reversal coordinator will call you with an appointment.

A Urological Vas Deferens “Hat trick?”

hat-trick

What is a “hat trick?” Click image above to find out!

What is a vas deferns “hat trick?” Well…

I am seeing patients one day and come to a room with a chart in the door which says “Post vasectomy.” I note that the patient had had a vasectomy by me about several years  prior to this visit.

I enter the room and there I see a husband and wife and the husband is holding a newborn baby. Only a urologist can really know how it feels to be told of a possibility of a patient having a child after you did the vasectomy. It is not a good feeling…like all the blood goes to your feet feeling.

I ask, “I did your vasectomy?”

The husband says, “Yes”

I say, “Is that y’all’s baby.”

The couple smiles and beaming in unison say, “Yes”

There is a pause. I don’t know really what to say. I was about to say, “I’m sorry. You know there is a one in 2000  chance of these tubes growing back together.”

The wife says, “We are here for a vasectomy.”

Aside: I have had pregnancies after a vasectomy in career about 5 times. Usually it is because the male did not assure sterility by bringing a specimen to the office to be checked. More commonly the couple will have sex too soon after the vasectomy assuming that “If I had a vasectomy then there are no sperm.” They forget that it takes approximately thirty ejaculations to clear the sperm after a properly performed vasectomy. So sex before the sperms clears can cause pregnancy as the sperm is beyond the vasectomy site of occlusion. So even though the urologist never wants to hear about pregnancy after the vasectomy, most commonly it is not because the vasectomy was not performed properly.

Aside 2: It is also common that when a couple has a child after a vasectomy, for whatever the reason, they are happy or shall I say not disappointed about it. Some will say, “It’s God’s will.” By the tone of the conversation with the referenced couple, I felt that they were happy to have a had a child and that were not angry at me nor blaming me for anything. 

Where was I? Anyway I say, “I am sorry about this. You came to me for the vasectomy because you did not want anymore children. Regardless of the cause I apologize and will happily do the vasectomy at no charge.”

The couple appears surprised and the wife says, “We wanted a baby.”

I am relieved and the blood in body is beginning to circulate to my upper extremities again.

Another pause and now the couple appears confused.

The wife says, “Doctor McHugh, there is no reason for an apology. We are very happy.”

The husband says, “Remember…you did my vasectomy reversal last year. We just had this beautiful baby and now I want a vasectomy.” The nurse had failed to put the most recent note in the chart of this patient which would have let me know this patient had had a reversal.

So…I do the vasectomy.

A vasectomy, a reversal and baby, and then another vasectomy. A urological vas deferns “Hat trick.”

Ta Daaaaaaaaaaaaaaaa!

237f903-hat

Does prior sperm aspiration have a negative impact on vasectomy reversal?

A lot of couples debate which of the two major methods of having a child after vasectomy they should pursue. Often times it is a decision based on cost. For that couple wanting to do IVF first, this study shows no significant scarring as a result of the aspiration and no significant negative effect to a successful vasectomy reversal.

Vasectomy Reversal Possible After PESA

Urology – July 30, 2008 – Vol. 24 – No. 07

Vasectomy reversal is possible after percutaneous sperm aspiration.

Article Reviewed: Results of Vasovasostomy or Vasoepididymostomy After Failed Percutaneous Epididymal Sperm Aspirations. Marmar JL, Sharlip I, Goldstein M: J Urol; 2008; 179 (April): 1506-1509.

Results of Vasovasostomy or Vasoepididymostomy After Failed Percutaneous Epididymal Sperm Aspirations.

Marmar JL, Sharlip I, Goldstein M:
J Urol; 2008; 179 (April): 1506-1509

Background: 4% to 6% of men consider having children after vasectomy. Choices are either vasectomy reversal or sperm aspiration for in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI). Percutaneous sperm aspiration (PESA) is one way for sperm retrieval, but the degree of epididymal damage is unknown. The request for microsurgical reconstruction after failed PESA is limited.

Objective: To investigate the ability to perform vasectomy reversal after failed PESA-IVF-ICSI. Design: Retrospective study involving a specialized subset of patients who requested and underwent a vasectomy reversal after PESA. Participants: 8 patients who failed 1 to 4 attempts at IVF-ICSI with sperm retrieved by PESA. Methods: Patients were identified from the records of 3 experienced infertility microsurgeons. The side of the PESA was determined. Vasovasostomy (VV) or vasoepididymostomy (VE) was performed based on standard of care–intraoperative fluid from the testicular end of the vas. Two-layer VV or end-to-side/2-stitch VE was performed. Postoperative semen analysis was performed at 3-month intervals. Results: All patients had bilateral PESAs performed. Of the 8 patients, 4 had no apparent abnormality to the caput of the epididymis, 2 had small blue cysts at the caput, and 2 had small areas (<0.5 cm) that appeared necrotic or ischemic. No specific puncture site for the PESA could be seen at the time of reconstruction. Ten of 16 vasal units had sperm in the testicular end of the vas at the time of vasectomy reversal. Six of 16 vasal units had pasty fluid and required VE, and 1 patient had a bilateral VE. The time from vasectomy was from 15 to 22 years. All patients postoperatively had sperm in the ejaculate from 1 to 200 million/cc, with 15% to 90% motility. Surgery resulted in 4 pregnancies leading to deliveries. Conclusions: PESA caused only limited trauma to the epididymis with 87.5% of patients able to have a vasovasostomy on at least one side. Vasoepididymostomy was more likely related to the duration from vasectomy than due to scarring from PESA. Reviewer’s Comments: This paper reports on an important question about a simple percutaneous procedure to retrieve sperm for IVF-ICSI. A select group of men will want to undergo vasectomy reversal after a failed IVF-ICSI cycle. This paper answers the concern about possible scarring from PESA–it does not appear to. The technique did not differ in outcome despite 3 different surgeons involved for both PESA and reversals. The study is, of course, limited by the small number, but this surgery is not performed very often. The ability to bypass/avoid scarring at the epididymis may be related to several ducts coming from the rete testes to become efferent ducts before becoming a single tubule. The caput is often the target for PESA; therefore, if any scarring occurs, then the other efferent ducts may provide sperm down the epididymis. (Reviewer–Ajay K. Nangia, MBBS).

 

 

What to expect after a vasectomy reversal…is it like having a vasectomy?

From Vasectomy.com

What You Can Expect After a Vasectomy Reversal

Vasectomy reversals are longer and more complicated than the original vasectomy procedure. Because of that, recovery takes more time, although it is still fairly quick. In general, side effects after a reversal tend to be mild and disappear within a short period of time.

The First Few Days

During the first couple of days after surgery, you may experience slight swelling or bruising in the scrotum. In addition, the surgery and anesthesia could cause a headache, general pain, and nausea, among other short-lived side effects.

To soothe the scrotal area and help minimize swelling during the first few days, you’ll need to elevate your legs, stay off your feet, and use ice packs. You’ll need to avoid submerging the incision in water fort he first 48 hours after the procedure–showers after a day or so are just fine but avoid baths and swimming, both of which increase the risk of infection. Your surgeon will also give you a course of antibiotics to prevent infection.

Contact your doctor immediately if you have sudden chills or fever, swelling or pain that gets worse, or drainage from the site of surgery. These are all potential signs of infection.

The First Few Weeks

After a vasectomy reversal, you will gradually be able to return to your previous physical activities, typically over the course of three to four weeks.

Within a week or so you should be able to return to work and handle most of your normal routine, but you’ll want to avoid major physical activity for two to three weeks. This includes heavy lifting, working out, and excessive walking or driving.

You should also be able to resume sexual activity within two to three weeks; the procedure should have no effect on your sex drive nor your ability to have an erection or orgasm.

Pregnancy after Reversal

Your doctor will begin checking for the presence of sperm in your semen after one or two months, and will continue testing periodically until sperm have reached acceptable levels. It’s normal for sperm to take several months to appear in ejaculate, and it can sometimes take up to 15 months for them to return.

One way in which the success of a vasectomy reversal is measured is sperm count and sperm motility. Both of these may not return to a normal range for three to six months. Overall, 92 percent of vasectomy reversals result in sperm returning to the semen.

The ultimate test for whether a reversal has been successful, however, is pregnancy, which can sometimes occur as quickly as a few months after the procedure or as long as several years later. Roughly 30 to 60 percent of vasectomy reversals ultimately lead to natural pregnancies, and over half result in pregnancy within two years.

Reviewed November 19, 2012 by Sarah K. Girardi, MD – Urologist

References

van Dongen J, Tekle FB, van Roijen JH. Pregnancy rate after vasectomy reversal in a contemporary series: influence of smoking, semen quality and post-surgical use of assisted reproductive techniques. BJU Int. 2012; 110(4):562-7.

Michielsen D, Beerthuizen R. State-of-the art of non-hormonal methods of contraception: VI. Male sterilisation. Eur J Contracept Reprod Health Care. 2010 Apr;15(2):136-49.

Vasectomy Reversal-Age of the female is important.

dsc_0132

In addition to the skill of the surgeon, the character of the fluid at the time of the reversal, and years since the vasectomy…the age of the female is an important factor in achieving pregnancy.

What Affects Pregnancy, Patency Rates After Vasectomy Reversal?

Urology – October 30, 2015 – Vol. 33 – No. 4

The Silber grading scale appears to dictate pregnancy rates after vasectomy reversal with increasing female age being a negative predictive factor.

Article Reviewed: Impact on Pregnancy of Gross and Microscopic Vasal Fluid During Vasectomy Reversal. Ostrowski KA, Polackwich AS, et al: J Urol; 2015;194 (July): 156-159.

Background: The examination of the vasal fluid at the time of vasectomy reversal has implications for surgical decision making with effects on patency and pregnancy rates. The Silber grading system characterizes these findings and has been used to help surgeons with the decision to perform vasovasostomy (VV) or the more technically challenging vasoepididymostomy (VE).

Objective: To determine both intraoperative and patient factors that affect pregnancy rates after vasectomy reversal.

Design: Retrospective review of prospectively maintained database.

Methods: This paper reviewed the results of a single surgeon series that encompassed >30 years of vasectomy reversals. Vasal fluid was characterized as opalescent, creamy, pasty or clear and intraoperative light microscopy was used determined if sperm parts were present or motile. Univariate and multivariate analysis examined the data set for significant factors that affected pregnancy rates.

Results: 2947 vasectomy reversals were included in the analysis. Pregnancy status was only known for 31% of these cases. Bilateral VV was performed 83% of the time and most patients fell into a Silber 1 to 3 classification. No factors met statistical significance for increasing the pregnancy rate, although the presence of motile sperm was almost significant (P =0.075).

Negative predictive factors for pregnancy were identified on multivariate analysis with increasing female age and the findings of either no sperm (odds ratio [OR], 0.08) or sperm heads only (OR, 0.46) on microscopy decreasing pregnancy rates. Rarely were sperm parts identified when pasty fluid was encountered.

Conclusions: The findings from this paper echo the findings of the Vasovasostomy study group, with the Silber grading system essentially dictating pregnancy rates.

Reviewer’s Comments: The decision to perform VV or VE can be a difficult one and is based on many factors including findings from the vasal fluid, time since vasectomy, and surgeon skill level. Few papers have examined this decision-making algorithm since the landmark paper by the Vasovasostomy study group in 1991. While most microsurgeons prefer VV to VE due to increased patency and pregnancy rates, the need to perform a VE is generally encouraged when pasty fluid or no sperm parts are found in the vas at the time of reversal. These findings are interesting and are another important addition to the literature. Unfortunately, despite the authors’ efforts, relatively few predictive factors were found. Their findings do somewhat parallel those published by the Vasovasostomy study group, wherein the Silber grading system appears to correlate with pregnancy rates. The authors identified sperm heads only (Silber 4) or no sperm (Silber 5) as negative predictors with motile sperm (Silber 1) almost achieving statistical significance as a positive factor.(Reviewer–Charles Welliver, MD).

Tubal ligation vs. Vasectomy-which is more common?

1427215753am

The more invasive tubal ligation still outnumbers vasectomy among the options for permanent sterilization for couples. The rationale for this involves speculation, but male partner anxiety surrounding issues of sexual function have been proposed and are certainly evident when counseling males before vasectomy.

Urology – April 30, 2016 – Vol. 34 – No. 1
Vasectomy is not associated with decreased frequency of sexual intercourse.
Article Reviewed: Relationship Between Vasectomy and Sexual Frequency. Guo DP, Lamberts RW, Eisenberg ML: J Sex Med; 2015;12 (September): 1905-1910.
Background: Men often report the concern that having a vasectomy will impair their future sexual function.

Objective: To determine in an objective and quantifiable manner if vasectomy leads to a decrease in sexual frequency.

Design: The authors analyzed data from the National Survey of Family Growth (NSFG), which is a large survey of American households.

Continue reading Tubal ligation vs. Vasectomy-which is more common?

Vasectomy Reversal Better With Same Partner as Prior to Vasectomy-Georgia Vasectomy Reversal

IMG_3116

If nothing else…this article is interesting. Although the most common cause of desiring a vasectomy reversal is a male who has had children and a vasectomy has remarried someone with no children. This study showed that %17 of the time a reversal is desired by a couple who have had a vasectomy and now desire more children. Their success rate is higher than if the male remarries and has a reversal.

Vasectomy Reversal Better With Same Partner as Prior to Vasectomy 

Urology – July 30, 2015 – Vol. 32 – No. 12

Vasectomy reversal success in regard to clinical pregnancy is improved if the patient has the same partner before and after vasectomy.

Article Reviewed: Higher Outcomes of Vasectomy Reversal in Men With the Same Female Partner as Before Vasectomy. Ostrowski KA, Polackwich AS, et al: J Urol; 2015;193 (January): 245-247.

Background: Vasectomy reversal is requested by around 6% of men who previously had undergone a vasectomy and desire subsequent fertility. Frequently, this is due to a new relationship; however, some couples desire another child or may have lost a child. Two small prior studies have suggested improved pregnancy rates following vasectomy reversal with the same partner as before vasectomy.

Objective: To determine if clinical pregnancy and birth rates are higher for men undergoing vasectomy reversal with the same female partner.

Design: Retrospective review of a prospectively collected database.

Methods: All patients from a single surgeon were reviewed from 1978 to 2011. Obstructive interval, surgery type, vasal fluid character, and sperm character were recorded. Men either self-reported pregnancy and birth rates or completed a survey response. All patients had at least 12 months of follow-up data.

Results: Over the time frame, 3135 men underwent vasectomy reversal; 17% (524 men) undergoing vasectomy reversal had the same female partner. A total of 258 (49%) responded to the survey, and 89% (229) underwent bilateral vasectomy reversal. The average patient and partner age was significantly higher in the same partner group compared to the new partner group, although the same partner group had a significantly shorter obstructive interval at 5.65 years versus 9.23 years. Overall, the clinical pregnancy rate for men with the same partner was 83% compared with 60% in men with a new partner. After regression, this maintained an odds ratio of 2 and was significant.

Conclusions: Men undergoing vasectomy reversal with the same partner experience a higher pregnancy rate compared men with a new partner.

Reviewer’s Comments: This article supports prior articles by Kolettis et al and Goldstein et al. The larger number of patients provides an excellent dataset even though it is a single surgeon. The success rates are substantially higher and maintain significance, even after controlling for ages and obstructive interval. It is also useful to have typical data of a 60% pregnancy rate for those with a new partner. Many patients are interested in “success” following surgery, and this is not solely a desire to have sperm return to the ejaculate. There are limitations, however, because the survey results were returned by only 49% of patients, leaving the potential for reporting bias. Overall, this information is useful when counseling patients with the same partner as prior to vasectomy.(Reviewer–Gregory Lowe, MD).

 

Author: Ostrowski KA, Polackwich AS, et al
Author Email: hedgesja@ohsu.edu

Does having a vasectomy cause prostate cancer?


Journal of Clinical Oncology September 2016

By Rebecca L Anderson, Eric J Jacobs, Christina C Newton, Victoria L Stevens
Purpose In a recent large prospective study, vasectomy was associated with modestly higher risk of prostate cancer, especially high-grade and lethal prostate cancer. However, evidence from prospective studies remains limited. Therefore, we assessed the associations of vasectomy with prostate cancer incidence and mortality in a large cohort in the United States.
Patients and Methods We examined the association between vasectomy and prostate cancer mortality among 363,726 men in the Cancer Prevention Study II (CPS-II) cohort, of whom 7,451 died as a result of prostate cancer during follow-up from 1982 to 2012. We also examined the association between vasectomy and prostate cancer incidence among 66,542 men in the CPS-II Nutrition Cohort, a subgroup of the CPS-II cohort, of whom 9,133 were diagnosed with prostate cancer during follow-up from 1992 to 2011. Cox proportional hazards regression modeling was used to estimate multivariable-adjusted hazard ratios (HRs) and 95% CIs.
Results In the CPS-II cohort, vasectomy was not associated with prostate cancer mortality (HR, 1.01; 95% CI, 0.93 to 1.10). In the CPS-II Nutrition Cohort, vasectomy was not associated with either overall prostate cancer incidence (HR, 1.02; 95% CI, 0.96 to 1.08) or high-grade prostate cancer incidence (HR, 0.91; 95% CI, 0.78 to 1.07 for cancers with Gleason score ≥ 8).

Conclusion Results from these large prospective cohorts do not support associations of vasectomy with either prostate cancer incidence or prostate cancer mortality.