Vasovasostomy: multiple children and long-term pregnancy rates

To determine the long-term patency and pregnancy rates after vasovasostomy and to determine the likelihood of having more than 1 child after this procedure.

We performed a retrospective examination of 73 patients that were at least 4 years out from vasovasostomy at our institution. Patients and their partners completed questionnaires that focused on their pre- and post-procedure fertility, vasal obstructive interval, time to pregnancy, and the number of children conceived. All patients were asked to obtain a current semen analysis.

From a population of 73 patients with proven prior fertility, 43 could be contacted for data collection. Of the 43 men, 39 (91%) reported that they had actively tried to father children. These 39 men are a mean of 84.8 months (range, 4 to 10 years) out from their surgery, with a mean vasal obstructive interval of 87 months (7.4 years). All men denied using assisted reproduction techniques except the father of the only twins, who reported the use of ICSI for female-factor infertility. He was excluded from further pregnancy calculations. Forty-five percent of couples achieved at least 1 pregnancy, whereas 6 of 17 (35%) conceived 2 children. Mean time to conception was 14.7 months for the first child and 51 months for the second (range, 13 to 108 months). In those that did not conceive (n = 21), the mean obstructive interval was 106 months versus 81 months for those that did conceive. This time interval was not statistically different (P > 0.05). Mean maternal age was significantly less in those that did versus those that did not conceive (32.2 vs 36.6 years) (P < 0.01). We also noted that 10 of 21 were with a different spouse that had never been pregnant. Three of these 10 had known female-factor fertility problems. Semen analyses were obtained in 6 of the 21 patients that did not father children. Only 1 of the 6 was azoospermic. Thirteen (33%) desired more than 1 child at the time of vasectomy reversal.

After vasovasostomy in patients with a vasal obstructive interval of 7 years, up to 45% of couples may achieve pregnancy and up to 35% could go on to conceive a second child. Long-term anastomosis patency after the procedure is estimated to be approximately 60%. Maternal age is a significant factor in predicting a couple's success in conceiving a child. Vasovasostomy remains a highly effective option for restoration of fertility in vasectomy patients, while offering the opportunity for multiple pregnancies with only a single intervention.