Vasectomy reversal outcomes and long-term kinetics: a multiinstitutional cohort

To compare vasectomy reversal outcomes among surgeons, including long-term success rates.

Datasets from eight centers were collated to perform analyses. Some centers maintained prospective databases of outcomes, whereas others performed a retrospective chart review to abstract preoperative, intraoperative, and postoperative information.

Men undergoing vasectomy reversals for fertility purposes.

Descriptive and comparative analyses of the datasets were performed to evaluate differences in outcomes across surgical centers.

The primary outcome measures were patency and sperm concentration at 1 year after reversal. Secondary outcomes included comparisons among preoperative patient factors, postoperative patency/concentrations at various timepoints, and changes in sperm kinetics over time. Only variables with at least 10 datapoints were included in the analyses.

A total of 4,568 patients were analyzed, with 2,398 having ≥2 semen analyses and 1,222 with at least one test >1 year. Patency rates at 1-year among surgeons ranged from 54%-93% (median of surgeons 82%), with median concentrations of 0-18.5 million/mL (median of surgeons 10.3 million/mL). Although preoperative patient characteristics were relatively similar, nearly every operative and postoperative factor assessed was statistically different among surgeons. Epididymovasostomy rates were linearly correlated with time since vasectomy. Although sperm patency and concentrations demonstrated a general decline over time, outcomes were surgeon-dependent and, counterintuitively, appeared inversely correlated with time since vasectomy (i.e., longer duration since vasectomy may have better patency long-term). In analyzing factors that were able to discriminate outcomes among surgeons, the use of sperm testing at 1 year appeared superior to earlier time points, with no appreciable differences observed using >0, ≥1 million/mL, or ≥5 million/mL sperm concentrations. Patients with tests >1 year had poorer outcomes compared with those without testing >1 year, suggesting that the currently reported findings at >1 year may be overly pessimistic and may overrepresent those with poorer initial results.

Patency rates and sperm concentration at 1 year vary widely among surgeons, with median sperm concentration generally declining as time since vasectomy reversal increases. Sperm outcomes at 1 year additionally appear to better discriminate among surgeons compared with other time points and may represent a preferred time point for defining success. Given the inherent limitations of retrospective data, the results likely underestimate true long-term outcomes.