Partial obstruction, not antisperm antibodies, causing infertility after vasovasostomy

Area of Science:

• Urology
• Reproductive Medicine
• Andrology

Background:

• Male infertility affects a significant portion of couples seeking reproductive assistance.
• Vasovasostomy, a procedure for vasectomy reversal, can sometimes lead to partial obstruction and antisperm antibodies, contributing to persistent infertility.
• Distinguishing specific causes of post-vasovasostomy infertility is crucial for effective treatment.

Purpose of the Study:

• To differentiate infertile men with partial obstruction and antisperm antibodies post-vasovasostomy from those with only antisperm antibodies.
• To evaluate the efficacy of repeat microsurgical reversal in men with partial obstruction and antisperm antibodies after vasovasostomy.

Main Methods:

• Indirect immunobead testing was used to assess antisperm antibodies in 412 patients.
• Patients with >20% antibody binding were categorized by history: vasovasostomy, varicocele, cryptorchidism, or epididymo-orchitis.
• Semen analysis and antibody binding variables were compared; pregnancy rates were analyzed post-treatment.

Main Results:

• Men with a history of vasectomy and reversal showed significantly lower sperm concentration, motility, and antibody binding compared to other groups.
• Of 20 patients with vasectomy reversal history, 14 diagnosed with partial obstruction underwent repeat reversal.
• Repeat reversal resulted in a 50% pregnancy rate, significantly higher than the 17.2% rate with assisted reproduction for the remaining patients.

Conclusions:

• Antisperm antibodies are not the primary factor in persistent infertility after vasovasostomy when specific criteria are met.
• Repeat microsurgical reversal is the most successful treatment for selected infertile men with partial obstruction and antisperm antibodies post-vasovasostomy.