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The fate of cryopreserved sperm acquired during vasectomy reversals
D B Glazier1, J L Marmar, E Mayer
1Division of Urology, Robert Wood Johnson Medical School, Camden, New Jersey, USA.
Insights
Intraoperative sperm banking during vasectomy reversal provides valuable insurance for future fertility. Cryopreserved sperm enabled successful intracytoplasmic sperm injection pregnancies, particularly for men with post-surgery low sperm counts.
Area of Science:
- Reproductive Medicine
- Urology
- Cryobiology
Background:
- Intraoperative sperm banking during vasectomy reversal is a recommended practice.
- Cryopreserved sperm serve as a backup for potential future fertility treatments like intracytoplasmic sperm injection (ICSI).
Purpose of the Study:
- To evaluate the utilization and outcomes of intraoperative sperm banking in patients undergoing vasectomy reversal.
- To assess the fate of cryopreserved sperm specimens collected during vasectomy reversal procedures.
Main Methods:
- Sperm banking was performed intraoperatively on 48 out of 75 patients undergoing vasectomy reversal.
- Cryopreservation included epididymal sperm, testicular tissue, and vasal sperm specimens.
- Follow-up data were collected on specimen usage and pregnancy outcomes.
Main Results:
- 14.6% of couples used cryopreserved sperm for ICSI, with successful fertilization and embryo development.
- Two live births resulted from ICSI using cryopreserved epididymal sperm.
- Natural pregnancy rates after vasectomy reversal were 43.7%, with an average time to pregnancy of 1 year.
Conclusions:
- Cryopreservation of sperm during vasectomy reversal is advisable for patients undergoing vasoepididymostomy or vasovasostomy.
- Sperm banking is particularly beneficial for men with persistent azoospermia or severe oligospermia post-surgery and for older women undergoing ICSI.
- While only a fraction of couples utilized banked sperm, the ICSI success rate and natural pregnancy rates offer valuable insights for patient counseling.
Purpose:
Intraoperative sperm banking has been recommended during vasectomy reversal. These specimens are maintained as insurance for possible future intracytoplasmic sperm injection. We evaluated the fate of specimens collected intraoperatively from 48 vasectomy reversal patients.
Materials And Methods:
Of 75 men 48 (64.0%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm, 81 vials of testicular tissue and 13 vials of vasal sperm were cryopreserved.
Results:
Among couples who stored sperm 10 (20.8%) voluntarily discarded the specimens within 4 months of vasectomy reversal. Specimens from 31 couples (64.5%) remain in storage. Seven couples (14.6%) have used frozen sperm for intracytoplasmic sperm injection. In 3 of these couples the men were azoospermic after surgery, 2 men had 10,000 to 15,000 sperm per ml. in the ejaculate with limited motility and 2 had 1 to 2 million sperm per ml. with limited motility. The 7 women who underwent intracytoplasmic sperm injection ranged between 37 and 39 years old, which was older than the mean age of the remaining study group (32.7 years). With intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) developed into embryos. Of 7 women 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurred in 7 of 16 vasectomy reversal couples (43.7%) who were followed at least 18 months postoperatively but the time to pregnancy averaged 1 year.
Conclusions:
Cryopreservation of sperm collected at vasectomy reversal is recommended for patients undergoing vasoepididymostomy or vasovasostomy. The couples who used the cryopreserved sperm for intracytoplasmic sperm injection included husbands whose postoperative ejaculate remained azoospermic or severely oligospermic and wives who were approaching 40 years old. Only a limited number of couples (14.6% of the study group) have used the cryopreserved sperm but the delivered newborn rate (28.6%) was comparable to other intracytoplasmic sperm injection data. The natural pregnancy rate after vasectomy reversal was 43.7% but the time to pregnancy after surgery was lengthy (average 1 year). These findings may be helpful for counseling couples who are planning vasectomy reversal surgery and may be considering intraoperative sperm banking.