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  • Title: Factors influencing the outcome of vasectomy reversal.
    Author: Bagshaw HA, Masters JR, Pryor JP.
    Journal: Br J Urol; 1980 Feb; 52(1):57-60. PubMed ID: 7426952.
    Abstract:
    Fifty-six vasectomy reversals performed during the period 1976 to 1978 have been reviewed with reference to factors which might influence the outcome. Spermatozoa appeared in the ejaculate in 51 (91%) and remained in numbers greater than 10 million per ejaculate in 35 (63%). The wives of 14 men conceived. The following factors have been shown to be associated with a favourable result: a short delay between vasectomy and its reversal, a short previously resected segment, opalescent fluid from the cut lower end of the vas and the absence of circulating antisperm antibodies. A substantially higher conception rate was achieved when the husband had remained with his original partner. Sixty-two testicular biopsies obtained at the time of vasectomy reversal were examined by light microscopy and showed no gross impairment of spermatogenesis. Immunofluorescent techniques failed to show the presence of antigen antibody complexes in 36 testicular biopsies and in 12 vasal stumps. Factors other than operative procedures which might affect the outcome of vasectomy reversal were analyzed. 56 men, aged 21-44 years, requesting vasectomy reversal were studied; reversal was by a technique similar to that of Amelar and Dubin (1979); at the time of reversal, testicular biopsy was performed, vas segment excision noted, and blood samples taken both pre- and postoperatively. Spermatozoa appeared in the ejaculate of 91% of men (51 of 56); 63% had greater than 10 million sperm/ejaculate. Plateau sperm counts were generally achieved by 6 months postreversal, though some had greater than 10 million sperm by 1 month; however, the early appearance of sperm was of no long-term prognostic importance. Conception occurred with equal frequency throughout the range of patients with semen quality better than 10 million sperm/ejaculate, and resumption of fertility was unrelated to age. By the time of this review, 14 partners had conceived. 4 factors were isolated from this review which could be associated with a favorable result after reversal: 1) time period between vasectomy and reversal, with the shorter the better; 2) length of resected segment (the shorter the better); 3) presence of opalescent fluid from the cut lower end of the vas; and 4) absence of circulating anti-sperm antibodies. As important was that a substantially higher conception rate was found among men who remained with the same sexual partner from pre- to postvasectomy through reversal. The testicular biopsies, examined by light microscopy, showed no damage to spermatogenesis, and 36 of 62 biopsy specimens did not reveal the presence of antigen-antibody complexes by immunofluorescence.
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