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  • Title: Experience with macroscopic vasectomy reversal at the Medical College of Wisconsin.
    Author: Dewire DM, Lawson RK.
    Journal: Wis Med J; 1994 Mar; 93(3):107-9. PubMed ID: 8009877.
    Abstract:
    Thirty-two men underwent vasectomy reversal using loupe magnification at the Medical College of Wisconsin between 1984 and 1991. Semen analysis and pregnancy data were available for 27 of them, and sperm were present in the ejaculate of 24, representing a patency rate of 89%. Pregnancy was established by 11, for a pregnancy rate of 41%. These results suggest that vasovasostomy using loupe magnification provides acceptable rates of patency and pregnancy, although the pregnancy rate appears to be somewhat lower than that reported for microsurgical repair. The lower cost of macroscopic vasectomy reversal may outweigh the potential statistical advantages for some couples. 32 men underwent vasectomy reversal using 2.0x to 4.0x loupe magnification at the Medical College of Wisconsin between 1984 and 1991. The mean patient age was 36 years. The mean interval from vasectomy to reversal was 6.4 years (range 1 to 18 years). All procedures were performed on an outpatient basis, using local anesthesia with intravenous sedation. Anastomoses were completed using a modification of the technique described by Middleton. A semen analysis was obtained 1 to 3 months postoperatively. The medical record of each patient was reviewed to determine data for semen quality. Patients were contacted by telephone to determine pregnancy status as of July 1993. Semen analysis and pregnancy data were available for 27 of the 32 men (84%) who underwent vasectomy reversal between 1984 and 1991. Sperm were present in the ejaculate of 24 men, representing a patency rate of 89%. 11 men (41%) established pregnancies during the study interval. A complete semen analysis including sperm count, percent motility, and morphology was performed in 23 patients. Semen quality was determined according to World Health Organization standards for normal. 5 men (22%) had normal postoperative semen quality in all 3 parameters. 15 (65%) men were subfertile in one or more parameters. Three patients (13%) had no sperm present in the ejaculate. Regarding pregnancy according to semen quality, 60% (3 of 5) of the men with normal postoperative semen analyses established a pregnancy, while 40% (6 of 15) of the patients with subfertile semen quality produced pregnancies. Vasovasostomy using loupe magnification provides acceptable rates of patency and pregnancy as compared to microsurgical repair, although the pregnancy rate appears to be slightly better with microsurgery. Because of the potential cost benefits to both the patient and the surgeon, the relatively simple macroscopic vasovasostomy will continue to play a role in the management of postvasectomy male infertility.
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