What is the best pregnancy rate that may be expected from vasectomy reversal?

Abstract

Pregnancy rates after vasectomy reversal vary among different reporting surgeons. To study those patients who are most likely to achieve pregnancy after vasectomy reversal, and to eliminate the effect of variations in surgical technique and operative findings on surgical outcome, the pregnancy rate after vasectomy reversal was calculated in men who achieved completely and consistently normal postoperative semen analyses (sperm concentration 20 x 10(6)/ml. or more and sperm motility 50% or greater). Of 95 patients who met the study criteria 58 (61.1%) achieved pregnancy and 37 (30.9%) did not. Including an allowance for some patients who will achieve pregnancy beyond the study-followup, it is concluded that the maximum pregnancy probability for vasectomy reversal is approximately 67%. Failure to achieve pregnancy in approximately a third of the patients may be explained by partner infertility, epididymal dysfunction and sperm antibodies. Studies that report pregnancy chances in excess of two-thirds must have different patient demographics and/or different methods of statistical analysis.

PIP: A urologist at the California-Pacific Medical Center in San Francisco studies 95 vasectomy reversal patients who either had a normal semen analysis during any 12 consecutive months after vasectomy reversal or within 3 months of achieving conception to determine their pregnancy rate. The urologist had performed the vasectomy reversal in all 95 cases between 1977 and 1989. This would minimize the effect of variations in surgical technique and operative findings on surgical outcome. The mean interval between vasectomy and reversal was 7.6 years. The spouse of 58 patients (61.1%) became pregnant. The average interval between vasectomy reversal and conception was 8.5 months. The average sperm count stood at 60.4 million/ml. Average sperm motility stood at 65.5%. Another study showed that the longterm pregnancy rate would be about 9% greater than the pregnancy rate at 12 months of normal semen analysis, which would place the San Francisco study's expected longterm pregnancy rate at 66.6% (i.e., 61.1% + 5.5% [9% of 61.1%]). Partner infertility, epididymal dysfunction, sperm antibodies, and other unknown factors may account for the 30.9% failure rate. Different patient demographics, and/or different methods of statistical analysis may account for studies with pregnancy rates greater than 66%.