Approximately 5% of men who undergo vasectomy eventually will consider vasectomy reversal, and this demographic appears to be increasing.
The question is, how do we further improve patency rates following vasovasostomy? The answer may lie in specific technical variations at the time of vasectomy, as this article will discuss. We outline four specific aspects of vasectomy technique designed to aid the urologic microsurgeon in performing MVR with greater potential for success.
Interval between vasectomy and reversal
The success of microsurgical vasectomy reversal progressively worsens as the interval of time from vasectomy increases. The Vasovasostomy Study Group reviewed the results of vasectomy reversal in 1,247 men and showed a clear relationship between the time interval between vasectomy and subsequent microsurgical reversal and the rate of return of sperm on SFA and pregnancy (J Urol 1991; 145:505-11). If the interval of obstruction following vasectomy was less than 3 years, the rate of sperm appearance on SFA and rate of eventual pregnancy were 97% and 76%, respectively; if the length of the interval was from 3 to 8 years, the rates were 88% and 53%, respectively. If the interval length was from 9 to 14 years, the rates were 79% and 44%, respectively; and if the interval was 15 or more years long, the rates were 71% and 30%, respectively. Thus, an important factor to consider is the time interval between vasectomy and the request for vasectomy reversal.
The median duration of a first marriage is 7.2 years, with subsequent marriage occurring 5.8 years after the divorce (Monthly Vital Statistics Report, March 22, 1995, vol. 43). This would indicate that, on average, a man would seek vasectomy reversal between 6 and 13 years after vasectomy. While urologists cannot influence when a man will seek vasectomy reversal, information can be distributed prior to vasectomy outlining the relationship between the obstructed interval and ultimate success of vasectomy reversal.