Factors influencing the success rate of pregnancy following microscopic vasovasostomy for postvasectomy sterility

Mo, Seong Jong; Park, Tong Choon

Abstract

Vasectomy has become a popular method for male sterilization in Korea and this, in turn, has been followed by an increase in the number of patients requesting vasectomy reversal. Recently, many authors have reported a high success rate of vasovasostomy using microsurgical techniques. However, a significant discrepancy persist between the patency and pregnancy rate despite improvements in surgical techniques. A total of 200 patients undergoing vasovasostomy from May 1983 to April 1990 were reviewed. Of these 200 patients, only 130 patients (98 patients by two-layer, 32 patients by modified two-layer technique) could be followed up and analyzed as to pregnancy rate related to age, vasal obstructive interval, gross appearance and sperm quality of the vas fluid, operative method, and presence or absence of sperm granuloma. Success rates were 90.3% for patency and 65.4% for pregnancy. With regard to factors influencing to operation, it seemed that the results were better when there was a shorter vasal obstructive interval, watery vas fluid, presence of normal morphologic sperm quality, presence of sperm granuloma, and when the operation was done using the two-layer technique. However, no statistically significant difference was found, except between the bilateral presence and absence of sperm granuloma at the vasectomy site. Thus it is suggested that the most important single factor influencing the success rate of vasovasostomy is a meticulous and skillful operative technique itself, althought other factors may affect the outcome. More effort and research are needed to find the factors affecting the success rate of vasovasostomy.