Work

Prognostic Factors for Pregnancy and Patency Rates After Microsurgery for Obstruction of the Upper Seminal Tract: A Retrospective Single-surgeon Series of 336 Cases

Year: 2025

Type: article

Abstract: In our study, nearly 87% of men regained their fertility after surgery for vasal obstruction and approximately half of the couples achieved pregnancy, with shorter times since vasectomy leading to better outcomes. The length of time between vasectomy and reconstruction is a key factor for success. To achieve optimal results in treating vasal obstruction, microsurgery is the standard of care. However, not all vasovasostomy (VV) or vasoepididymostomy (VE) procedures lead to subsequent pregnancy. Identification of parameters that can predict success in restoring fertility is clinically relevant. We evaluated various parameters in relation to patency and pregnancy outcomes in a retrospective single-surgeon series. We analysed data for 336 men with azoospermia due to vasal obstruction who underwent microsurgery to restore fertility. Seminal fluid was harvested intraoperatively from the testicular stump for analysis of gross quality. Intraoperative parameters, time to conception, patency rate, age of the female partner, and time from vasectomy to reconstruction were assessed in relation to pregnancy outcomes. Multivariable logistic regression was performed to identify independent prognostic parameters. The median age at surgery was 42 (range 27–70) yr for the men and 33 (range 19–46) yr for their female partners. The overall patency rate after surgery was 86.8% (236/272). Secondary obstruction occurred in 14/272 men (5.1%). Pregnancy was achieved in 127/258 couples (49.2%). The most significant predictor of successful treatment was the obstruction time ( p < 0.01), with significantly lower success rates for longer times since vasectomy. None of the intraoperative parameters we analysed was associated with subsequent pregnancy. The primary limitation of our study is its retrospective design. Patency and pregnancy rates in our series are similar to rates reported in the literature. Pregnancy success after vasectomy reversal mainly depends on the time since vasectomy. Additional biomarkers are needed to predict postoperative pregnancy outcomes. In our study, nearly 87% of men were fertile again after surgery to reverse a vasectomy, and about half of the couples were then able to get pregnant. The key factor for success was the time since vasectomy, with better results for shorter times. More research is needed to find reliable ways to predict if a couple will get pregnant after this surgery.

Source: European Urology Open Science

DOI: 10.1016/j.euros.2024.08.010

Authors: Marco A. Sieber, Jan Blaser, Roland Seiler, Dominik Abt, Jennifer Blarer, Adrian Sieber

Institutions: Spitalzentrum Centre hospitalier Biel- Bienne, University of Bern, University Hospital of Bern

Language: English

Topic: Male Reproductive Health Studies

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,800