Study Conducted by Physician-Scientists at NewYork-Presbyterian/Weill Cornell
Sep 23, 2004
The small number of men who remain with their female partner and undergo microsurgical vasectomy reversal — performed because of the death of a child or a change of heart — achieve a much higher natural pregnancy and live-birth rate than the overall group of men who undergo vasectomy reversal — most commonly due to divorce and remarriage. The reasons for this discrepancy, identified in a new study by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, are not yet fully understood.
Of the 2.6 percent men who underwent vasectomy reversal while remaining with their female partner, 86 percent were able to achieve a natural pregnancy during a three-year follow-up period, compared to 54 percent for the cohort group. Additionally, the live-birth rate for the same-partner group was 82 percent, compared to 63 percent for the cohort group. Most impressively, among a subgroup of patients that experienced the death of a child (one-third of the same-partner group), the live-birth rate was 100 percent. The NewYork-Presbyterian/Weill Cornell study was published in the journal Fertility and Sterility.
"There are a few possible explanations for this discrepancy, although further study is necessary," says Dr. Marc Goldstein, the study's lead author, Professor of Reproductive Medicine and Urology at Weill Cornell Medical College, and Surgeon-in-Chief of Male Reproductive Medicine and Surgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.
According to the study, it is possible that couples who had children together before vasectomy have a proven "reproductive compatibility," which contributes to superior natural fertility outcomes post-reversal. (All couples in the same-partner group had children before vasectomy.) Additionally, the fact that these men are determined to undergo surgical reconstruction in order to have children may be a sign that the couples are more than normally dedicated to achieving pregnancy. This emotional dedication factor — which may include a firmer commitment to timing sexual intercourse to the female partner's cycle, avoiding potential environmental toxins, and stress reduction, among other reasons — is seemingly underscored by the 100-percent live-birth rate of the subgroup of patients in which the child had died previously.
"While these two hypotheses may help explain the high success rate of the same-partner group, when one looks at the success rates — especially those of the subgroup that experienced the death of a child — one is almost tempted to believe that there may be a 'higher power' at work," says Dr. Goldstein.
According to Dr. Goldstein, the current study's findings are even more surprising considering that the mean age of the female partners in the same-partner group (37.2 years) is significantly higher than in the historic cohort (29.9 years) — a fact that would normally translate to a lower fertility rate in the same-partner group.
The study employed a retrospective analysis of 1,048 vasectomy reversals performed between 1986 and 2002 by Dr. Goldstein. The study looked at men who remained with the same female partner for more than nine years prior to the vasectomy reversal and three years after the procedure. All men in the cohort group remained with their new partners for three years post-reversal. All female partners were also evaluated by reproductive gynecologists in order to ensure fertility.
The study notes that the same-partner group had a mean time since vasectomy of 6.2 years, compared with 8.1 years for the cohort group. But even when this was controlled for, the results were still superior in the same-partner group. (Pregnancy rates are the same for men who undergo vasectomy reversal one year post-vasectomy or 15 years post-vasectomy, according to a study by Dr. Goldstein, published in the January Journal of Urology.)
Vasectomy reversal with microsurgical vasovasostomy (VV) or vasoepididymostomy (VE) has been established as a more cost-effective fertility management option compared with up-front assisted reproduction, such as in vitro fertilization (IVF). Vasovasostomy involves a reconnection of the vas deferens to the vas deferens. Vasoepididymostomy connects the vas deferens to the epididymis, a duct that carries sperm to the vas deferens. In general, if sperm is present in the vas fluid, VV is performed. If sperm is not present in the vas fluid, VE is performed. Both outpatient procedures take less than three hours.
Approximately half a million vasectomies are performed each year in the U.S., and it is estimated that between 2 percent and 6 percent of the men will ultimately seek reversal.
Recognized as leaders in the field of male reproductive surgery, Dr. Goldstein and his colleagues at the Center for Male Reproductive Medicine and Microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have received honors for their instructional videos. In 2003, they received the American Urological Association's "Audio-Visual Award" (first prize) for "Ultra-Precise Multilayer Microsurgical Vasovasostomy: Trick of the Trade." And in 2002, they received American Society for Reproductive Medicine's "Best Video Award" for "Three Techniques of Microsurgical Intussusception Vasoepididymostomy: Cost-Effective Options for Obstructive Azoospermia."