Feb 19, 2004
Debunking a popular myth about vasectomy, a new study by physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center finds that vasectomy reversal is highly effective, even 15 years or more after the vas deferens, the tube that carries sperm, is blocked. The study, published in the January Journal of Urology, documents the highest pregnancy rates following vasectomy of any study to date.
Whether a man had a vasectomy this year or 15 years ago, there was no difference in the pregnancy rate achieved following a vasectomy reversal, with an average 84-percent likelihood of pregnancy over two years, the study finds. (Comparatively, healthy men without vasectomy can expect a pregnancy rate of 90 percent.) Previous studies have demonstrated pregnancy rates following vasectomy reversal of only 50-60 percent, a difference that can be attributed to advances in vasectomy-reversal techniques. The study also finds that at intervals of greater than 15 years, the pregnancy rate dropped to 44 percent.
Vasectomy is not a permanent condition. For men who had a vasectomy less than 15 years ago, a reversal will result in a much higher pregnancy rate than sperm aspiration and in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). Even at intervals greater than 15 years, reversal outcomes will equal or exceed those of IVF with ICSI, 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 Microsurgery at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. IVF with ICSI results in pregnancy rates of up to 50 percent per attempt at the best centers, and may take two or three tries to achieve one pregnancy.
Additionally, vasectomy reversal is a more cost-effective option, especially for couples seeking more than one child, adds Dr. Goldstein. IVF with ICSI typically costs approximately two to three times more than vasectomy reversal. And, unlike IVF with ICSI, a reversal is covered by health insurance in certain states, including New York.
Men seek to reverse a vasectomy for two main reasons: they either remarried or they lost a child, says Dr. Goldstein. Approximately half a million vasectomies are performed each year in the U.S., and it is estimated that between two percent and six percent of the men will ultimately seek reversal.
The study involved a retrospective analysis of 213 vasectomy reversals performed at NewYork-Presbyterian Hospital/Weill Cornell Medical Center between 1984 and 2001. Outcomes data were stratified according to obstructive interval: less-than 5 years, 5-10 years, 10-15 years, and greater than 15 years. Only men with fertile female partners were studied.
The study also found that the level of patency (or lack of obstruction) in the vas deferens remained high up to 15 years, averaging at 90 percent, and holding at this rate no matter when the vasectomy was performed. This finding contradicts other study results; this may be explained by the recent introduction of improved surgical techniques for vasectomy reversal. One such technique, the microdot method for precision suture placement, was pioneered by Dr. Goldstein in 1998.
Another vasectomy myth holds that the presence of granulomas knots that form in the vas deferens when a vasectomy is too tight result in a higher patency and pregnancy rate. The current study finds that granulomas, which occurred in 28 percent of vasectomies, did not increase patency to a statistically significant level and had no impact on pregnancy.
The study represents the first analysis of pregnancy and patency following two different types of vasectomy reversal vasovasostomy (VV) and vasoepididymostomy (VE) finding that patients who underwent a bilateral VV had a significantly greater patency rate (95%) than patients who had unilateral VV and VE (83%) and bilateral VE (83%). However, pregnancy rates were consistent.
Vasovasostomy (VV) involves a reconnection of the vas deferens to the vas deferens. Vasoepididymostomy (VE) 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.
For men unable to achieve pregnancy following VV or VE, the next step is assisted reproductive techniques such as intra-uterine insemination (IUI) or IVF with ICSI, says Dr. Goldstein.
The study's co-authors are Dr. Stephen Boorjian, a urology resident at NewYork-Presbyterian Hospital/Weill Cornell and Michael Lipkin, a medical student.
Recognized as leaders in the field 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: Tricks of the Trade. And in 2002, they received the American Society for Reproductive Medicine's Best Video Award for Three Techniques of Microsurgical Intussusception Vasoepididymostomy: Cost-Effective Options for Obstructive Azoospermia.