The relationship between intravasal sperm quality and patency rates after vasovasostomy.

PURPOSE: Most surgeons examine the intravasal fluid at vasectomy reversal. Vasovasostomy is performed when sperm are identified in the intravasal fluid or when sperm are absent but the fluid is copious and clear. When sperm are absent and the intravasal fluid is not copious and clear, vasoepididymostomy is often performed. Frequently the intravasal fluid contains only fragments of sperm. This study examines patency rates after microsurgical vasovasostomy as a function of the quality of sperm in the intravasal fluid.

MATERIALS AND METHODS: The records of patients who had undergone microsurgical vasovasostomy were reviewed. The intravasal fluid was examined and sperm quality was recorded as no sperm, sperm heads, sperm with short tails or whole sperm. Results of postoperative semen analyses were recorded. Patency rates and postoperative semen parameters were compared.

RESULTS: A total of 53 patients satisfied the entrance criteria. Ages ranged from 25 to 53 (mean age 39). Mean obstructive interval was 9.9 years (range 1 to 20). Overall patency was 98% (52 of 53 cases). Patency rates were 95% for the group with sperm heads and 100% for whole sperm, sperm with short tails and absent sperm groups. Patency rates did not vary significantly as a function of intravasal sperm quality.

CONCLUSIONS: Modern microsurgical techniques yield excellent patency rates. The presence of sperm parts compared to whole sperm does not adversely affect patency rates after vasovasostomy. Vasovasostomy should be performed if any sperm parts are identified in the intravasal fluid.