Microscopic visualization of intravasal spermatozoa is positively associated with patency after bilateral microsurgical vasovasostomy

Abstract

SUMMARYWe evaluated pre-operative and intraoperative factors associated with successful patency following bilateral microsurgical vasovasostomy (VV). We retrospectively reviewed the charts of 1331 men who underwent bilateral VV by two surgeons between 2006 and 2013. Vasal fluid was examined intraoperatively for gross quality (i.e., clear or opaque and creamy/thick) and for the presence of spermatozoa on microscopy (i.e., whole spermatozoa, sperm fragments, or azoospermia). Post-operative patency was assessed by semen analysis or patient report of conception. Perioperative factors were explored using descriptive statistics and examined in logistic regression models for associations with post-operative patency. The median age at VV was 39 years [interquartile range (IQR): 35-44] and the median obstructive interval (OI) was 7 years (IQR: 4-11). Overall, 1307 patients achieved post-operative patency (98%) while 24 remained obstructed (2%). Among those who became patent, 410 reported conception. After adjustment for potential confounders, only microscopic examination of the intravasal fluid for the presence of spermatozoa (bilateral or unilateral whole spermatozoa vs. sperm parts/azoospermia) at the time of VV was significantly associated with post-operative patency with an odds ratio (OR) of 14.2 (95% CI: 5.8-34.9; p = <1 9 10 À8 ). Identification of bilateral or unilateral sperm fragments vs. azoospermia was also associated with increased odds of post-operative patency with an OR of 3.5 (95% CI: 0.9-13.6; p = 0.08). There was no statistically significant association between age at VV, OI, presence of granuloma, gross fluid quality, or surgeon and post-operative patency after controlling for potential confounders. Identification of whole spermatozoa in the vasal fluid at the time of VV was positively associated with post-operative patency. Our findings stress the need for intraoperative microscopy to aid in post-operative patient counseling.

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade

“…In a systematic review and meta‐analysis of the reports on the association between the presence of sperm in the intraoperative vasal fluid and patency, it was reported that the odds ratio of postoperative patency was 4.1‐fold higher in the presence of intravasal sperm or sperm parts than in their absence . Another study confirmed the association between the presence of intravasal spermatozoa during a VV and having a successful patency outcome in a large series from 2 experienced surgeons (n = 1331) . It also showed that the odds of postoperative patency were ~14‐fold higher in the presence of intravasal whole spermatozoa than by having merely sperm fragments or azoospermia.…”

“…It reported that a longer obstructive interval, an absence of a sperm granuloma on physical examination, and the presence of sperm or sperm parts at the time of reversal were associated with the success of a VR. The predictors of postoperative patency and pregnancy that have been reported in recent years are summarized in Table . With marked improvement in reproductive techniques, including microscopic epididymal sperm aspiration and TESE in combination with ICSI, the number of treatment options for couples who are challenged with male infertility has increased.…”

“…Some reports show that the intraoperative sperm status, including the gross fluid quality and microscopic characteristics, are strong predictors of postoperative patency . During the operation, the surgeon's decision to proceed with a VV rather than with a VE depends on the gross fluid quality that is expressed from the testicular end of the vas deferens and the microscopic examination of the fluid.…”

“…Surgeons' experience also affects the patency rate as a predictor in relation to the VV and VE . The odds ratio of postoperative patency was 3.8‐fold higher in those patients who were operated on by an experienced surgeon (number of operations: 1250 cases) than in those patients who were operated on by an inexperienced surgeon (number of operations: 57 cases) …”

“…The predictors of postoperative patency and pregnancy that have been reported in recent years are summarized in Table 4. 38,41,[67][68][69][70][71][72][73][74][75] With marked improvement in reproductive techniques, including microscopic epididymal sperm aspiration and TESE in combination with ICSI, the number of treatment options for couples who are challenged with male infertility has increased.…”