Vasectomy reversal outcomes in men after testosterone therapy

Bash, Jasper; Lo, Jamie O.; Kapadia, Akash A.; Mason, Malachi; Hedges, Jason C.

doi:10.1038/s41598-022-22823-8

Cited by 2 publications

(2 citation statements)

References 13 publications

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“…The current investigation represents that largest analysis of the impact of TT on VR outcomes published to date. Consistent with the findings of the current study, a retrospective case series of 14 men by Bash et al ( 2022) 8 reported high rates of VV (96%) and sustained patency rates among patients using TT prior to VR. Moreover, Coward et al (2014) 9 reported an overall patency rate of 83% with spontaneous pregnancy rates of 50% among 6 men with prior TT, suggesting that VR after TT can have outcomes comparable to those in the general population.…”

Section: Discussionsupporting

confidence: 91%

Testosterone therapy at the time of vasectomy reversal

Grober,

Blankstein

2024

CUAJ

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Introduction: During vasectomy reversal (VR), accurate intraoperative microscopic assessment of the vasal fluid for sperm presence and quality is essential in determining the indication for a vasovasostomy (VV) or vasoepididymostomy (VE). The use of testosterone therapy (TT), known to supress spermatogenesis, can potentially interfere with this determination. This initiative evaluated the impact of TT on vasal and epididymal fluid sperm characteristics and intraoperative decision-making among men on TT at the time of VR. Methods: Of 2622 consecutive VRs performed from 2007–2023, patients actively using TT at the time of VR were identified. Details as to the type, dose, and duration of TT were documented. All patients were counselled regarding the impact of TT on spermatogenesis and encouraged to discontinue TT if possible. During VR, vasal and epididymal fluid (as indicated) was sampled and each aspirate underwent microscopic evaluation for sperm presence and quality, and categorized as: motile sperm/intact-non-motile sperm/sperm parts/no sperm. Rates of sperm presence/absence in the vasal/epididymal fluid, frequency of VV/VE, postoperative patency (presence of motile sperm), and semen parameters were compared among patients on TT vs. clinically matched patients not using TT at the time of VR. Results: Among the 2622 VRs reviewed, 54 men (2%) reported using TT at the time of their VR. Despite its impact on spermatogenesis, intraoperative microscopic analysis of the reproductive fluid (vasal or epididymal) identified the presence of sperm in 95% (51/54) of patients. Testis biopsy confirmed sperm production among three patients with absence of sperm within the vasal or epididymal fluid. Rates of VV or VE did not significantly differ among men using TT at the time of VR compared to nonusers. Postoperative patency rates (TT: 78 % vs. no TT: 93%) and mean total motile sperm counts (TMC) were lower among patients using TT at the time of VR (7.9 vs. 28.3, p=0.02). Conclusions: Use of TT at the time of VR does not appear to impact rates of intraoperative microscopic identification of sperm within the reproductive fluid or the indication for VV/VE. Postoperative patency rates and total motile sperm counts may be lowered by use of TT. Moreover, the determination to the etiology azoospermia postoperatively (production vs. obstruction) may be clouded by the use of TT during VR.

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Section: Discussionsupporting

confidence: 91%

Testosterone therapy at the time of vasectomy reversal

Grober,

Blankstein

2024

CUAJ

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“…Ultimately, 95 studies were included in this review. Eighty studies were included in the quantitative analyses, 25–104 whereas 15 studies were only included in the quantitative synthesis (Figure 1). 105–119 …”

Section: Resultsmentioning

confidence: 99%

Vasovasostomy: A systematic review and meta‐analysis comparing macroscopic, microsurgical, and robot‐assisted microsurgical techniques

Seth,

Gibson,

Bulloch

et al. 2023

Andrology

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Background and objectivesVasovasostomy is a cost‐effective procedure for the reversal of vasectomy. A water‐tight adequately blood‐supplied mucosal anastomosis is required for better outcomes. This review aimed to compare the outcome of vasovasostomy performed by three different techniques: macroscopic, pure microsurgical, and robot‐assisted microsurgical techniques.MethodsScopus, Web of Science, PubMed, Embase, and Cochrane library databases were searched for relevant studies from January 1901 to June 2023. We conducted our quantitative syntheses using the inverse variance method in OpenMeta software. The study's protocol was registered on PROSPERO.ResultsThis review involved 95 studies of different designs, with a total sample size of 48,132. The majority of operations were performed bilaterally, and participants were monitored for up to 10 years. The pooled patency rate was the highest following robot‐assisted vasovasostomy (94.4%), followed by pure microsurgical vasovasostomy (87.5%), and macroscopic vasovasostomy (83.7%). The pooled pregnancy rate following purely microsurgical vasovasostomy was higher than that of macroscopic vasovasostomy (47.4 vs. 43.7%). Definitive pregnancy rates in robotic vasovasostomy are yet to be determined.ConclusionPatency outcomes for vasovasostomy were best with robot‐assisted microsurgical technique, followed by pure microsurgical technique, and conventional macroscopic technique. Further investigations of robot‐assisted microsurgical vasovasostomy outcomes and randomized control trials are required to support this evidence.

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Vasectomy reversal outcomes in men after testosterone therapy

Cited by 2 publications

References 13 publications

Testosterone therapy at the time of vasectomy reversal

Testosterone therapy at the time of vasectomy reversal

Vasovasostomy: A systematic review and meta‐analysis comparing macroscopic, microsurgical, and robot‐assisted microsurgical techniques

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