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- Title
Pregnancy after vasectomy: surgical reversal or assisted reproduction?
- Authors
Valerie, U.; De Brucker, S.; De Brucker, M.; Vloeberghs, V.; Drakopoulos, P.; Santos-Ribeiro, S.; Tournaye, H.; Uvin, Valerie
- Abstract
<bold>Study Question: </bold>Should we opt for surgical vasovasostomy or IVF/ICSI after a vasectomy?<bold>Summary Answer: </bold>Both options reveal acceptable pregnancy rates though the time to pregnancy was significantly lower in the immediate IVF/ICSI group.<bold>What Is Known Already: </bold>About 7.4% of men regret their vasectomy and express a renewed child wish. The choice between surgical vasectomy reversal or ICSI remains difficult for patients and their fertility specialist.<bold>Study Design, Size, Duration: </bold>This study was a retrospective single-center cohort analysis of all males with a vasectomy in the past seeking treatment between 2006 and 2011 (n = 163). One group of patients opted for a reanastomosis procedure while the others opted for an immediate IVF/ICSI treatment. This included 99 males who underwent reanastomosis and 64 couples who immediately underwent ICSI treatment.<bold>Participants/materials, Setting, Methods: </bold>All reanastomosis procedures were done by the same surgeon. ICSI was used in all cases where testicular sperm were extracted by fine needle aspiration (FNA) or testicular sperm extraction (TESE).<bold>Main Results and the Role Of Chance: </bold>The mean male age at vasectomy was 35.5 years and 44.4 years at reanastomosis. The mean (range) obstructive interval was 9.53 years (1-27). No significant differences were found between the two groups in female patient characteristics, such as age and parity. In the reversal group, the crude cumulative delivery rate (CDR) was 49.5%. However, in the 45 patients of this group who attempted to conceive spontaneously ('primary reanastomosis' pathway), the crude CDR was 40.0%. The remaining 54 patients (the 'switchers' pathway) who underwent a reversal procedure and later switched to ART, had a crude CDR of 57.4%. Of these, four patients opted for insemination, including two who later decided to switch to IVF/ICSI. The 64 patients who immediately underwent IVF/ICSI ('primary IVF/ICSI' pathway) had a crude CDR of 43.8% and an expected CDR of 51.6%. The difference in delivery rates between the primary reanastomosis group (40.0%) and the primary IVF/ICSI group (43.8%) was not statistically significant. Time to pregnancy was significantly shorter in the primary IVF/ICSI pathway, at 8.2 versus 16.3 months in the reanastomosis group.<bold>Limitations, Reasons For Caution: </bold>The study population was rather small. Furthermore, the study may be limited by the fact that the reason for the renewed child wish in most cases was a new relationship with another woman, a factor which may also play a role in the cause of infertility.<bold>Wider Implications Of the Findings: </bold>Recanalisation of the vas seems to be a reasonable alternative for patients who do not wish to undergo immediate IVF/ICSI. In those who opt for ART immediately, the cumulative pregnancy rates seem comparable but the pregnancies occurred earlier.<bold>Study Funding, Competing Interest(s): </bold>No funding was used for this study. There is no conflict of interest for this study.<bold>Trial Registration Number: </bold>N/A.
- Subjects
VASOVASOSTOMY; MALE infertility; HUMAN in vitro fertilization; PREGNANCY; REPRODUCTIVE technology
- Publication
Human Reproduction, 2018, Vol 33, Issue 7, p1218
- ISSN
0268-1161
- Publication type
journal article
- DOI
10.1093/humrep/dey101