During a 5-year period between 1973 and 1977, 87 patients underwent vasovasostomy to correct postvasectomy sterility. Sixty-one patients had single-layer macroscopic reanastomoses and 26 patients had two-layer microscopic reanastomoses. Patency rates of 90% and 96% and pregnancy rates of 46% and 54% for the macroscopic and microscopic techniques were achieved.
PIP: The experience with macroscopic and microscopic reanastomoses was compared in a series of 87 patients ages 24-53 who underwent vasovasostomy to reverse a previous vasectomy. The average interval since vasectomy was 5 years. 61 of these patients had single-layer macroscopic reanastomoses and 26 patients had 2-layer microscopic reanastomoses. Criteria for inclusion in the study were availability for 1-year follow-up, sterility secondary to vasectomy, and a report of pregnancy validated by a sperm count. Patients with congenital and inflammatory vasal occlusions and vasoepididymal anastomoses were excluded. 41 patients in the macroscopic technique group met these criteria. Spermatozoa were present in the ejaculates of 37 patients, for a patency rate of 90%. There were 19 pregnancies in this group, yielding a pregnancy rate of 46%. Of the 26 patients in the microscopic technique group, 25 had spermatozoa in their ejaculate, for a 96% patency rate. There were 14 pregnancies, yielding a 54% pregnancy rate. The discrepancy noted in this series between the patency and pregnancy rates is consistent with results of other research. Analysis of data collected in this series suggests that a low pregnancy rate is associated with a low sperm count. Men with sperm counts 35 million achieved ad 25% pregnancy rate compared with a 77% rate for men with counts 35 million. In addition, patients presenting for vasectomy reversal 2 years after vasectomy had a 100% patency rate and an 88% pregnancy rate overall. Comparison of the rates for the 2 techniques suggests only a slight advantage to use of the microscope. Factors other than technique may be involved in pregnancy achievement. However, use of the microscope is favored so that convoluted vas and epididymis can be explored in cases where the lumen in the cut and of the vas is not enlarged or where no sperm are found in the fluid from the cut end. It is predicted that the microscopic technique will provide better pregnancy rates in the future as experience is accumulated.