Shorter Obstructive Intervals and Motile Sperm on Intraoperative Vasal Fluid Evaluation Predict Favorable Semen Parameters Following Vasovasostomy

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BACKGROUND: Vasectomy reversal is the primary method of fertility restoration for men who wish to pursue natural conception following vasectomy. The existing body of literature evaluating vasovasostomy (VV) success is primarily focused on endpoints that capture the presence or absence, rather than the quantity and quality, of sperm in postoperative semen analyses (SAs). OBJECTIVES: To identify reproductive and surgical factors associated with favorable postoperative semen parameters in men who underwent bilateral VV. MATERIALS AND METHODS: We performed a retrospective study of men meeting strict inclusion criteria who underwent bilateral VV at a large academic center. Postoperative semen parameters, operative findings, and clinical characteristics were analyzed. Associations between predictors and semen outcomes were evaluated using univariate linear and logistic regression models. RESULTS: One hundred men who underwent bilateral VV were included in the final analysis. The median age was 39.9 years, and the median obstructive interval was 8.6 years. Those with motile sperm on initial postoperative SA had shorter mean obstructive intervals (8.1 vs. 11.0 years, p = 0.04) and had a higher proportion of motile sperm in vasal fluid during intraoperative assessment (51.1 vs. 8.1%, p = 0.01). Fifty-eight percent of men (n = 44/76) exhibited a TMSC > 4.55 million, the lowest TMSC with a confirmed spontaneous pregnancy in our cohort. Motile sperm on postoperative SA were best predicted by the intraoperative presence of motile sperm in vasal fluid (OR: 11.51, 95% CI: 1.43-93.01, p = 0.02) and shorter obstructive intervals (OR: 0.87, 95% CI: 0.76-0.99, p = 0.04) on univariate regression. Postoperative normozoospermia was associated with shorter obstructive intervals (OR: 0.80, 95% CI: 0.69-0.92, p = 0.002) but was not statistically associated with the intraoperative presence of motile sperm. DISCUSSION: These findings highlight the utility of intraoperative vasal fluid evaluations for postoperative prognostication. CONCLUSION: Intraoperative sperm motility and obstructive interval duration are predictive of postoperative semen quality.

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