Long-term patency and pregnancy after vasovasostomy: a comprehensive review.

BACKGROUND Vasovasostomy (VV) is often pursued by men seeking natural conception after vasectomy. Microsurgical VV is associated with high patency rates (~95%) and moderate pregnancy rates (~40%), according to existing literature. However, long-term outcome data remain limited. This review evaluates patency and pregnancy rates at ≥12 months following microsurgical VV.

MATERIALS AND METHODS A comprehensive literature search was conducted via PubMed using the terms "vasovasostomy," "patency rate," and "pregnancy rate." Studies were included if they reported patency or pregnancy outcomes ≥12 months post-VV. Data were categorized and analyzed using MedCalc, applying the Freeman-Tukey transformation for normalization.

RESULTS Only four clinical studies reported long-term patency data, and six studies reported long-term pregnancy rates following microsurgical VV. Patency rates ranged from 77% to 99%, with a mean follow-up of 25 months. Patency was defined as the presence of any sperm in the ejaculate in five studies, and as >1 million non-immotile sperm/mL in one study. Using the >1 million sperm definition, the patency rate was 77% at 12 months, but decreased to 33% when defined as ≥30% motile sperm in the ejaculate. Pregnancy rates across the six studies ranged from 28% to 54%, with a mean follow-up of 21 months.

CONCLUSIONS Long-term patency and pregnancy rates following VV vary widely due to inconsistent definitions and limited follow-up data. These findings underscore the need for standardized outcome measures and longitudinal follow-up to better understand factors influencing long-term success after VV.