Microscopic vasectomy reversal 30 years later: a summary of 4010 cases by the same surgeon.

Between 1975 and 2003, a total of 4010 patients have undergone microscopic vasectomy reversal by 1 surgeon at 1 institution. Of these cases, 3904 had available records and 1735 were successfully contacted to obtain reliable long-term data. A total of 1556 (89.7%) were able to establish a pregnancy in their female partner, resulting in 2111 pregnancies. When there was no sperm in the vas fluid at the time of vasectomy reversal, vasoepididymostomy was performed rather than vasovasostomy. A total of 1581 patients underwent bilateral vasovasostomy; 1184 underwent vasoepididymostomy on one side and vasovasostomy on the other side; and 1139 underwent bilateral vasoepididymostomy. Of patients undergoing vasovasostomy, 2.1% had no sperm in the ejaculate postoperatively, and 10.3% of patients undergoing bilateral vasoepididymostomy had no sperm in the ejaculate postoperatively. Thus on average a patency rate of 96.2% in the total group of patients was achieved. When the vasectomy was less than 10 years prior to reversal, the patency rate was 98%. When the vasectomy was 10 or more years prior to reversal, the patency rate was 93%. Among all the patients, 77.7% had sperm counts greater than 5 million/mL postoperatively. Among patients undergoing bilateral vasovasostomy and those undergoing bilateral vasoepididymostomy, 92.5% and 84.3% eventually achieved a pregnancy, respectively. The pregnancy rate did not differ with patients that had a sperm count of greater than 5 million sperm/mL. The pregnancy rate for less than 5 million sperm/mL was 78.3% and when there was greater than 5 million sperm/mL the pregnancy rate was 91.9%. Although the duration of time between vasectomy and vasectomy reversal had an impact on preg-