Frozen semen -- a poor form of fertility insurance.

Two previously fertile males have requested surgical vasectomy reversal after divorce and failure of their new younger wives to conceive by repeated inseminations with their stored frozen semen. The sperm had been preserved for six and five years, respectively, as "fertility insurance" prior to sterilization by bilateral vasectomy. It is clear that the storage of fertile semen does not guarantee future fertility.     

Should vasectomy reversal be performed in men with older female partners?

PURPOSE: An assumption exists that men with older female partners who seek treatment of post-vasectomy infertility should undergo in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) rather than vasectomy reversal. Although several studies have reviewed ICSI success rates with advancing maternal age, to our knowledge none has compared them to outcomes for vasectomy reversal in men with older partners. MATERIALS AND METHODS: The records of all patients with ovulating partners older than 37 years who underwent vasectomy reversal from 1994 through 1998 were reviewed. Patients were contacted to establish pregnancy and birth rates. Costs of vasectomy reversal, testicular sperm extraction, IVF and ICSI were obtained from the financial office of our institution. RESULTS: A total of 29 patients underwent vasectomy reversal with a followup of 3 to 59 months (median 25). Median male age was 46 years (range 37 to 67) and median female age was 40 years (range 38 to 48). A total of 5 pregnancies and 4 live births were achieved. In the 23 patients followed for more than 1 year the pregnancy rate was 22% and live birth rate was 17%. Using this 17% birth rate at our $4,850 cost for vasectomy reversal the cost per newborn was $28,530. In comparison, using the 8% birth rate per cycle of ICSI for women older than 36 years at a cost of $8,315 for testicular sperm extraction and 1 cycle of IVF with ICSI, the cost per newborn was estimated at $103,940. CONCLUSIONS: Vasectomy reversal appears to be cost-effective to achieve fertility in men with ovulating partners older than 37 years.     

Need for sperm retrieval and cryopreservation at vasectomy reversal

PURPOSE: Controversy exists on whether to obtain sperm for cryopreservation routinely at vasectomy reversal. With recent improvements in in vitro fertilization with intracytoplasmic sperm injection, it is now possible to obtain a small amount of testicular tissue for cryopreservation in the event of reversal failure. However, to our knowledge no studies exist of who is most likely to benefit from this procedure. MATERIALS AND METHODS: We reviewed 84 consecutive vasectomy reversals performed by 1 surgeon (J. I. S.) between July 1996 and March 2000 with followup available for 77. We grouped cases by procedure as vasovasostomy, vasoepididymostomy and vasovasostomy with vasoepididymostomy as well as bilateral or unilateral. Sperm was retrieved at reversal in 15 of 46 vasovasostomy (none used), 11 of 18 vasoepididymostomy (3 used) and 13 of 20 vasovasostomy with vasoepididymostomy (none used) cases. RESULTS: The overall anastomotic patency rate after unilateral or bilateral vasovasostomy, unilateral vasovasostomy with contralateral vasoepididymostomy and unilateral or bilateral vasoepididymostomy was 96%, 83% and 57%, respectively. The natural pregnancy rate without in vitro fertilization was 57%, 50% and 14%, respectively. The most recent vasoepididymal anastomoses were performed by the Berger triangulation technique with a 78% patency and 25% pregnancy rate. Only 8% of men with banked sperm eventually used it for assisted reproductive techniques, in whom unilateral or bilateral vasoepididymostomy failed in all. CONCLUSIONS: We currently do not recommend routine sperm retrieval for cryopreservation in men who undergoing vasovasostomy. We encourage men who require bilateral vasoepididymostomy to bank sperm at reversal. In men who undergo vasovasostomy with vasoepididymostomy we base the decision on preoperative counseling and intraoperative findings.     

Results of 1,469 microsurgical vasectomy reversals by the Vasovasostomy Study Group

During a 9-year period 1,469 men who underwent microsurgical vasectomy reversal procedures were studied at 5 institutions. Of 1,247 men who had first-time procedures sperm were present in the semen in 865 of 1,012 men (86%) who had postoperative semen analyses, and pregnancy occurred in 421 of 810 couples (52%) for whom information regarding conception was available. Rates of patency (return of sperm to the semen) and pregnancy varied depending on the interval from the vasectomy until its reversal. If the interval had been less than 3 years patency was 97% and pregnancy 76%, 3 to 8 years 88% and 53%, 9 to 14 years 79% and 44% and 15 years or more 71% and 30%. The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures and they were statistically the same for all patients regardless of the surgeon. When sperm were absent from the intraoperative vas fluid bilaterally and the patient underwent bilateral vasovasostomy rather than vasoepididymostomy, patency occurred in 50 of 83 patients (60%) and pregnancy in 20 of 65 couples (31%). Neither presence nor absence of a sperm granuloma at the vasectomy site nor type of anesthesia affected results. Repeat microsurgical reversal procedures were less successful. A total of 222 repeat operations produced patency in 150 of 199 patients (75%) who had semen analyses and pregnancy was reported in 52 of 120 couples (43%).     

Vasoepididymostomy for Vasectomy Reversal: A Critical Assessment in the Era of Intracytoplasmic Sperm Injection

Purpose

We compared vasoepididymostomy to microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection for treatment of epididymal obstruction secondary to vasectomy.

Materials and Methods

Results in patients who underwent vasoepididymostomy for vasectomy reversal at our institution were compared to those reported previously for microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection performed for obstructive azoospermia. The pregnancy rates, delivery rates, complications, cost per procedure and cost per delivery were compared. A cost per newborn analysis was performed using pregnancy and delivery rates, and reported cost estimates for the complications of assisted reproductive techniques.

Results

A total of 55 men underwent 58 vasoepididymostomies in an attempt to restore fertility after vasectomy. Median followup was 19 months (range 0 to 115). Median obstructive interval was 12 years. There were no major complications. The patency rate after 6 months was 85%. Of the couples 20 achieved 24 pregnancies and 16 had 17 live births. The pregnancy rate at 1 year was 44%. There were 4 miscarriages and there are 3 ongoing pregnancies. The live delivery rate was 36%. Assuming a 29% delivery rate for microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection, the cost per newborn was $51,024, compared to $31,099 for vasoepididymostomy.

Conclusions

Vasoepididymostomy is more successful and more cost-effective than microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection for vasectomy reversal. It does not expose the women to complications in the treatment of a male problem and it is indicated for treatment of epididymal obstruction secondary to vasectomy. Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection should be reserved for cases not amenable to surgical reconstruction.     

A Retrospective Review of Factors Associated with Vasovasostomies in United States Military Members

Background

Men seeking a vasectomy should receive counseling prior to the procedure that includes discussion of later seeking a reversal. We sought to determine demographic factors that may predispose patients to possibly later seek a vasectomy reversal.

Methods

All U.S. Military electronic health records were searched between 2000 and 2009 for either a vasectomy or vasovasostomy procedure code. Aggregate demographic information was collected and statistical analysis performed.

Result

A total of 82,945 patients had a vasectomy of which 4,485 had a vasovasostomy resulting in a vasovasostomy-to-vasectomy rate of 5.04%. The average age at vasovasostomy was 34.9±5.0, with an average interval of 4.1±2.2 years. Men undergoing a vasectomy at a younger age were more likely to have a vasovasostomy. Various religions did have statistically significant differences. Within ethnic groups, only Native Americans [OR=1.39 (95% CI 1.198-1.614)] and Asians [OR=0.501 (95% CI 0.364-0.690)] had statistically significant differences when compared to Caucasians. Men with more children at the time of vasectomy were more likely to have a vasovasostomy.

Conclusion

Younger men, Native Americans, and men with more children at vasectomy were more likely to undergo a vasovasostomy. The reason for these differences is unknown, but this information may assist during pre-vasectomy counseling.Key Words: Vasovasostomy, Vasectomy counseling, Demographics, Infertility     

Reversal of vasectomy using a macroscopic technique: a retrospective study.

Eighty-five men underwent vasectomy reversal in our department between 1981 and 1994. All operations were performed without the aid of magnification. The results of semen analysis was available in 66 and the patency rate was 74%. A postal survey was sent to patients we could follow up, and among those who replied the pregnancy rate was 41% (16/39 respondents). These results are similar to those found by others using a macroscopic reversal of vasectomy and since the operator does not rely on the use of a microscope, which both incurs an added cost and requires extra expertise, we feel that the operation as described has a part to play in the management of men seeking reversal of vasectomy.     

Laser-assisted vasectomy reversal: experience in 32 patients

A Food and Drug Administration approved protocol using a microsurgical carbon dioxide laser to assist in vasectomy reversal was instituted in January 1987. Between January 1987 and December 1988 the procedure was performed on 32 patients, 31 of whom submitted sperm and were available to evaluate. Success rates for sperm in the ejaculate in patients who underwent vasectomy less than 10 years previously were excellent, approaching 95%. The pregnancy rate in this group was 35%. In patients whose vasectomy was performed more than 10 years before reversal the results were much poorer. The success rate for sperm in the ejaculate was only 36% and the pregnancy rate was only 9%. The advantage of laser-assisted vasectomy reversal is that it is a simpler technical procedure that requires considerably less time than a 2-layer microsurgical technique. There were no significant complications, sperm granuloma, or even significant swelling or hematoma in any patient operated upon. Laser-assisted vasectomy reversal is at least equal to conventional microsurgical techniques and definitely easier to perform surgically.     

The impact of obstructive interval and sperm granuloma on outcome of vasectomy reversal

PURPOSE: We studied the impact of the interval from vasectomy to reversal and presence of sperm granuloma on outcomes of reversal. MATERIALS AND METHODS: A total of 213 microsurgical vasectomy reversals performed by a single surgeon were stratified according to obstructive intervals of less than 5 years, 5 to 10 years, 10 to 15 years and greater than 15 years. The effects of obstructive interval on patency and pregnancy rates were assessed using multivariate logistical regression. The impact of sperm granuloma on patency and pregnancy was assessed using the chi-square test. RESULTS: Patency did not change with increasing obstructive intervals as can be seen with 91% patency at less than 5 years, 88% at 5 to 10 years, 91% at 10 to 15 and 89% at greater than 15 years. There was no difference in pregnancy rates (89%, 82% or 86%) at obstructive intervals of 0 to 5, 5 to 10 or 10 to 15 years, respectively. Pregnancy rates were significantly lower (44%, p <0.05) with obstructive intervals greater than 15 years. Men with at least unilateral sperm granuloma had patency of 95% vs 78% without granulomas, a trend which did not quite reach statistical significance (p = 0.07). There was no difference in pregnancy rates with or without granulomas. CONCLUSIONS: Vasectomy reversal patency rates are high regardless of time since vasectomy. Pregnancy rates are lower more than 15 years after vasectomy. Sperm granuloma had a favorable impact on patency. Our data indicate that for obstructive intervals less than 15 years vasectomy reversal yields much higher pregnancy rates than in vitro fertilization and intracytoplasmic sperm injection, and that even for intervals greater than 15 years reversal outcomes equal or exceed those of in vitro fertilization and intracytoplasmic sperm injection.     

Repeat vasectomy reversal after initial failure: overall results and predictors for success

PURPOSE: We review the treatment outcomes for microsurgical reconstruction following failed vasectomy reversal and identify predictors for success. MATERIALS AND METHODS: We performed a retrospective review of our experience with microsurgical reconstruction in 41 men who underwent 1 or more prior unsuccessful vasectomy reversal procedures. Of these patients 20 underwent bilateral (16) or unilateral (4) vasoepididymostomy, 11 underwent bilateral (7) or unilateral (4) vasovasostomy and 10 underwent unilateral vasoepididymostomy with contralateral vasovasostomy. Postoperative followup consisted of serial semen analyses and telephone interviews. RESULTS: Patency and pregnancy followup data were available in 33 and 31 patients, respectively. Five couples had ongoing uncorrected female factor infertility problems and were not included in pregnancy rate calculations. Mean obstructive interval was 10.6 years. Overall patency and pregnancy rates were 79 and 31%, respectively. Mean total motile sperm count for patients demonstrating patency at followup was 38.0 million. History of conception with the current partner was predictive of future conception with 4 of 5 nonremarried couples (80%) initiating a pregnancy versus 3 of 18 remarried couples (17%) (p = 0.006). Other factors, including smoking history and obstructive interval, did not correlate with postoperative success. Reconstruction with vasovasostomy on at least 1 side trended toward improved patency (p = 0.17) and pregnancy rates (p = 0.15), although they did not assume statistical significance. CONCLUSIONS: Microsurgical reconstruction following failed vasectomy reversal is associated with high patency and moderate pregnancy rates at short-term followup. In our series previous conception with the current partner was predictive of future conception after reconstruction. Urologists performing repeat vasectomy reversal must be familiar with microsurgical techniques, since almost three-quarters of patients will require at least unilateral vasoepididymostomy.     

Intravasal "toothpaste" in men with obstructive azoospermia is derived from vasal epithelium, not sperm

PURPOSE: Men undergoing vasectomy reversal many years after vasectomy are at increased risk for secondary epididymal obstruction. When this occurs the intravasal fluid is often a thick, white, toothpaste-like material devoid of sperm. In this study we characterize the vasal fluid found in men with a newly described entity, segmental dysplasia of the vas deferens, in which at least 2 distinct sites of vasal obstruction are present. We determine the significance of this fluid in men with obstructive azoospermia. MATERIALS AND METHODS: Three men who underwent scrotal exploration for obstructive azoospermia due to segmental dysplasia of the vas deferens were evaluated. Each underwent scrotal exploration including bilateral vasotomy and testicular biopsy. Intravasal fluid was collected, evaluated microscopically and sent for cytopathological evaluation. RESULTS: All men had isolated segments of the vas 2 to 5 cm in length that were not connected to the epididymis or ejaculatory ducts. We have named this condition segmental dysplasia of the vas deferens. Vasotomy was performed between aplastic segments, revealing thick, white, toothpaste-like material identical to that seen in men with secondary epididymal obstruction undergoing vasectomy reversal. Cytopathological evaluation of this fluid revealed proteinaceous concretions and rare clusters of degenerated columnar epithelial cells, but no sperm or sperm products. CONCLUSIONS: Thick, white, toothpaste-like material is produced between 2 obstructed segments as seen in men with segmental dysplasia of the vas deferens and with secondary epididymal obstruction. Our findings in men with segmental dysplasia of the vas deferens indicate that vasal "toothpaste" must be derived from vasal epithelium, not sperm.     

Treatment of sperm with subnormal host scores with chymotrypsin/viable pregnancy after IUI

Men with low hypoosmotic swelling test (HOST) scores (<50%) rarely achieve a pregnancy with intercourse or conventional intrauterine insemination (IUI) or even IVF. The defect seems to be related to a toxic factor attached to the sperm that can be transferred to the zona pellucida, which ultimately interferes with implantation. A small case series showed optimistic pregnancy outcome with treatment of the sperm with low HOST scores with chymotrypsin. However, the live pregnancy rate in 90 subsequent IUI cycles in men whose low HOST scores were improved by chymotrypsin was only 3.3%. IVF with ICSI remains the only highly effective treatment of this disorder.     

A different female partner does not affect the success of second vasectomy reversal

The aim of the study was to determine whether the pregnancy rate with the same female partner or younger partners was higher compared with different or older partners after undergoing repeated vasectomy reversal. A total of 44 patients were enrolled in the present study. The cause of reversal in patients with the same partner was the desire to have more children in 14 cases, the loss of a child in 7 cases, and the desire for a son in 7 cases. Patients were asked about pregnancy and childbirth during follow-up visits and by telephone or mail. Following microsurgical vasectomy reversal, patency was observed in 38 men (86.4%). Twenty-five of the couples (56.8%) achieved pregnancy without any artificial conception technique. We did not observe a significant difference in the pregnancy rate (57.1% vs 56.3%, P=.954) between patients with the same or a different female partner. In the multivariate model used, partner age was the only independent predictor for pregnancy. Patients with a partner less than 35 years old had a 4.1-fold greater chance (odds ratio, 4.13; 95% confidence interval, 1.06-16.10; P=.041) of pregnancy than those with a partner 35 years old or older. The area under the receiver operating characteristics curve for partner age was 73.0% (95% confidence interval 56.8-89.2, P=.011). Our findings suggest that repeat microsurgical vasectomy reversal still remains a reasonable choice for patients with different female partners. However, it should be considered that the likelihood of achieving pregnancy after repeat vasectomy reversal may decrease with advancing age of the female partner.     

精液冻存时间对精液质量及受孕能力的影响

目的旨在探讨供精精液冻存时间对精液质量及受孕能力的影响。方法回顾性分析广东省人类精子库280对夫妇使用供精冷冻精液成功怀孕在再次生育时使用同一供精者精液用于人工授精技术的临床使用、随访反馈等相关资料。结果已确认妊娠的人工授精周期复苏后供精精液质量如下:精子浓度,首次生育时(67.5±19.8)×10^6/m L,再次生育时(69.3±21.7)×10^6/m L,两组差异无统计学意义(P>0.05);前向运动精子百分比,首次生育时(54.7±8.8)%,再次生育时(51.0±7.0)%,两组差异有统计学意义(P<0.05)。再次生育精液与首次生育精液的冻存时间差与前向运动精子百分比差的相关性无统计学意义(P>0.05)。再次生育时精液周期妊娠率为20.9%,与同期首次生育的周期妊娠率21.49%相比,差异无统计学意义(P>0.05)。结论再次生育时精液质量与首次生育时比较略下降,提示精液冷冻保存时间的延长对精子活力有影响,但冷冻保存时间的长短与对精液质量影响大小的相关性无统计学意义。     

Varicocelectomy improves intrauterine insemination success rates in men with varicocele

PURPOSE: We determined whether varicocele treatment before intrauterine insemination significantly affects intrauterine insemination success rates. MATERIALS AND METHODS: A total of 58 infertile couples, of whom the women had normal evaluations and men had abnormal semen analyses and a history of varicocele, were included in this study. They were identified after reviewing the charts of all women undergoing intrauterine insemination for male factor infertility at our center. Of the men 24 participated in 63 intrauterine insemination cycles without varicocele treatment, while in the remaining 34 varicocele was treated before a total of 101 intrauterine insemination cycles. Variables associated with pregnancy or live birth were analyzed using repeat measures logistic regression with generalized estimating equation techniques. An initial stepwise generalized estimating equation was performed without including varicocele treatment status. Subsequently varicocele treatment status and the significant associated factors were included in analysis. The semen characteristics of untreated and treated varicocele groups were compared with repeat measures analysis of variance. RESULTS: On pre-wash semen analysis patients with untreated varicocele had significantly higher mean motility plus or minus standard error than patients whose varicoceles were treated (48.6% +/- 2.3% versus 38.1% +/- 1.8%, p = 0.02). However, no statistically significant difference was noted in the mean post-wash total motile sperm count in the treated and untreated groups (7.2 +/- 1.0 versus 14.8 +/- 2.6, p = 0.1). Despite these findings the pregnancy and live birth rates per cycle were significantly higher in patients in whom varicocele was treated than in those without varicocele treatment (11.8% versus 6.3%, p = 0.04 and 11.8% versus 1.6%, p = 0.007, respectively). CONCLUSIONS: Varicocele treatment may not improve semen characteristics in all men but it appears to improve pregnancy and live birth rates among couples undergoing intrauterine insemination for male factor infertility. A functional factor not measured on routine semen analysis may affect pregnancy rates in this setting. Men should be screened for varicocele before intrauterine insemination is initiated for male factor infertility.     

Pregnancy following in vitro fertilization using cryopreserved semen from a man with testicular teratoma

Semen for cryopreservation was collected in a man with a testicular teratoma after unilateral orchidectomy but before chemotherapy which rendered him azoospermic. After two years artificial insemination using this semen in his wife failed repeatedly. The semen quality on thawing was extremely poor in terms of sperm motility. A pre-freeze motility of 90 per cent was reduced to 2 per cent, and the movement was graded as sluggish. Using the techniques of semen and oocyte preparation and in vitro fertilization, a number of cleaving embryos was produced. A pregnancy was established after four of these embryos were replaced in the wife. The pregnancy aborted spontaneously, but a subsequent course of treatment resulted in an on-going twin pregnancy. The potential of in vitro fertilization for overcoming the poor quality of semen after storage by cryopreservation from men with testicular neoplasms is discussed.     

Should all urologists performing vasectomy reversals be able to perform vasoepididymostomies if required?

PURPOSE: While vasectomy reversal is a highly successful procedure 10% to 30% of reversals may fail. Despite the general consensus that an epididymal obstruction may occur following a vasectomy and that some men should undergo vasoepididymostomy (VE) rather than vasovasostomy (VV), the practice of many urologists in our region has been to offer only VV for vasectomy reversal. We examined the potential causes for vasectomy reversal failure in patients who had undergone VV without an attempt at VE. MATERIALS AND METHODS: We conducted a retrospective review of patients who had undergone redo vasectomy reversal from January 1999 to September 2001. A total of 22 patients underwent redo reversal with a minimum followup of 2 years. The medical records of all patients were then reviewed. Patients and partners seen postoperatively in the clinic were questioned regarding any pregnancy or deliveries. RESULTS: We examined 22 patients who had undergone redo vasectomy reversal. Of 22 patients 9 (40.9%) underwent repeat VV, 8 (36.3%) underwent bilateral VE for a presumed unrecognized epididymal obstruction and 5 (22.7%) had a combination of VE and VV. Of the 44 reproductive units studied 23 (52.3%) had a failed vasal anastomosis while 21 (47.7%) had an unrecognized epididymal obstruction. Based on semen analysis patency was observed in 75% of patients who had undergone vasovasostomy as a redo procedure. A patency rate of 60% was found in patients who underwent vasoepididymostomy and vasovasostomy unilaterally, and patency rates for bilateral VE were 63%. CONCLUSIONS: Our study indicates that a large proportion of men (48%) have an epididymal obstruction as the etiology for vasectomy reversal failure. We recommend that all surgeons offering vasectomy reversals be able to offer VE if required based on intraoperative findings to serve the patient adequately as well as his partner and their future fertility.     

Vasektomie heute

We report on a large series of 1,275 patients who underwent outpatient vasectomy performed by a single urological surgeon within a 10-year period. In addition, the results of a prospective questionnaire-based study on 217 patients regarding their opinions and motivation, and the financial aspects of the vasectomy are discussed. The mean age was 37.0+/-5.9 years. A total of 98.4% of the patients had an uneventful postoperative course. The average duration of sick leave was 2.2+/-0.21 days. During the study period, the length of sick leave dropped significantly from 2.63 (1990/91) to 1.1 days (1998/99; P=0.001). Efficacy was documented with azoospermia rates of 96.6% and 98.5% in patients who presented for two and three sperm examinations, respectively. A vast majority of patients (94.6%) felt that the procedure should be covered by their health insurance, although 88.1% stated they would also pay by themselves. A minority of patients (0.7%: 9/1,275) subsequently considered vasectomy reversal. The wish to reverse the vasectomy was significantly associated with a younger patient age. In conclusion, outpatient vasectomy provides a safe and reliable form of contraception at low cost. Overall satisfaction in appropriately counselled patients is very high. Based on these findings, further attempts to propagate vasectomy as a timely form of contraception are medically and socioeconomically recommended.     

The Feasibility of Cryopreservation of Sperm Harvested Intraoperatively During Vasectomy Reversals

Purpose

Intracytoplasmic sperm injection during in vitro fertilization involves the microinjection of a single sperm into each egg from the partner. Pregnancies have resulted from this powerful new technology when fewer than 100 motile sperm were present in the semen, or when sperm were obtained from the epididymis or testicle by open operations or needle aspirations. Some surgeons have cryopreserved sperm obtained from the vas or epididymis during vasectomy reversals. However, cryopreservation of nonmotile sperm serves no useful purpose.

Materials and Methods

We performed a retrospective analysis of 603 vasectomy reversals in which the intraoperative vasal and/or epididymal fluid was examined microscopically. The motility of the sperm obtained intraoperatively was used as a gauge for the potential use of such sperm for in vitro fertilization and intracytoplasmic sperm injection after cryopreservation and thawing, should the vasectomy reversal fail.

Results

Motile sperm were present in the intraoperative vasal or epididymal fluid in 35% of all vasectomy reversals (34% of first and 39% of repeat procedures). The percentage of reversals in which motile sperm were present in the intraoperative fluid was not related to the time from vasectomy until reversal.

Conclusions

The absence of motile sperm in the intraoperative vasal or epididymal fluid precludes consideration of sperm cryopreservation during vasectomy reversals. Although to our knowledge the minimum percentage of sperm motility needed for in vitro fertilization and intracytoplasmic sperm injection after cryopreservation and thawing has not been established, our results provide surgeons with information to judge the merit of sperm harvesting and cryopreservation during vasectomy reversals.     

Risk factors in vasectomy--a comparison of satisfied vasectomized males with dissatisfied males seeking refertilization

Ninety-two men were explored by depth psychological interviews before vasectomy and 12-15 months later. Eighty-six of them were completely satisfied with the operation. Six men were dissatisfied and would not undergo the operation again. Forty men requesting refertilization were also explored by depth psychological interviews one day before operation. The comparison of these two groups shows that vasectomy is problematic for men who are younger than 30 years, being in training, and whose partners are not willing to undergo sterilization as well. Men without partners and without children should reconsider their decision for vasectomy and particularly those who show the above-mentioned characteristics and/or those who make the decision without being able to use condoms and/or are unable to handle the situation in case of an abortion. The length of partnership is not important for the sequelae of vasectomy.