PARTIAL OBSTRUCTION, NOT ANTISPERM ANTIBODIES, CAUSING INFERTILITY AFTER VASOVASOSTOMY

Purpose: We determined whether men who may have partial obstruction an d antisperm antibodies after vasovasostomy can be distinguished from o ther infertile men with antisperm antibodies only, and whether repeat microsurgical reversal is beneficial in such patients. Materials and M ethods: A total of 412 patients underwent indirect immunobead testing for antisperm antibodies at our laboratory from December 1991 through July 1996. Of 95 patients with an assay greater than 20% binding 49 ha d normal partners and were grouped by history of vasovasostomy (20), v aricocele (9), cryptorchidism (8) and epididymo-orchitis (12). Semen a nalysis characteristics and antisperm antibody binding variables were compared across histories. Pregnancy rates were compared between patie nts treated surgically for partial obstruction and those treated for a ntisperm antibodies. Mean followup was 33.8 months. Results: Compared to the other 3 groups, men with a history of vasectomy and reversal ha d significantly lower sperm concentration (p = 0.002), poorer motility (p <0.001), lower overall binding on the indirect immunobead assay (p <0.001) and lower IgA binding (p = 0.008). The clinical diagnosis of partial obstruction was based on a sense of epididymal fullness by pal pation, as well. as the aforementioned semen parameters. Of the 20 pat ients with a history of vasectomy and reversal 14 were diagnosed with partial obstruction and underwent repeat microsurgical reversal and 6 with a history of vasovasostomy but no evidence of obstruction receive d no further therapy and never established pregnancies. The remaining 29 patients underwent sperm washing and assisted reproduction. Of 14 p atients 7 (50%) established pregnancies after repeat reversal compared to only 5 of 29 patients (17.2%) treated with assisted reproduction ( P = 0.025). Conclusions: Antisperm antibodies are not a significant fa ctor in persistently infertile post-reversal cases with the aforementi oned criteria. Repeat reversal appears to be the most successful treat ment option in this setting.