Patient characteristics associated with vasectomy reversal

Purpose: More than 30 million couples throughout the world are using vasect omy as a method of birth control. It is estimated that up to 6% of men who undergo voluntary sterilization will eventually request reversal, despite t he high cost and relatively low success rate of the procedure. We identifie d characteristics that predict which vasectomy patients may request reversa l. We also examined the cost and effectiveness of pre-vasectomy sperm cryop reservation followed by intrauterine insemination as an alternative method of achieving pregnancy. Materials and Methods: We reviewed medical charts of 365 patients who under went vasectomy and 290 who underwent vasectomy reversal between 1990 and 19 97. Data were collected on patient age at the time of vasectomy, religion, occupation, wife employment status, number of marriages, number of children , reason far reversal, and number of years between vasectomy and reversal. Based on previously reported values, pregnancy rates and cost per successfu l pregnancy were estimated for vasectomy reversal surgery, and compared wit h a calculated cost per pregnancy for sperm cryopreservation and intrauteri ne insemination. Results: Patient factors significantly associated with increased vasectomy reversal included younger age at time of vasectomy (p <0.001) and a wife wh o worked outside the home (p <0.001). Vasectomy reversal occurred 12.5 time s more often (95% confidence interval [CI] 7.6 to 20.7) in men who underwen t vasectomy in their 20s than in men who were older. Men whose wives were n ot employed requested reversal 0.48 times as often (95% CI 0.33 to 0.71) as those whose wives worked. Men who were younger at vasectomy tended to wait longer before reversal (median 10 years) than other patients (p <0.001). A t 10 years our calculated pregnancy rates and cost per pregnancy were 44% a nd $12,727 for vasectomy reversal, and 41% and $9,512 for intrauterine inse mination with banked sperm (3 attempts). Conclusions: Patients who requested vasectomy reversal most often chose vol untary sterilization at a younger age. We believe that younger men should b e given better pre-vasectomy counseling. However, the success rate and cost -effectiveness of sperm cryopreservation before vasectomy, with subsequent intrauterine insemination, may make this nonsurgical alternative desirable for younger couples who choose vasectomy even when properly informed about reversal rates.