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 fert ilization with intracytoplasmic sperm injection, it is now possible to obta in a small amount of testicular tissue for cryopreservation in the event of reversal failure. However, to our knowledge no studies exist of who is mos t likely to benefit from this procedure. Materials and Methods: We reviewed 84 consecutive vasectomy reversals perfo rmed by 1 surgeon (J. I. S.) between July 1996 and March 2000 with followup available for 77. We grouped cases by procedure as vasovasostomy, vasoepid idymostomy and vasovasostomy with vasoepididymostomy as well as bilateral o r unilateral. Sperm was retrieved at reversal in 15 of 46 vasovasostomy (no ne used), 11 of 18 vasoepididymostomy (3 used) and 13 of 20 vasovasostomy w ith vasoepididymostomy (none used) cases. Results: The overall anastomotic patency rate after unilateral or bilateral vasovasostomy, unilateral vasovasostomy with contralateral vasoepididymost omy and unilateral or bilateral vasoepididymostomy was 96%, 83% and 57%, re spectively. The natural pregnancy rate without in vitro fertilization was 5 7%, 50% and 14%, respectively. The most recent vasoepididymal anastomoses w ere 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 vasoepid idymostomy failed in all. Conclusions: We currently do not recommend routine sperm retrieval for cryo preservation in men who undergoing vasovasostomy. We encourage men who requ ire bilateral vasoepididymostomy to bank sperm at reversal. In men who unde rgo vasovasostomy with vasoepididymostomy we base the decision on preoperat ive counseling and intraoperative findings.