Valerie U, et al. - Researchers investigated whether surgical vasovasostomy or IVF/ICSI should be preferred after a vasectomy. They identified that despite significantly lower time to pregnancy in the immediate IVF/ICSI group, both options demonstrate acceptable pregnancy rates.

Methods

• Researchers performed a retrospective single-center cohort analysis of all males with a vasectomy in the past seeking treatment between 2006 and 2011 (n = 163).
• A reanastomosis procedure was opted by one group of patients (99 males) while the others opted for an immediate IVF/ICSI treatment.
• They identified 64 couples who immediately underwent ICSI treatment.
• The same surgeon performed all reanastomosis procedures.
• In all cases where testicular sperm were extracted by fine needle aspiration (FNA) or testicular sperm extraction (TESE), ICSI was used.

Results

• Males at vasectomy had mean age of 35.5 years and at reanastomosis, of 44.4 years.
• Researchers observed the mean (range) obstructive interval of 9.53 years (1–27).
• The two groups were not significantly different in terms of female patient characteristics, such as age and parity.
• they observed the crude cumulative delivery rate (CDR) of 49.5% in the reversal group.
• However, the crude CDR of 40.0% was evident among the 45 patients of this group who attempted to conceive spontaneously (‘primary reanastomosis’ pathway).
• A crude CDR of 57.4% was observed for the remaining 54 patients (the ‘switchers’ pathway) who underwent a reversal procedure and later switched to ART.
• Of these, insemination was opted by 4 patients, including two who later decided to switch to IVF/ICSI.
• A crude CDR of 43.8% and an expected CDR of 51.6% was noted for the 64 patients who immediately underwent IVF/ICSI (‘primary IVF/ICSI’ pathway).
• No statistically significant difference in terms of delivery rates between the primary reanastomosis group (40.0%) and the primary IVF/ICSI group (43.8%) was noted.
• In the primary IVF/ICSI pathway, time to pregnancy was significantly shorter, at 8.2 vs 16.3 months in the reanastomosis group.