title: Increased follicle-stimulating hormone is associated with higher assisted reproduction use after vasectomy reversal.
abstract: OBJECTIVE
  Of men with vasectomy 6% elect to have more children. When considering vasectomy reversal vs in vitro fertilization/intracytoplasmic sperm injection, an elucidation of preoperative factors that predict surgical success would help determine appropriate management. We tested the hypothesis that preoperative follicle-stimulating hormone 10 U/l or greater predict a lower paternity rate after vasectomy reversal.
  
  
  METHODS
  Using preoperative follicle-stimulating hormone levels we retrospectively reviewed the records of patients who underwent vasectomy reversal. Follicle-stimulating hormone was measured in cases suspicious for impaired spermatogenesis. The final analysis included 206 men, who were divided by follicle-stimulating hormone less than 10 U/l (normal in 155) and 10 U/l or greater (high in 51). Nominal logistic regression was performed to evaluate assisted reproduction predictors.
  
  
  RESULTS
  Mean ± SD follicle-stimulating hormone in the normal and high groups was 5.1 ± 2.2 and 16.2 ± 6.2 U/l, respectively. Postoperative semen parameters were similar. However, in the high hormone group there was greater use of any type of assisted reproduction (78.4% vs 54.8%, p = 0.0028). On multivariate analysis follicle-stimulating hormone 10 U/l or greater (OR 3.02, 95% CI 1.34-6.83) and vasoepididymostomy that was bilateral or to a solitary testis (OR 3.26, 95% CI 1.09-9.69) was associated with greater assisted reproduction use.
  
  
  CONCLUSIONS
  We evaluated preoperative follicle-stimulating hormone as a predictor of reproductive outcome in men with suspected subfertility who underwent vasectomy reversal. Increased follicle-stimulating hormone was associated with a higher rate of assisted reproduction even after controlling for confounding covariates. Thus, men with increased follicle-stimulating hormone should be counseled on the increased likelihood of needing assisted reproduction to achieve pregnancy after vasectomy reversal.
authors.affiliation: Center for Male Reproductive Medicine, Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College, New York, New York, USA.
authors.forename: Wayland
authors.initials: W
authors.lastname: Hsiao
authors.forename: Raymond
authors.initials: R
authors.lastname: Sultan
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy / Q000706:statistics & numerical data; D057234:Preoperative Period; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014669:Vasovasostomy
chemical_list: D005640:Follicle Stimulating Hormone