title: Impact on Pregnancy of Gross and Microscopic Vasal Fluid during Vasectomy Reversal.
abstract: OBJECTIVE
  We compared fertility outcomes with gross and microscopic fluid findings at vasectomy reversal at a high volume vasectomy reversal center.
  
  
  METHODS
  A retrospective study of a prospective database was performed. All vasectomy reversals were performed by a single surgeon (EFF) between 1978 and 2011. The clinical pregnancy rate was self-reported or determined via patient mailers. Patient and operative findings were determined through database review. We classified vasal fluid as opalescent, creamy, pasty or clear. Intraoperative light microscopy was used to determine if sperm or sperm parts were present and if they were motile. Multivariate analysis was performed evaluating patient age, partner age, years after vasectomy, type of surgery, and gross and microscopic fluid analysis.
  
  
  RESULTS
  A total of 2,947 microsurgical vasectomy reversals were reviewed after we excluded reversals performed for post-vasectomy pain. We determined the pregnancy status of 902 (31%) cases. On univariate analysis with respect to pregnancy the presence of motile sperm at vasovasostomy neared statistical significance (p=0.075) and there was no difference between bilateral vs unilateral motile sperm. Gross fluid appearance was not statistically significant but we found the order of pregnancy success to be opalescent, creamy, clear then pasty fluid. On multivariate analysis only female partner age and sperm heads only or no sperm seen on light microscopy had statistical significance (p <0.05).
  
  
  CONCLUSIONS
  The presence of motile sperm at vasectomy reversal approaches statistical significance on univariate analysis as a factor that affects clinical pregnancy rates. On multivariate analysis female partner age and microscopic findings of sperm heads only or no sperm are inversely related to pregnancy rates. These data will help counsel couples after vasectomy reversal and reinforce the importance of female partner age.
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Ostrowski
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, Oregon.
authors.forename: A Scott
authors.initials: AS
authors.lastname: Polackwich
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Conlin
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, Oregon. Electronic address: hedgesja@ohsu.edu.
authors.forename: Jason C
authors.initials: JC
authors.lastname: Hedges
authors.affiliation: Department of Urology, Oregon Health & Science University, Portland, Oregon.
authors.forename: Eugene F
authors.initials: EF
authors.lastname: Fuchs
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055101:Semen Analysis / Q000379:methods; D014649:Vas Deferens; D014669:Vasovasostomy
keywords: infertility; pregnancy; vasovasostomy