Sperm parameters predicting fertility after vasectomy reversal

The mainstay of evaluation of the effectiveness of a vasectomy reversal is the semen analysis that is performed following the procedure, and of course the end-point of achieving a pregnancy.  This is how we assess if the vasectomy reversal was successful or not.  It is not uncommon for semen parameters to be suboptimal early after vasectomy reversals, for example, at the 6 week mark after reversal.  Typically semen parameters improve over time after the vasectomy reversal and at some point plateau as the man’s baseline parameters.  This may impact time to pregnancy after vasectomy reversal in some couples.

A recent study that was published challenges the dogma of what are considered adequate semen parameters for conception after vasectomy reversal.  The World Health Organization (WHO) published reference ranges in 2010 to help define a fertile semen analysis.  Although there is a lot of controversy regarding what reference ranges truly define a fertile semen analysis, these are the current set of references used to assess the semen volume, the sperm concentration (number of millions of sperm per milliliter of semen), the motility (percentage of sperm swimming), and the morphology (percent with normal appearing shapes).  The conclusion of this recent publication suggests that the “normal” ranges of semen parameters established by the 2010 WHO standards may not adequately predict post-vasectomy reversal fertility.  In this study, the post-vasectomy reversal semen parameters of patients with spontaneous pregnancy were substantially lower than “normal” values published by the WHO in 2010.  This study revealed spontaneous pregnancy occurring in 15%, 21%, and 15% of patients with sperm concentration <5 million/ml, motility of <10%, and normal morphology <1%, respectively, which are traditionally considered relatively poor semen parameters.  Overall, spontaneous pregnancy was reported in nearly 50% of the patients in the study overall.  To read more on this study click here…  http://www.fertstert.org/article/S0015-0282(17)30062-6/fulltext