The Jourrnal of Urology / American Urological Association
April 2023
By: Ethan Grober, Udi Blankstein
Abstract
INTRODUCTION AND OBJECTIVE:
During vasectomy reversal (VR), accurate intra-operative microscopic assessment of the vasal fluid for sperm presence and quality is essential in determining the indication for a vasovasostomy (VV) or vasoepididymostomy (VE). The use of testosterone therapy (TT), known to suppress spermatogenesis, can potentially interfere with this determination. The current initiative evaluates the impact of testosterone therapy on vasal and epididymal fluid sperm characteristics and intra-operative decision-making among men on testosterone therapy at the time of VR.
During vasectomy reversal (VR), accurate intra-operative microscopic assessment of the vasal fluid for sperm presence and quality is essential in determining the indication for a vasovasostomy (VV) or vasoepididymostomy (VE). The use of testosterone therapy (TT), known to suppress spermatogenesis, can potentially interfere with this determination. The current initiative evaluates the impact of testosterone therapy on vasal and epididymal fluid sperm characteristics and intra-operative decision-making among men on testosterone therapy at the time of VR.
METHODS:
Of 2622 consecutive VRs performed between 2007-2022, patients actively using TT at the time of VR were identified. Details as to the type, dose and duration of TT were documented. All patients were counselled regarding the impact of TT on spermatogenesis and encouraged to discontinue TT if possible. During VR, vasal and epididymal fluid (as indicated) was sampled and each aspirate underwent microscopic evaluation for sperm presence and quality and was categorized as: motile sperm/intact-non-motile sperm/sperm parts/no sperm. Rates of sperm presence/absence in the vasal/epididymal fluid, frequency of VV/VE, post-operative patency (presence of motile sperm) and semen parameters were compared among patients on TT vs. clinically-matched patients not using TT at the time of VR.
Of 2622 consecutive VRs performed between 2007-2022, patients actively using TT at the time of VR were identified. Details as to the type, dose and duration of TT were documented. All patients were counselled regarding the impact of TT on spermatogenesis and encouraged to discontinue TT if possible. During VR, vasal and epididymal fluid (as indicated) was sampled and each aspirate underwent microscopic evaluation for sperm presence and quality and was categorized as: motile sperm/intact-non-motile sperm/sperm parts/no sperm. Rates of sperm presence/absence in the vasal/epididymal fluid, frequency of VV/VE, post-operative patency (presence of motile sperm) and semen parameters were compared among patients on TT vs. clinically-matched patients not using TT at the time of VR.
RESULTS:
Among the 2622 VRs reviewed, 54 men (2%) reported using TT at the time of their VR. Despite its impact on spermatogenesis, intra-operative microscopic analysis of the reproductive fluid (vasal or epididymal) identified the presence of sperm in 95% (51/54) of patients. Testis biopsy confirmed sperm production among 3 patients with absence of sperm within the vasal or epididymal fluid. Rates of VV or VE, did not significantly differ among men using TT at the time of VR compared to nonusers. Post-operative patency rates (TT:78 % vs. No TT:94%) and mean total motile sperm counts (TMC) were lower among patients using TT at the time of VR (7.9 vs. 28.3, p=0.02).
Among the 2622 VRs reviewed, 54 men (2%) reported using TT at the time of their VR. Despite its impact on spermatogenesis, intra-operative microscopic analysis of the reproductive fluid (vasal or epididymal) identified the presence of sperm in 95% (51/54) of patients. Testis biopsy confirmed sperm production among 3 patients with absence of sperm within the vasal or epididymal fluid. Rates of VV or VE, did not significantly differ among men using TT at the time of VR compared to nonusers. Post-operative patency rates (TT:78 % vs. No TT:94%) and mean total motile sperm counts (TMC) were lower among patients using TT at the time of VR (7.9 vs. 28.3, p=0.02).
CONCLUSIONS:
Use of TT at the time of VR does not appear to impact rates of intra-operative microscopic identification of sperm within the reproductive fluid or the indication for VV/VE. Post-operative patency rates and total motile sperm counts may be lowered by use of TT. Moreover, the determination to the etiology azoospermia post-operatively (production vs. obstruction) may be clouded by the use of TT during VR.
Use of TT at the time of VR does not appear to impact rates of intra-operative microscopic identification of sperm within the reproductive fluid or the indication for VV/VE. Post-operative patency rates and total motile sperm counts may be lowered by use of TT. Moreover, the determination to the etiology azoospermia post-operatively (production vs. obstruction) may be clouded by the use of TT during VR.