Vasovasostomy and Vasoepididymostomy Workup

Updated: Nov 22, 2021
  • Author: Kristen Meier, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Vasectomy reversal

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  • Men who request a vasovasostomy or vasoepididymostomy reversal require no further workup as long as their scrotal examination reveals normal-sized testicles and they have not developed any fertility-impacting medical conditions (eg, history of chemotherapy, radiation therapy) since their original vasectomy.

  • In the case of small testes or history of a potentially gonadotoxic insult to the testis, perform a testis biopsy at the time of, or prior to, the procedure to document normal sperm production.

  • Approximately 60% of men who undergo bilateral vasectomy develop circulating antisperm antibodies afterward, and the effect of these on conception and pregnancy is controversial. While preoperative antisperm antibody testing is available, its effects on postoperative fertility is of unproven benefit.

Nonvasectomy reversal

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  • To be a candidate for a vasoepididymostomy, men with normal–semen volume azoospermia must have active sperm production, an epididymal obstruction, and a patent vas deferens. Normal serum gonadotropin levels (eg, follicle-stimulating hormone [FSH]) suggest normal spermatogenesis, although, occasionally, a patient with an interruption in the normal sperm development (maturation arrest) has normal FSH levels.

  • Definitive proof of normal sperm production is required and can be provided by a testis biopsy at the same time as the planned reconstruction (or at an earlier date).

  • At the time of planned reconstruction, a vasogram is performed to confirm patency of the entire vas deferens and ejaculatory duct. Performing a vasogram at an earlier time may result in scarring of the vas, rendering definitive reconstruction more difficult.