Presentation Authors: Mary K. Samplaski, Nusbaum David J.*, Los Angeles, CA, Matthew B. F. Marks, Sheldon F. Mark, Tuscon, AZ
Introduction: Paternal age is rising, and births to men over 40 and 50 years have doubled in the past 40 years. Men who desire paternity post vasectomy may opt for vasectomy reversal (VR), however, there is no data looking at outcomes in advanced paternal age. Advancing paternal age has also been associated with impaired semen parameters and reproductive outcomes. We evaluated reproductive outcomes in men undergoing VR â‰¥50 years of age.
Methods: Reproductive outcomes after VR were assessed for men < 50 and â‰¥50 years of age, performed by a single reproductive urologic microsurgeon (SFM). We looked at obstructive interval, female partner age, anastomosis type, post-VR total motile sperm count (TMC), and pregnancy rates. Statistical analysis was performed in R using Students t-test or Chi-squared test, with p < 0.05 considered significant. Multiple logistic regression was performed in R using the &[prime]glm&[prime] function.
Results: 3988 men < 50 years and 542 men â‰¥50 years were identified. Many of the results are in Table 1. The mean obstructive interval for men < 50 was ~10 years less than for men â‰¥50. The chances of needing a VE were higher in men â‰¥50 years (p < 0.001). The post-VR TMC was higher in men < 50 years. 32.6% of men < 50 years contributed to a pregnancy (1 pregnancy: 1086 men, 2 pregnancies: 175, 3 pregnancies: 31, 4 pregnancies: 2; 5 pregnancies: 5). 24.7% of men â‰¥50 years contributed to a pegnancy (1 pregnancy: 116 men, 2 pregnancies: 16, 3 pregnancies: 2) (p < 0.001). _x000D_
On multiple logistic regression analysis, obstructive interval < 10 years (OR 1.23, 95% CI 1.04-1.45, p=0.02), female age < 35 (OR 1.60, 95% CI 1.35-1.88, p < 0.001), and post-VR TMC â‰¥50 million (OR 1.88, 95% CI 1.60-2.21, p < 0.001) were associated with achieving a pregnancy. Age < 50 years or â‰¥50 years at time of VR was not associated with achieving a pregnancy (p=0.48).
Conclusions: Age at VR was not an independent predictor of achieving a pregnancy. Men â‰¥50 years had a longer obstructive interval and higher chance for needing VE versus men < 50 years. Post-VR TMC and pregnancy rates were higher in men < 50 years. Regardless, many men â‰¥50 years may still achieve a pregnancy after VR (32.6% for men < 50 years and 24.7% for men â‰¥50 years). Shorter obstructive interval, younger female age, and higher post-VR TMC were associated with achieving a pregnancy. VR should be considered in men â‰¥50 years when performed by a trained microsurgeon.