Introduction: Over the last decade, a 4-fold rise in treatment of late onset hypogonadism with testosterone therapy (TT) has been observed in the United States. More men with a prior vasectomy on TT are seeking vasectomy reversal (VR). Medical management (MT) strategies for these patients prior to VR include using clomiphene citrate (CC) or human chorionic gonadotropin (hCG) to recover spermatogenesis, however, there is very limited data on these strategies. We present our management and outcomes of VR in men previously on TT.
Methods: We reviewed all patients who underwent VR from 2008 to 2021 from our institution. Patients who started on TT following their vasectomy prior to VR procedure were included in the study. Along with discontinuation of TT, patients were offered CC with or without hCG. Testosterone and FSH levels were obtained 4 weeks following initiation of MT for dose adjustment. VR procedures were performed after 3 months of MT. Intraoperative findings, patency rates and hormone levels were assessed.
Results: Of the men who underwent VR during the study period, 15 men met our inclusion criteria. Median age at VR was 45 with a median obstructive interval of 12 years. In our cohort, 1 patient elected to forego MT and wait 12 months off TT prior to VR. For the remaining 14 patients, the median time from MT to VR was 5 months. We performed vasovasostomy (VV) on 29/30 testicles based on the characteristics of the vasal fluid and/or microscopic findings. All 15 men had sperm on post-operative semen analysis. Six men achieved pregnancy.
Conclusions: Our findings confirm the expediency of MT for spermatogenesis in patients previously on TT who desire VR. Median time from MT to VR of 5 months reduces the recommended wait time with TRT discontinuation alone by more than half. An interesting finding of our study is a high rate of VV (96%) despite a 12-year median obstructive interval suggesting a decrease of epididymal obstruction due to decrease in spermatogenesis due to TT. These data will help guide management strategies.