https://doi.org/10.4081/aiua.2026.14877
Long-term patency and pregnancy after vasovasostomy: a comprehensive review
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Published: 10 March 2026
Background: Vasovasostomy (VV) is often pursued by men seeking natural conception after vasectomy. Microsurgical VV is associated with high patency rates (~95%) and moderate pregnancy rates (~40%), according to existing literature. However, long-term outcome data remain limited. This review evaluates patency and pregnancy rates at ≥12 months following microsurgical VV.
Materials and methods: A comprehensive literature search was conducted via PubMed using the terms “vasovasostomy,” “patency rate,” and “pregnancy rate.” Studies were included if they reported patency or pregnancy outcomes ≥12 months post-VV. Data were categorized and analyzed using MedCalc, applying the Freeman-Tukey transformation for normalization.
Results: Only four clinical studies reported long-term patency data, and six studies reported long-term pregnancy rates following microsurgical VV. Patency rates ranged from 77% to 99%, with a mean follow-up of 25 months. Patency was defined as the presence of any sperm in the ejaculate in five studies, and as >1 million non-immotile sperm/mL in one study. Using the >1 million sperm definition, the patency rate was 77% at 12 months, but decreased to 33% when defined as ≥30% motile sperm in the ejaculate. Pregnancy rates across the six studies ranged from 28% to 54%, with a mean follow-up of 21 months.
Conclusions: Long-term patency and pregnancy rates following VV vary widely due to inconsistent definitions and limited follow-up data. These findings underscore the need for standardized outcome measures and longitudinal follow-up to better understand factors influencing long-term success after VV.
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CRediT authorship contribution
Ramsey Ghaleb, study concept, data analysis and interpretation, manuscript original drafting. Marwan Hamadeh, study concept, data analysis and interpretation, manuscript original drafting. Fred Lee, literature search and data extraction. Mohamad Abou Chakra, literature search, data extraction, and manuscript editing. Kareem Touleimat, data analysis. Mahmoud Mima, study supervision and final manuscript review.
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