To perform a systematic review and meta-analysis of the published literature evaluating vasovasostomy for vasectomy reversal outcomes.

We conducted a review of English language articles describing results of microscopic vasovasostomy for vasectomy reversal. Two reviewers independently examined the studies for eligibility and evaluated data from each study. Meta-analysis was performed using a random effects model.

Thirty-one studies with 6633 patients met inclusion criteria. Mean patient age at time of vasectomy reversal was 38.9 years with a mean obstructive interval of 7.2 years. The mean postprocedure patency and pregnancy rates weighted by sample size were 89.4% and 73.0%, respectively. A meta-analysis comparing an obstructive interval (OI) of <10 years to an OI of at least 10 years duration produced a pooled incidence ratios (IR; meta-IR) of 1.17 (95% confidence interval [CI], 1.09-1.25) for patency and 1.24 (95% CI, 1.12-1.38) for pregnancy. Incidence of patency for modified 1-layer technique was similar to that after a 2-layer procedure with a meta-IR of 1.04 (95% CI, 1.00-1.08). Because of a small number of relevant studies, a meta-analysis for other predictors of success such as sperm granuloma, quality of vasal fluid, and female factors was not feasible.

We found no statistically significant difference in vasovasostomy outcomes when comparing the impact of single vs multilayer anastomoses. Patients with an OI <10 years showed higher patency and pregnancy rates compared with those with an OI ≥10 years. Uniform definitions of patency are necessary to characterize success and standardize outcome reporting.