Introduction: Literature regarding the influence of maternal age on pregnancy rates with male partners who have undergone vasectomy reversal is sparse. With the tendency towards delayed childbirth, the increased use of vasectomy as means of family planning, and advances in reproductive techniques, this issue is very important for patient counseling. The aim of this study is to determine the importance of maternal age on pregnancy rates following vasectomy reversal. Subjects and Methods: A retrospective analysis was performed on 212 patients who underwent vasectomy reversal by a single surgeon (W.H.W.). Patient characteristics of the male and the female partner were evaluated using the Fisher exact test and predictors of pregnancy were identified using multivariable logistic regression analyses. Results: The mean age of the male patients was 40.4 years and the mean age of their female partners was 31.3 years. The postoperative vas patency rate was 93.4%, which resulted in a pregnancy rate of 72.2%. In univariate and multivariable analysis, the age of the female partner (p = 0.014 univariate and p = 0.010 multivariable) and Silber score (p = 0.028 univariate and p = 0.024 multivariable) were predictive of pregnancy following vasectomy reversal with age of the female partner >40 years being associated with lower pregnancy rates compared to those ≤29 and 30-39 years. Conclusion: Maternal age of ≥40 years is an independent predictor of a lower rate of pregnancy following vasectomy reversal but still compared favorably to published pregnancy rates following intracytoplasmatic sperm injection in patients aged 40 years and older. Therefore, vasectomy reversal should be the treatment of choice for patients with advanced maternal age desiring reinstated fertility following vasectomy. Copyright © 2008 S. Karger AG.