Objectives. To review the fertility outcomes of patients who underwent vasectomy reversal and attempted conception with the same female partners. Methods. A retrospective review of two surgeons' experience was performed. Patency was defined as the presence of motile sperm. Patients with less than 6 months of follow-up were excluded from the patency rate analysis unless they had sperm in the semen sample. Similarly, patients with less than 6 months of follow-up or no ongoing interest in establishing conception were excluded from the pregnancy rate analysis unless they had established a pregnancy. Results. Of 200 consecutive men, 34 (17%) underwent microsurgical vasectomy reversal with the same female partner. All but two of the couples had previous proven fertility. The procedures performed for those who pursued fertility were bilateral vasovasostomy (n = 27), vasovasostomy/vasoepididymostomy (n = 4), and bilateral vasoepididymostomy (n = 1). The mean obstructive interval was 5 years (range 4 months to 10 years). The mean female partner age was 31.9 years (range 26 to 38). The median follow-up was 8 months (range 1 to 48). Patency was achieved in 27 (93%) of 29, and pregnancy occurred in 15 (60%) of 25 cases with sufficient follow-up. The ongoing or delivered rate was 56% (14 of 25). Female factor problems were present in three couples, and two miscarriages occurred for couples with known female factor problems. Conclusions. Microsurgical vasectomy reversal may have higher success rates when performed for couples with the same female partner. These results may be related to a shorter obstructive interval and a history of previous fertility as a couple. © 2003 Elsevier Inc.