How little is enough? The evidence for post-vasectomy testing.
TL;DR: The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations, and patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success.
Abstract: Purpose: Post-vasectomy semen analysis (PVSA) is the traditional method of confirming sterility after vasectomy. However, PVSA protocols vary in the end points accepted, and the number and timing of tests. In this systematic review we make evidence based recommendations on the appropriate PVSA protocol. Materials and Methods: Databases (MEDLINE, Current Contents, Cochrane Library and EMBASE) were searched up to and including March 2003. Studies were included if they dealt with post-vasectomy testing and contained data on at least 1 of the time or number of ejaculations to azoospermia, pregnancy, repeat vasectomy and histological analysis of vas specimens. Results: A total of 56 studies were included in the review. Time to achieve azoospermia was variable, although the median incidence of patients with azoospermia was consistently more than 80% after 3 months and after 20 ejaculations. A small percent of patients (14,845 or 1.4%) demonstrated persistent nonmotile sperm, although some of them eventually achieved azoospermia. The reappearance of nonmotile sperm was reported in 7 studies, occurring up to 22 months after vasectomy. Conclusions: The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations. If the sample is positive, periodic testing can continue until azoospermia is achieved. Patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success. No evidence was located to support histological testing of the excised vas deferens.
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TL;DR: These guidelines aim to provide information and recommendations for physicians who perform vasectomies and to promote the provision of adequate information to the patient before the operation to prevent unrealistic expectations and legal procedures.
Abstract: Context: The European Association of Urology presents its guidelines for vasectomy. Vasectomy is highly effective, but problems can arise that are related to insufficient preoperative patient information, the surgical procedure, and postoperative follow-up. Objective: These guidelines aim to provide information and recommendations for physicians who perform vasectomies and to promote the provision of adequate information to the patient before the operation to prevent unrealistic expectations and legal
112 citations
Cites methods from "How little is enough? The evidence ..."
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TL;DR: Although the estimated number of vasectomies performed in the United States during 2002 represents an increase from 1991 and 1995, incidence rates remained unchanged at approximately 10/1,000 men 25 to 49 years old.
Abstract: Purpose: We estimated the number of vasectomies performed in the United States in 2002 and gathered information on the vasectomy procedures and protocols used. It follows similar studies done in 1991 and 1995.Materials and Methods: A retrospective mail survey with telephone followup was performed in 2,300 urologists, family physicians and general surgeons randomly sampled from the American Medical Association Physician Masterfile.Results: The response rate was 73.8%. An estimated 526,501 vasectomies were performed in 2002 for a rate of 10.2/1,000 men 25 to 49 years old. Overall 37.8% of physicians reported currently using no scalpel vasectomy and almost half of the vasectomies performed in 2002 were no scalpel vasectomies. Methods of vas occlusion varied in and among specialties with a combination of ligation and cautery being most common (41.0% of cases). Of the physicians 45.6% reported routinely performing fascial interposition, 94.4% reported removing a vas segment, 23.3% reported routinely folding ba...
100 citations
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TL;DR: An overview of vasectomy use and techniques is provided, and reasons for the disparity in vasectomy utilization in the United States are explored.
Abstract: Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.
83 citations
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TL;DR: Presumed early recanalization was characterized by a very low sperm concentration within two weeks after vasectomy followed by return to large numbers of sperm over the next few weeks.
Abstract: Our understanding of early post-vasectomy recanalization is limited to histopathological studies. The objective of this study was to estimate the frequency and to describe semen analysis patterns of early recanalization after vasectomy. Charts displaying serial post-vasectomy semen analyses were created using the semen analysis results from 826 and 389 men participating in a randomized trial of fascial interposition (FI) and an observational study of cautery, respectively. In the FI trial, participants were randomly allocated to vas occlusion by ligation and excision with or without FI. In the cautery study, sites used their usual cautery occlusion technique, two with and two without FI. Presumed early recanalization was based on the assessment of individual semen analysis charts by three independent reviewers. Discrepancies were resolved by consensus. Presumed early recanalization was characterized by a very low sperm concentration within two weeks after vasectomy followed by return to large numbers of sperm over the next few weeks. The overall proportion of men with presumed early recanalization was 13% (95% CI 12%–15%). The risk was highest with ligation and excision without FI (25%) and lowest for thermal cautery with FI (0%). The highest proportion of presumed early recanalization was observed among men classified as vasectomy failures. Early recanalization, occurring within the first weeks after vasectomy, is more common than generally recognized. Its frequency depends on the occlusion technique performed.
36 citations
References
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TL;DR: Suggestions are made that future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome.
Abstract: Objective: To recommend further research on vasectomy based on a systematic review of the effectiveness and safety of vasectomy. Design: A systematic MEDLINE review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998. Main Outcome Measure(s): Early failure rates are ,1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, including hematoma, infection, sperm granulomas, epididymitis-orchitis, and congestive epididymitis, occur in 1%‐ 6% of men undergoing vasectomy. Incidence of epididymal pain is poorly documented. Animal and human data indicate that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes after vasectomy are transient in men with vasectomies. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these cancers. Conclusion(s): Publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future studies should include evaluations of the long-term effectiveness of vasectomy, evaluating criteria for postvasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain syndrome. (Fertil Sterilt 2000;73:923‐36. ©2000 by American Society for Reproductive Medicine.)
172 citations
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TL;DR: It is contended that the end point for disappearance of sperm following vasectomy can be determined in a rapid and consistent manner and aspermia was demonstrated after 6-10 ejaculations after vasectomy.
Abstract: The authors contend that the end point for disappearance of sperm following vasectomy can be determined in a rapid and consistent manner. Bilateral vasectomy was performed with separate scrotal incisions on 13 men under local anesthesia. 1 1/2-2 cm of vas was resected. A preoperative semen specimen and 10 postoperative specimens were supplied as rapidly as possible. The mean number of days to collect the specimens was 15. An average of 68% of the sperm remaining in the vas distal to the vasectomy are ejaculated at each emission. Aspermia was demonstrated after 6-10 ejaculations following vasectomy.
111 citations
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TL;DR: From April 1970 to December 1980, 14 047 men underwent vasectomy for sterilisation under local anaesthetic at this clinic, and the wives of six of these men subsequently became pregnant between 16 months and three years after vasectomy.
Abstract: From April 1970 to December 1980, 14 047 men underwent vasectomy for sterilisation under local anaesthetic at this clinic. In each man sterility was confirmed by two analyses of semen showing azoospermia. Allowing for a minimum follow up of three years, the wives of six of these men subsequently became pregnant between 16 months and three years after vasectomy. Analyses of semen confirmed recanalisation of the vasa deferentia in all six men. Only five similar cases initially fulfilling the same criteria for sterility have previously been reported. Full account of the rare possibility of recanalisation should be taken both when couples are counselled preoperatively and when pregnancy occurs after the male partner has been confirmed to be sterile.
74 citations