Criteria for Determining a Vasectomy has Succeeded

Portrait of a doctor or nurse. (iStockphoto/Thinkstock)
Portrait of a doctor or nurse. (iStockphoto/Thinkstock)

No-scalpel vasectomy procedure became popular in North America after U.S. surgeons went to China and learned the technique. The procedure is simple with a low complication rate. Infection and scrotal bleeding occur in four to 22 per cent of patients, chronic scrotal pain in two to five per cent, and failure to achieve sterilization in 0.03 to 12 per cent.

Vasectomy is one of the oldest and most commonly performed surgical procedures worldwide. However, there is no general agreement on the best approach to ensure contraceptive success. Surgeons differ significantly in their use of cautery, clips, ties and fascial interposition (position of outer tissue between the two ends of the divided vas). One international multicenter trial in 2004, of vasectomy with and without fascial interposition, demonstrated a twofold reduction of failure with the use of fascial interposition.

The American Urological Association, Inc. (AUA) recommends physicians not consider pathology confirmation of the vas deferens as a measurement of success. The finding of no sperm after vasectomy is the standard of success (2003). The AUA says the persistence of sperm in the semen after vasectomy is a surgical failure, regardless of a pathology report stating both vas deferens were removed.

Semen analysis after vasectomy is required to establish sterilization. Patient should deliver the specimen to the laboratory within one hour of collection. The general consensus in medical literature is one semen specimen three months after surgery should be analysed to confirm success. This protocol varies widely. Several studies document decreased patient compliance with each additional test.

An article in the Journal of the Royal Society of Medicine (2001) states post-vasectomy sterilization is confirmed by semen analysis, but the disappearance of sperm from the semen can be slow. Age and frequency of ejaculation influence the time to achieve complete disappearance of sperm from the semen. The authors state some patients will have small numbers of non-motile sperm in their semen for months or years after vasectomy. The authors go on to report that no pregnancies have been reported in the partners of these men. Many surgeons advise their patients that alternative contraception can be safely discontinued at this stage.

A Dutch study published in 2005, based on guidelines issued by Dutch Urological Association, says patients can stop using contraception at three months if their first semen analysis has no sperm or if less than 100,000 non-motile sperms are present. Researchers found 51 per cent of the samples contained no sperm and 45 per cent contained less than 100,000 non-moving sperms. Follow-up at least one year later showed none of these men, 96 per cent, reported getting a woman pregnant.

If there are motile sperms present six months after a vasectomy, repeat surgery is considered. When counseling a patient regarding the potential risks and benefits of a vasectomy, it is important to emphasize that a vasectomy can fail early or late. Late failure happens less often.

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