Effectiveness of Vasectomy Techniques

https://doi.org/10.1016/j.ucl.2009.05.008Get rights and content

Section snippets

Definition and measurement of vasectomy outcomes

Vasectomy effectiveness may be defined by the absence or occurrence of pregnancy (contraceptive effectiveness) or by the results of semen analyses (occlusive effectiveness).

Effectiveness of vasectomy occlusion techniques

Many vasectomy occlusion techniques have been developed over the years, and these techniques continue to evolve (see the articles by Sheynkin and by Art and Nangia elsewhere in this issue). The authors have reviewed the effectiveness of the vas occlusion techniques that are most commonly used in the United States.10

Most physicians use a combination of these techniques (some investigators do not classify the last four techniques as methods of vas occlusion):

  • Ligation

  • Cautery (intraluminal)

  • Clips

Summary and recommendations

In the United States and other high-resource settings, there seem to be fewer vasectomy failures and fewer postvasectomy pregnancies than in low-resource settings. This is probably due mainly to differences in vas occlusion methods and subsequent recanalizations.

Given the number of vasectomy procedures performed annually around the world, there is surprisingly little high-quality evidence on the relative effectiveness of various techniques for vas occlusion. Nonetheless, taking into account the

Acknowledgments

The authors thank their many colleagues and coauthors at FHI, EngenderHealth, and around the world who contributed to the studies reviewed in this article. Also, thanks to Kerry Aradhya for editorial assistance.

First page preview

First page preview
Click to open first page preview

References (89)

  • B. Steward et al.

    Diagnostic accuracy of an initial azoospermic reading compared with results of post-centrifugation semen analysis after vasectomy

    J Urol

    (2008)
  • M. Chafer Rudilla et al.

    Actas Urol Esp

    (2007)
  • K.L. Klotz et al.

    Clinical and consumer trial performance of a sensitive immunodiagnostic home test that qualitatively detects low concentrations of sperm following vasectomy

    J Urol

    (2008)
  • B. Cruickshank et al.

    Regeneration of vas deferens after vasectomy

    Urology

    (1987)
  • H. Hayashi et al.

    The mechanism of spontaneous recanalization of human vasectomized ductus deferens

    Fertil Steril

    (1983)
  • S.S. Schmidt et al.

    Spermatic granuloma: the complication of vasectomy

    Fertil Steril

    (1973)
  • J.O. Esho et al.

    Recanalization following vasectomy

    Urology

    (1974)
  • M.A. Barone et al.

    A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision

    J Urol

    (2003)
  • G.E. Lemack et al.

    Presence of sperm in the pre-vasectomy reversal semen analysis: incidence and implications

    J Urol

    (1996)
  • T.M. Jaffe et al.

    Sperm pellet analysis: a technique to detect the presence of sperm in men considered to have azoospermia by routine semen analysis

    J Urol

    (1998)
  • J.C. Smith et al.

    Fatherhood without apparent spermatozoa after vasectomy

    Lancet

    (1994)
  • M. Labrecque et al.

    Effectiveness and complications associated with 2 vasectomy occlusion techniques

    J Urol

    (2002)
  • I. Craft et al.

    Sperm-counts after vasectomy

    Lancet

    (1973)
  • M. Labrecque et al.

    Association between the length of the vas deferens excised during vasectomy and the risk of postvasectomy recanalization

    Fertil Steril

    (2003)
  • D. Kirby et al.

    An implantable ligation device that achieves male sterilization without cutting the vas deferens

    Urology

    (2006)
  • L.A. Levine et al.

    Persistent motile sperm after ligation band vasectomy

    J Urol

    (2006)
  • S.S. Schmidt

    Prevention of failure in vasectomy

    J Urol

    (1973)
  • D.B. Rhodes et al.

    Vasectomy: efficacy of placing the cut vas in different fascial planes

    Fertil Steril

    (1980)
  • E.I. Shapiro et al.

    Open-ended vasectomy, sperm granuloma, and postvasectomy orchialgia

    Fertil Steril

    (1979)
  • W.M. Moss

    A sutureless technic for bilateral partial vasectomy

    Fertil Steril

    (1972)
  • W.M. Moss

    Sutureless vasectomy, an improved technique: 1300 cases performed without failure

    Fertil Steril

    (1976)
  • W.M. Moss

    A comparison of open-end versus closed-end vasectomies: a report on 6220 cases

    Contraception

    (1992)
  • S.S. Schmidt et al.

    The bipolar needle for vasectomy. I. Experience with the first 1000 cases

    Fertil Steril

    (1978)
  • J.O. Esho et al.

    Recanalization rate following methods of vasectomy using interposition of fascial sheath of vas deferens

    J Urol

    (1978)
  • S.S. Schmidt et al.

    The vas after vasectomy: comparison of cauterization methods

    Urology

    (1992)
  • A.S. Gupta et al.

    Vas occlusion by tantalum clips and its comparison with conventional vasectomy in man: reliability, reversibility, and complications

    Fertil Steril

    (1977)
  • B.B. Errey et al.

    Open-ended vasectomy: an assessment

    Fertil Steril

    (1986)
  • EngenderHealth

    Contraceptive sterilization: global issues and trends

    (2002)
  • T. Philp et al.

    Late failure of vasectomy after two documented analyses showing azoospermic semen

    Br Med J (Clin Res Ed)

    (1984)
  • P.M. Alderman

    The lurking sperm. A review of failures in 8879 vasectomies performed by one physician

    JAMA

    (1988)
  • S.S. Schmidt

    Vasectomy by section, luminal fulguration and fascial interposition: results from 6248 cases

    Br J Urol

    (1995)
  • H. Fu et al.

    Contraceptive failure rates: new estimates from the 1995 National Survey of Family Growth

    Fam Plann Perspect

    (1999)
  • D.J. Jamieson et al.

    The risk of pregnancy after vasectomy

    Obstet Gynecol

    (2004)
  • Royal College of Obstetricians & Gynaecologists

    Male and female sterilization, evidence-based clinical guideline no. 4

    (2004)
  • Cited by (28)

    • Risk of vasectomy failure by ligation and excision with fascial interposition: A prospective descriptive study

      2020, Contraception
      Citation Excerpt :

      Most recent clinical practice guidelines from United States of America [3], United Kingdom [21], Europe [22], and Canada [23] recommend that cautery of the mucosa of the vas lumen, preferably combined with interposing the fascia between the divided ends of the vas should be used to occlude the vas. Combining mucosal cauterization of the vas deferens with fascial interposition results in the lowest risk of occlusive failure (well below 1 % based on post-vasectomy semen analysis) [4,18,19]. This technique has been successfully integrated into vasectomy programs in Rwanda [24], Haiti, Kenya, and, more recently, in Colombia after we made the results of our study available locally [12].

    • Who chooses vasectomy in Rwanda? Survey data from couples who chose vasectomy, 2010-2012

      2014, Contraception
      Citation Excerpt :

      In 2010, the Rwanda Ministry of Health, with technical assistance from FHI 360, took initial steps to reverse this trend by training three Rwandan physicians to become master vasectomy trainers in NSV with thermal cautery (TC) and fascial interposition (FI) on the prostatic end [14]. This method is now considered the most effective technique for vasectomy [15,16]. These master trainers, in turn, trained 64 physicians and 103 nurses in every district of Rwanda during the period of November 2010 to January 2012 [14].

    • Strengthening vasectomy services in Rwanda: Introduction of thermal cautery with fascial interposition

      2013, Contraception
      Citation Excerpt :

      The most common vas occlusion method, ligation and excision (LE), consists of putting two ligatures on the vas and excising a small segment between the ligatures [4]. Recent and robust studies show that this technique is associated with a high risk of occlusive failure based on semen analysis results (8% to 13%), even when combined with fascial interposition (FI) (6%) [3]. The risk of contraceptive failure is also unacceptably high with simple LE, varying between 4% and 9% after three to 10 years, as reported in Asian countries [4].

    • Vasectomy Surgical Techniques in 2022

      2023, Medecine de la Reproduction
    View all citing articles on Scopus

    This work was partially supported by Family Health International (FHI) with funds from the US Agency for International Development (USAID), Cooperative Agreement GPO-A-00-05-00022-00 (Sokal), and the Fonds de la recherche en santé du Québec (Labrecque). The views expressed in this article are those of the authors and do not necessarily reflect those of FHI, USAID, or Laval University.

    View full text