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Vasectomy Introduction Many men choose a vasectomy as a permanent form of contraception. Vasectomy is a safe method of contraception. This reference summary will help explain the vasectomy procedure. ...




... Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vasectomy View a PDF version of our " Vasectomy " fact sheet. The decision to proceed with a vasectomy is a very personal one. So it is ...




... Information Clinical Trials Resources and Publications En Español Vasectomy: Overview Skip sharing on social media links Share this: Page Content A vasectomy (pronounced va-SEK- t uh -mee ) is a ...




Dr. Selvey's assertions regarding vasectomy (Journal, January 13) should not be allowed to go unchallenged, unsupported as they are by published data or the experience of many Australian vasectomists. In Australia most vasectomies are at present being performed by doctors other than specialist surgeons so that any escalation of demand will not change the situation or provide any great problems. The use of non-absorbable sutures does not reduce the failure rate. Many ligatures (for example, nylon and Dexon) may slip off the vas after a time, often by loosening at the knot. Occlusion of the vas lumen is achieved by fibrosis and the greater the length of lumen which is so fibrosed the less the likelihood of a "blow-out" and subsequent sperm granuloma formation which is often the forerunner of recanalization. Dr. Selvey states that surgical reanastomosis of the vas is a simple procedure and that it is not necessary to suture the luminal endothelium. This is at variance with other work. Dr. Selvey seems unreasonably apprehensive regarding recanalization and his suggestion that in all cases 5 cm of each vas be removed, will make it almost impossible to rejoin the vas at a subsequent date. If he knows of any sure way to identify which man will, within five years of operation, lose a child or a wife, whether by death or divorce, and so realize the need for a restoration of his fertility then I should be very glad to hear of it. His major concern seems to be the failure rate and, excluding those pregnancies associated with repeated and confirmed azoospermia (which are hardly likely to be operative failures) the Schmidt's technique is more effective than any doubling back or different suture materials and equally as good as excising the 5 cm Dr. Selvey suggested. During more than six years of working in vasectomy clinics in Sydney I have performed almost 3000 vasectomies using a variety of methods. These have included black silk and Dexon ligatures, the use of cautery to the stump, and the introduction of fascial barrier sheath and with all these methods there were five failures in 1395 cases (0.35%). With the intravasal bipolar cautery to the lumen (Schmidt VaSeal technique) there have been no failures in 533 consecutive cases. All the failures were apparent within three months of operation at the time of the first semen analysis. PMID:449769

Simcock, B W





6367 vasectomies have been performed by this surgeon in Brisbane, Queensland, Australia. In less than 6 of these procedures has reanastomasmosis been requested because of some domestic tragedy. As there has only been 75% acceptance of the need for a postoperative semen analysis, the method taught must be perfect. Most of the failures have been caused by a failure of identifcation of the right structure and not recanalizations or a 2nd unidentified vas. Consequently a safe flushing agent positively identifies the vas as it is being handled. 1% xylocaine was used because nothing else could be obtained in Brisbane. It proved to be almost spermicidal. 600 cases were checked 6 weeks postoperatively after 10 c.c. flushing. 85% of the 67% who consented to be tested had no sperms. Of another subset of 130 men who brought both a pre- and postoperative semen sample, with the 1st collected within 4 hours, but using 20 c.c. of xylocaine through each vas, a 98% clearance of all sperms by the 4th day was achieved, with only the occasional live sperm seen. The complication rate has been a high 1 in 10 if all are included, but only 1 patient in 100 has had significant minor infections or internal bruising and 1 in 1000 has had a major hemorhhage or late hydrocoele needing hospitalization and surgical drainage. PMID:12260590

Errey, B



Vasectomy - series (image)  


Vasectomy is the surgical division of the vas deferens. Vasectomy prevents sperm from being released into semen during ejaculation, thus preventing pregnancy. Vasectomy may be recommended for adult men who are ...


Reversing vasectomy.  


Advances in surgical techniques have made the reversal of vasectomy a realistic prospect. Currently, some 3% of patients request the reversal of vasectomy. Reversal techniques include macroscopic vasovasostomy, vasovasostomy with optical loupe magnification, and microsurgical methods. All of these methods have demonstrated acceptable rates of patency and pregnancy. Common to the success of these methods is the accurate apposition of mucosa to mucosa. The results of uniting the straight segments of the vas are better than those obtained with vasoepididymostomy. Recent reports indicate up to 80% patency and 30% pregnancy rates after macrosurgical anastomosis and up to 90% patency and 40% pregnancy rates after microsurgery. Operation failure could result from the following: poor anastomotic surgical technique, infection leading to fibrosis, formation of anastomotic sperm and suture granulomas, more than 10 years elapsing between the vasectomy and the reversal, and the removal of either too long a portion of the vas or part of the convoluted portion of the vas during the initial vasectomy. Although uncommon, some complications during the reversal procedure have been reported. As the reports indicate, pregnancy and patency differ significantly. Several explanations exist: 1) semen quality after reversal may be poor; 2) a secondary anastomotic stricture in the vas may gradually develop; 3) pressure mediated local changes may affect the testis and epididymis; 4) there might be a an injury to the sympathetic nerve fibers in the vas sheath; 5) antibodies to sperm may be present. While reversal is possible, the article cautions that the public should not consider vasectomy a reversible method of birth control. PMID:1392787

Banerjee, A K; Simpson, A



Vasectomy reversal.  


A vasovasostomy may be performed on an outpatient basis with local anesthesia, but also may be performed on an outpatient basis with epidural or general anesthesia. Local anesthesia is preferred by most of my patients, the majority of whom choose this technique. With proper preoperative and intraoperative sedation, patients sleep lightly through most of the procedure. Because of the length of time often required for bilateral microsurgical vasoepididymostomy, epidural or general anesthesia and overnight hospitalization are usually necessary. Factors influencing the preoperative choice for vasovasostomy or vasoepididymostomy in patients undergoing vasectomy reversal are considered. The preoperative planned choice of vasovasostomy or vasoepididymostomy for patients having vasectomy reversal described herein does not have the support of all urologists who regularly perform these procedures. My present approach has evolved as the data reported in Tables 1 and 2 have become available, but it may change as new information is evaluated. However, it offers a logical method for planning choices of anesthesia and inpatient or outpatient status for patients undergoing vasectomy reversal procedures. PMID:3811050

Belker, A M



Vasectomy and vasectomy reversal: An update  

PubMed Central

Vasectomy is an elective surgical sterilization procedure for men that is intended to obstruct or remove a portion of both vas deferens, thereby preventing sperm from moving from the testes to the ejaculatory ducts. Although intended for permanent sterilization, vasectomy can be reversed in most men seeking to restore their fertility due to a change in marital status or reproductive goals. The purpose of this document is to provided a synopsis of the latest techniques used in vasectomy and reversal. PMID:21716894

Ramasamy, Ranjith; Schlegel, Peter N.



Unintended Pregnancy Prevention: Vasectomy  


... occurred in the first three months after the vasectomy, and no failures occurred after 72 weeks. 1 CDC research also examined regret among women whose partner underwent a vasectomy. 2 In interviews with female partners of men ...


Post Vasectomy Pain Syndrome  

Microsoft Academic Search

Although the prevalence of post vasectomy pain syndrome is unknown, it is certain that the incidence of this uncommon complication\\u000a will increase because of the continued popularity of vasectomy as a highly effective and economic means of contraception.\\u000a This chapter covers the evaluation of and treatment options available for the sequelae of symptoms associated with post vasectomy\\u000a pain syndrome and

Jeannette M. Potts


Techniques of vasectomy.  


Vasectomy remains a safe and effective method of contraception for men. Many variations in surgical technique currently are used by surgeons in the United States, each with its own benefits and drawbacks. Regardless of the surgical method used, the most important factor for successful vasectomy remains the experience and skill of the surgeon. The amount of evidence-based literature on the rationale for the different techniques for vasectomy remains limited. Careful study and innovation of vasectomy techniques will ensure that the most commonly performed urologic surgical procedure remain an excellent form of contraception in the future. PMID:19643233

Art, Kevin S; Nangia, Ajay K



Cellular responses to vasectomy  

Microsoft Academic Search

A number of cell populations in the reproductive tract show a response to vasectomy. Some cell types show similar responses in man and all laboratory species, whereas others show marked species variations. This chapter describes these effects in a broadly chronological order and, in a general way, considers changes close to the site of vasectomy first and the longer term

Stuart W McDonald



Vasectomy and vasectomy reversal the Thai way.  


In 1972 the ratio of female sterilization acceptors to vasectomy acceptors in Thailand was 24.5:1; in 1978 the ratio was 2.8:1. Several factors are responsible for this change. First, a national family planning program to support voluntary family planning started in 1970 and lowered the population growth rate from 3.2% in 1973 to 2.1% in 1982. Second, the desired family size in Thailand is 3 and it is generally agreed that the solution is voluntary sterilization as a more cost effective fertility control method. Thirdly, misunderstandings about vasectomy were cleared up through media campaigns which cleared the way for greater acceptance. Fourth, in 1975 special clinics at big hospitals and a mobile unit were set up to perform vasectomies. Lastly, a group of nongovernment organizations has been set up, such as the Thai Association for Voluntary Sterilization, to provide the infrastructure for vasectomy campaigns. Requests for vasectomy reversals have, expectedly, increased as well, usually caused by marriage, child's death, improved finances, and psychosexual health. In a recent study of 32 cases, positive sperm reappearance after vas reanastomosis was found in 71.4% and the pregnancy rate was 52.3%. PMID:12265673

Gojaseni, P



Cellular responses to vasectomy.  


A number of cell populations in the reproductive tract show a response to vasectomy. Some cell types show similar responses in man and all laboratory species, whereas others show marked species variations. This chapter describes these effects in a broadly chronological order and, in a general way, considers changes close to the site of vasectomy first and the longer term effects on the testis itself later. Following vasectomy, epididymal distension and sperm granuloma formation result from raised intraluminal pressure. The sperm granuloma is a dynamic structure and a site of much spermatozoal phagocytosis by its macrophage population. In many species, spermatozoa in the obstructed ducts are destroyed by intraluminal macrophages, and degradation products, rather than whole sperm, are absorbed by the epididymal epithelium. Humoral immunity against spermatozoal antigens following vasectomy is well established and there is evidence of modest T-lymphocyte activity. The role of lymphocytes in the reproductive tract epithelium and interstitium following vasectomy is poorly defined. In laboratory animals, there is evidence that pressure-mediated damage to the seminiferous epithelium can follow sperm granuloma formation and obstruction in the epididymal head. However, the contribution of lymphocytes and antisperm antibodies to testicular damage after vasectomy is far from clear. A number of studies have suggested that testicular changes may follow vasectomy in man but their validity and mechanism of occurrence require further study. PMID:10874581

McDonald, S W



Vasectomy failure and open-ended vasectomy.  


The author of this letter comments on the earlier exchange of letters on vasectomy failure. In the present author's opinion, vasectomy failures are most often caused by the inadequate creation of a barrier of fascia between the cut ends of the vas. The use of a magnifier makes it easier to spot and correct this error. The conventional electrosurgical unit is the worst cautery used due to the potential for current leakage between the wall of the vas and the fascia. The desiccating effect of cautery units using red hot wire makes this the unit of choice. At present, the open-end technique appears to be most effective, although the creation of a spermatic granuloma risks involvement of the spermatic nerve. Research is needed in terms of observations of the vas end in humans after open-end vasectomy and an explanation of the difference in spermatic granulomas between cases in which the end of the vas is sealed and those in which the testicular end of the vas is left open. It is speculated that this difference is due to the difference in time of development of these granulomas. Finally, it is recommended in cases of postoperative orchialgia that the vas be transected about 1 cm proximal to the vasectomy and be left open to reduce the pressure within the epididymis and create a low-pressure spermatic granuloma. PMID:4054335

Schmidt, S S



How Is a Vasectomy Done?  


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Safety and effectiveness of vasectomy  

Microsoft Academic Search

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,

Pamela J. Schwingl; Harry A. Guess



Vasectomy without complication.  


In a four-year period 500 outpatient vasectomies were performed by the author. Bilateral scrotal incisions were used in all cases as were metal clips to occlude the vas deferens. Operating time rarely exceeded fifteen minutes. No failures and no sperm granulomas were encountered. Complications were rare and included a single scrotal hematoma and six minor infections. Unilateral absence of the vas deferens was noted in 2 patients. The technique to be described is a simple, complication-free method of vasectomy. PMID:1246787

Bennett, A H



Vasectomy: an update.  


Vasectomy remains an important option for contraception. Research findings have clarified many questions regarding patient selection, optimal technique, postsurgical follow-up, and risk of long-term complications. Men who receive vasectomies tend to be non-Hispanic whites, well educated, married or cohabitating, relatively affluent, and have private health insurance. The strongest predictor for wanting a vasectomy reversal is age younger than 30 years at the time of the procedure. Evidence supports the use of the no-scalpel technique to access the vasa, because it is associated with the fewest complications. The technique with the lowest failure rate is cauterization of the vasa with or without fascial interposition. The ligation techniques should be used cautiously, if at all, and only in combination with fascial interposition or cautery. A single postvasectomy semen sample at 12 weeks that shows rare, nonmotile sperm or azoospermia is acceptable to confirm sterility. No data show that vasectomy increases the risk of prostate or testicular cancer. PMID:17186713

Dassow, Paul; Bennett, John M



Vasectomy and prostate cancer  

Microsoft Academic Search

Numerous epidemiologic studies of vasectomized men have been conducted over the last decade. The majority of the reports have been reassuring with regard to possible long-term health consequences following male sterilization. In February 1993, two articles suggesting a relationship between vasectomy and prostate cancer appeared in the literature. Following publication of these studies, the United States National Institutes of Health

A. E. Pollack



Side effects of vasectomy.  


Less than 1% of all vasectomies give rise to epididymitis, or swelling and tenderness near the testes. The condition is usually caused by engorgement of the epididymal tubules with sperm rather than bacteria. Epididymitis is managed by application of heat and wearing of support. Epididymo-orchitis, a painful enlarged testicle often associated with acute epididymitis is managed by antibiotics and bedrest. Infection following vasectomy is infrequent and may occur at any of the following sites: incision, vas, epididymis and testes. Sperm granulomas (inflammatory response to the leakage of sperm from the vas or epididymis into surrounding tissues) occur in 0.1 to 3% of vasectomy cases and are usually so small and harmless that they may go unnoticed except in cases of later surgery. Their true incidence may thus be as high as 20%. Fulguration reduces the incidence of sperm granulomas but should be used with caution. Vasectomy failures are caused by 1) spontaneous recanalization; 2) division of the wrong suture; 3) inadequate occlusion of the vas; 4) duplication of vas; and 5) unprotected intercourse. PMID:12310335

Weisberg, E



Vasectomy: benefits versus risks.  


The benefits and risks of modern vasectomy are presented, including a discussion of precautions and contraindications, the incidence of specific complications and suggestions for minimizing them, and the incidence of and reasons for procedure failures. Long-term side effects, including psychological sequelae, are also discussed. PMID:606587

Davis, J E



Vasectomy: benefits and risks.  


Bilateral occlusion of the vas deferens, vasectomy, is progressively becoming the method of choice for couples seeking permanent contraception at a younger age, with smaller families. They are apparently well-informed and view the procedure as a natural step. Vasectomy is an inexpensively performed office procedure that causes minimal disruption of routine and has a high degree of community acceptance. The risks of significant hematoma, infection, discomfort and other sequelae are within acceptable limits. Improved techniques will continue to reduce the small failure rate. Antibodies observed in half of the patients have not been linked to systemic disease, although they are a hazard for the one patient in 500 returning for a vasovasostomy. Refinements in microsurgery and availability of artificial insemination enhance vasectomy as the method of choice. Evidently, extending the minimum time of sterility confirmation permits detection of occasional recanalization from technical failures. Adequate screening of the couple's motivation and expectations can prevent the rare psychologic disturbances, the greatest risk with this procedure and a problem associated with all options. For the male, there is no competitive technique at this time. In a world striving for equal rights, where the female still carries the burden of temporary contraception, the simplicity and popularity of vasectomy for permanent contraception add the desired undertones of social equilibrium. PMID:39815

Ackman, C F; MacIsaac, S G; Schual, R


Safety and effectiveness of vasectomy.  


Vasectomy has been recognized as a simple and highly effective contraceptive method. In order to recommend further research on vasectomy, researchers conducted a systematic review of the literature on the safety and effectiveness of vasectomy between 1964 and 1998. Early failure rates are 1%; however, effectiveness and complications vary with experience of surgeons and surgical technique. Early complications, which include 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 suggest that vasectomy does not increase atherosclerosis and that increases in circulating immune complexes following vasectomy are transient. The weight of the evidence regarding prostate and testicular cancer suggests that men with vasectomy are not at increased risk of these diseases. The findings indicate that publications to date continue to support the conclusion that vasectomy is a highly effective form of contraception. Future research should include evaluations of the long-term effectiveness of this method, evaluating criteria for post-vasectomy discontinuation of alternative contraception for use in settings where semen analysis is not practical, and characterizing complications including chronic epididymal pain. PMID:10785217

Schwingl, P J; Guess, H A



Evidence-based counselling for vasectomy.  


Couples requesting vasectomy need to be properly counselled. Vasectomy is generally safe but it can fail in up to 6% of cases. Reversal is possible but not always successful. Most men are azoospermic six weeks after vasectomy. They must be warned that the procedure may have to be repeated if there are persistent motile sperm in their post-vasectomy semen analysis. PMID:10954959

Kenogbon, J I



Effectiveness of vasectomy using cautery  

Microsoft Academic Search

BACKGROUND: Little evidence supports the use of any one vas occlusion method. Data from a number of studies now suggest that there are differences in effectiveness among different occlusion methods. The main objectives of this study were to estimate the effectiveness of vasectomy by cautery and to describe the trends in sperm counts after cautery vasectomy. Other objectives were to

Mark A Barone; Belinda Irsula; Mario Chen-Mok; David C Sokal



Noninvasive laser vasectomy  

NASA Astrophysics Data System (ADS)

Development of a noninvasive vasectomy technique may eliminate male fear of complications (incision, bleeding, infection, and scrotal pain) and result in a more popular procedure. These studies build off previous studies that report the ability to thermally target tissue substructures with near infrared laser radiation while maintaining a healthy superficial layer of tissue through active surface cooling. Initial studies showed the ability to increase the working depth compared to that of common dermatological procedures and the translation into an ex vivo canine model targeting the vas deferens in a noninvasive laser vasectomy. Laser and cooling parameter optimization was required to determine the best possible wavelength for a safe transition to an in vivo canine model. Optical clearing agents were investigated as a mechanism to decrease tissue scattering during in vivo procedures to increase optical penetration depth and reduce the overall power required. Optical and thermal computer models were developed to determine the efficacy for a successful transition into a human model. Common clinical imaging modalities (ultrasound, high frequency ultrasound, and optical coherence tomography) were tested as possible candidates for real-time imaging feedback to determine surgical success. Finally, a noninvasive laser vasectomy prototype clamp incorporating laser, cooling, and control in a single package was designed and tested in vivo. Occlusion of the canine vas deferens able to withstand physiological burst pressures measured postoperative was shown during acute and chronic studies. This procedure is ready for azoospermia and recanalization studies in a clinical setting.

Cilip, Christopher Michael


Vasectomy-behind testis.  


The findings in a series of 100 scrotal dissections seem to indicate that the conventional method of vasectomy may be partly responsible for the persistent failures of vaso-vasostomy. It is suggested that the selection of a different site for vasectomy is necessary in order to minimize the percentage of failures attending the operation of vaso-vasostomy for refertility. Anatomically, vasectomy performed above the level of the upper pole of the testis carries some disadvantages. There is a greater possibility of damaging the vessels. Defining the ends of vas in relatively loose tissue calls for a wider dissection and possibly may prove more damaging when done for the subsequent operation of anastomosis. Thus, the blood supply to both the testis and vas may be jeopardized. The resultant scar tissue is also significantly large. When the vas is exposed at the back of the upper 1/3 of the testis, the testicular artery has already divided into branches and left the vas. The venous plexus is yet to form a veil for it. The vas is comparatively better anchored in the surrounding areolar tissue. Since in most of the cases the vas is not coiled in this region, no difficulty should be encountered, and the difficulty of anastomozing the ends of the coiled portion of the vas deferens is generally accepted when the patients comes for an anastomotic operation at a later date. Also the scar tissue will be less. It is recommended that the method be used on a larger scale. PMID:12254773

Shahade, M G; Shah, V C; Boradkar, R V



Recent research on vasectomy techniques.  


Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA. PMID:12937807

Sokal, David C



Effectiveness of vasectomy techniques.  


The effectiveness of various vasectomy techniques is reviewed, with a focus on methods used for vas occlusion. Spontaneous recanalization of the vas is more common than generally recognized and is often transient. Simple ligation and excision has an unacceptably high risk for failure. Techniques that include cautery seem to have a lower risk for failure than techniques that do not include cautery. There is insufficient evidence to recommend a particular standardized cautery technique, but adding fascial interposition to cautery seems to be associated with the lowest risk for failure. PMID:19643234

Sokal, David C; Labrecque, Michel



Serious complications after vasectomy rare, experts say.  


The chief of the women's health and fertility branch of the Centers for Disease Control's Division of Reproductive Health in Atlanta, Georgia and other reproductive health specialists have determined that vasectomies are very safe and adequately protect against pregnancy. The most common method to occlude the vas deferens is ligation. If the clinician ties the ligatures too tightly or loosely, sperm can enter adjacent tissues causing sperm granulomas and fistulous tracts. Up to 40% of vasectomies result in sperm granulomas, consisting of sperm, epithelial cells, and lymphocytes, either at the vasectomy site or the epididymis. This condition can cause the vas ends to rejoin spontaneously. Coagulation of the vas mucosa reduces sperm granulomas but it makes it more difficult for clinicians to perform vasectomy reversal. Reversal is more likely to occur if the interval between vasectomy and reversal procedure is 10 years. Vasectomy failure rates vary from 0% to 2%. Failures tend to happen because men fail to use a condom soon after the procedure or the vas has rejoined spontaneously. So the Association for Voluntary Surgical Contraception suggests that couples practice other family planning methods for the 1st 15 ejaculations after vasectomy or for 6 weeks after vasectomy. As of late 1990, 160,000 men had undergone a vasectomy and only 2 died from the procedure. 1 man suffered scrotal hematoma formation and infection while the other man died from general anesthesia when his health provider had to drain a scrotal hematoma which developed after the vasectomy. Hematomas tend to happen when physicians with no to limited experience perform the vasectomy (4.6% for physicians who do 1-10 vasectomies/year vs. 1.6% for 50 vasectomies/year). Overall hematoma incidence is 2%. Infections are limited to 2% of vasectomies. Epididymitis occurs even more rarely than infection (1%). Vasectomy does not appear to be correlated with increased risk of atherosclerosis or urogenital tract disease. PMID:12317890




PubMed Central

CD4+CD25+ regulatory T cells (Tregs) strongly influence the early and late autoimmune responses to meiotic germ cell antigens (MGCA) and the gonadal immunopathology in vasectomized mice. This is supported by the published and recently acquired information presented here. Within 24 hours of unilateral vasectomy (uni-vx) the ipsilateral epididymis undergoes epithelial cell apoptosis followed by necrosis, severe inflammation, and granuloma formation. Unexpectedly, vasectomy alone induced MGCA-specific tolerance. In contrast, uni-vx plus simultaneous Treg depletion resulted in MGCA-specific autoimmune response and bilateral autoimmune orchitis. Both tolerance and autoimmunity were strictly linked to the early epididymal injury. We now discovered that testicular autoimmunity in uni-vx mice did not occur when Treg depletion was delayed by one week. Remarkably, this delayed Treg depletion also prevented tolerance induction. Therefore, tolerance depends on a rapid de novo Treg response to MGCA exposed after vasectomy. Moreover, tolerance was blunted in mice genetically deficient in PD-1 ligand, suggesting the involvement of induced Treg. We conclude that pre-existing natural Treg prevents post-vasectomy autoimmunity, whereas vasectomy-induced Treg maintains post-vasectomy tolerance. We further discovered that vasectomized mice were still resistant to autoimmune orchitis induction for at least 12–16 months; thus, tolerance is long-lasting. Although significant sperm autoantibodies of low titers became detectable in uni-vx mice at seven months, the antibody titers fluctuated over time, suggesting a dynamic “balance” between the autoimmune and tolerance states. Finally, we observed severe epididymal fibrosis and hypo-spermatogenesis at 12 months after uni-vx: findings of highly critical clinical significance. PMID:24080233

Rival, Claudia; Wheeler, Karen; Jeffrey, Sarah; Qiao, Hui; Luu, Brian; Tewalt, Eric F; Engelhard, Victor H; Tardif, Stephen; Hardy, Daniel; del Rio, Roxana; Teuscher, Cory; Tung, Kenneth



Effectiveness of vasectomy using cautery  

PubMed Central

Background Little evidence supports the use of any one vas occlusion method. Data from a number of studies now suggest that there are differences in effectiveness among different occlusion methods. The main objectives of this study were to estimate the effectiveness of vasectomy by cautery and to describe the trends in sperm counts after cautery vasectomy. Other objectives were to estimate time and number of ejaculations to success and to determine the predictive value of success at 12 weeks for final status at 24 weeks. Methods A prospective, non-comparative observational study was conducted between November 2001 and June 2002 at 4 centers in Brazil, Canada, the UK, and the US. Four hundred men who chose vasectomy were enrolled and followed for 6 months. Sites used their usual cautery vasectomy technique. Earlier and more frequent than normal semen analyses (2, 5, 8, 12, 16, 20, and 24 weeks after vasectomy) were performed. Planned outcomes included effectiveness (early failure based on semen analysis), trends in sperm counts, time and number of ejaculations to success, predictive value of success at 12 weeks for the outcome at 24 weeks, and safety evaluation. Results A total of 364 (91%) participants completed follow-up. The overall failure rate based on semen analysis was 0.8% (95% confidence interval 0.2, 2.3). By 12 weeks 96.4% of participants showed azoospermia or severe oligozoospermia (< 100,000 sperm/mL). The predictive value of a single severely oligozoospermia sample at 12 weeks for vasectomy success at the end of the study was 99.7%. One serious unrelated adverse event and no pregnancies were reported. Conclusion Cautery is a very effective method for occluding the vas. Failure based on semen analysis is rare. In settings where semen analysis is not practical, using 12 weeks as a guideline for when men can rely on their vasectomy should lessen the risk of failure compared to using a guideline of 20 ejaculations after vasectomy. PMID:15260885

Barone, Mark A; Irsula, Belinda; Chen-Mok, Mario; Sokal, David C



The need for epididymovasostomy at vasectomy reversal plateaus in older vasectomies: a study of 1229 cases.  


Vasectomy reversal involves either vasovasostomy (VV) or epididymovasostomy (EV), and rates of epididymal obstruction and EV increase with time after vasectomy. However, as older vasectomies may not require EV for successful reversal, we hypothesized that sperm production falls after vasectomy and can protect the system from epididymal blowout. Our objective was to define how the need for EV at reversal changes with time after vasectomy through a retrospective review of consecutive reversals performed by three surgeons over a 10-year period. Vasovasotomy was performed with Silber score 1-3 vasal fluid. EVs were performed with Silber score 4 (sperm fragments; creamy fluid) or 5 (sperm absence) fluid. Reversal procedure type was correlated with vasectomy and patient age. Post-operative patency rates, total spermatozoa and motile sperm counts in younger (<15 years) and older (>15 years) vasectomies were assessed. Simple descriptive statistics determined outcome relevance. Among 1229 patients, 406 had either unilateral (n = 252) or bilateral EV's (n = 154) constituting 33% (406/1229) of reversals. Mean patient age was 41.4±7 years (range 22-72). Median vasectomy interval was 10 years (range 1-38). Overall sperm patency rate after reversal was 84%. The rate of unilateral (EV/VV) or bilateral EV increased linearly in vasectomy intervals of 1-22 years at 3% per year, but plateaued at 72% in vasectomy intervals of 24-38 years. Sperm counts were maintained with increasing time after vasectomy, but motile sperm counts decreased significantly (p < 0.001). Pregnancy, secondary azoospermia, varicocoele and sperm granuloma were not assessed. In conclusion, and contrary to conventional thinking, the need for EV at reversal increases with time after vasectomy, but this relationship is not linear. EV rates plateau 22 years after vasectomy, suggesting that protective mechanisms ameliorate epididymal 'blowout'. Upon reversal, sperm output is maintained with time after vasectomy, but motile sperm counts decrease linearly, suggesting epididymal dysfunction influences semen quality after reversal. PMID:24243789

Mui, P; Perkins, A; Burrows, P J; Marks, S F; Turek, P J



Experience with vasectomy in Rajshahi.  


619 vasectomy cases in Rajshahi, Pakistan were followed. 2 failures in the series were reported. l2 of the patients experienced postoperative pain, tenderness, or swelling. There was 1 case of decreased libido, which was later attributed to causes other than the vasectomy. The preponderance of the acceptors were low-income illiterates 35-44 years of age and had 4-6 living children. It was found that family planning information was best communicated through a newtork of kinship in which a member had been sterilized. Since most of the acceptors were from the lowest socioeconomic class, a study of middle class values and motivation for family planning is recommeded. PMID:12305226

Mafakhkharul Islam Ai, M



Vasectomy and the risk of prostate cancer: a meta-analysis examining vasectomy status, age at vasectomy, and time since vasectomy  

Microsoft Academic Search

The aim of this study was to conduct a quantitative review of prostate cancer studies to pool relative risk (RR) estimates on the association between prostate cancer and vasectomy, in an attempt to determine whether there is an association, and if so, its magnitude. Random-effects models were examined along with a linear model for time since vasectomy. The pooled RR

L K Dennis; D V Dawson; M I Resnick



Vasectomy and risk of prostate cancer.  


Most studies do not support an association between vasectomy and prostate cancer, but a few have suggested a link. Vasectomy is a common birth control method, and prostate cancer is the most frequently diagnosed solid tumor in men, making this a major public health question. This study was specifically designed to determine whether or not vasectomy is associated with risk of prostate cancer. To examine this issue, we conducted a population-based case-control study in King County, Washington. Interviews were completed with men ages 40-64 years newly diagnosed with prostate cancer between January 1993 and December 1996 who were ascertained through the Seattle-Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry (n = 753) and with comparison men without prostate cancer identified from the same general population (n = 703). The odds ratio (OR) for prostate cancer in relation to vasectomy was assessed. The prevalence of vasectomy was similar in cases (39.4%) and controls (37.7%), resulting in no association (adjusted OR, 1.10; 95% confidence interval, 0.9-1.4). There was no consistent evidence that risk varied by the age at which vasectomy was performed, the time since vasectomy, or the calendar period when the vasectomy was performed. The OR in relation to vasectomy was higher in men with less aggressive prostate cancer. Risk estimates did not differ according to age, race, or family history of prostate cancer. This study suggests that vasectomy is not associated with the risk of developing prostate cancer. It also provides evidence that vasectomized men may be more likely to present with earlier-stage, lower-grade prostate tumors. PMID:10548316

Stanford, J L; Wicklund, K G; McKnight, B; Daling, J R; Brawer, M K



Vasectomy complications at a family practice center.  


Vasectomy is a safe, effective, economical, and convenient form of permanent sterilization since it can be performed in an outpatient setting. Seventy-three vasectomies were performed during a nine-year period at the Kanawha Valley Family Practice Center. The procedures were performed by family practice residents under the active instruction and supervision of the attending staff. The complication type and frequency are as follows: epididymitis, 5.5 per cent; sperm granuloma, 2.7 per cent; wound infection, 1.4 per cent, and hematoma, 12 per cent. No failures occurred in this study group. All of the complications were minor and responded to conservative medical management. The results of this study reveal that vasectomy complications at this teaching family practice center are comparable to those reported in the medical literature. This study therefore supports the opinion that vasectomies can be performed safely and taught by trained family practitioners in the outpatient setting. PMID:2781781

Beavers, C H



Weak autoantibody reactions to antigens other than sperm after vasectomy  

Microsoft Academic Search

Autoantibody activity against various antigens was measured by indirect immunofluorescence in 97 men about to undergo vasectomy and 170 men who had undergone the operation up to six years earlier. There was a significantly higher prevalence of weakly positive autoantibody reactions among those who had undergone vasectomy. There was, however, no evidence that vasectomy could induce stronger autoantibody reactions such

J D Mathews; D C Skegg; M P Vessey; M Konice; E J Holborow; J Guillebaud



Vasectomy management in Morecambe Bay NHS Trust.  

PubMed Central

INTRODUCTION: Vasectomy is a common method of contraception in the UK. However, there is a wide variation in management protocols. The aim of the present study was to identify differences within the hospitals of Morecambe Bay NHS Trust and to recommend a uniform practice. PATIENTS AND METHODS: Retrospective case notes review of 395 vasectomy procedures performed within the Morecambe Bay NHS Trust in a 1-year period. RESULTS: Inconsistency was found with regards to the anaesthetic technique, the vas histology request and the timing of the semen analysis. The non-compliance rate for postvasectomy semen analysis was 33.4%. The complication and failure rates were 4.04% and 0.51%, respectively. Motile sperm (n = 4) was submitted at an average time of 8 weeks' postvasectomy. In half of those cases, vasectomy proved unsuccessful. Immotile sperm (n = 41) was submitted at an average time of 9.5 weeks and, in 80% of those men, semen cleared at an average time of 15.5 weeks' postvasectomy. An azoospermic (n = 285) sample was submitted at an average time of 10.5 weeks. Eleven of those men submitted a second sample with immotile sperm at an average time of 12 weeks' postvasectomy and that was eventually clear at 18 weeks in the majority of cases. CONCLUSIONS: A uniform vasectomy practice should include vasectomy under local anaesthesia if possible, no vas histology and a request for a single sample at 12 weeks. If this is clear, vasectomy should be considered successful. If any sperm are present, then a further sample should be requested at 16 weeks' postvasectomy. Immotile sperm at that time should not justify any further samples and a 'special clearance' should be issued to those men. PMID:15826426

Katsoulis, I. E.; Walker, S. R.



Vasectomy surgical techniques: a systematic review  

Microsoft Academic Search

BACKGROUND: A wide variety of surgical techniques are used to perform vasectomy. The purpose of this systematic review was to assess if any surgical techniques to isolate or occlude the vas are associated with better outcomes in terms of occlusive and contraceptive effectiveness, and complications. METHODS: We searched MEDLINE (1966-June 2003), EMBASE (1980-June 2003), reference lists of retrieved articles, urology

Michel Labrecque; Caroline Dufresne; Mark A Barone; Karine St-Hilaire



Effect of Vasectomy on Psychological Functioning  

Microsoft Academic Search

Pie- to postoperative changes in couples electing vasectomy are discussed. High satisfaction with the operation is found, along with apparently desirable changes in attitudes toward child rearing and views of self and spouse. There is, however, concurrent evidence (both on psychometric scales and on clinical ratings) of adverse psychological changes in both husband and wife and of reduced marital satisfaction



Vasectomy and subsequent cardiovascular disease in US physicians  

Microsoft Academic Search

Due to previous animal research suggesting accelerated atherosclerosis following vasectomy, we examined whether vasectomy increases the risk of subsequent cardiovascular disease (CVD), including myocardial infarction (MI), angina pectoris, coronary revascularization, and stroke, in the US Physicians’ Health Study. Of 22,071 US male physicians participating in the study, aged 40 to 84 years at entry and free from cardiovascular disease and

JoAnn E Manson; Paul M Ridker; Angela Spelsberg; Umed Ajani; Paulo A Lotufo; Charles H Hennekens



Should We Still be Performing Vasectomies?  

PubMed Central

Longterm safety of vasectomy has been questioned, based on the possibility of sperm antigens causing an antibody response. The point at which the antigens enter the circulation is unknown. Animal experiments have shown atherosclerosis as a result of antibody production, but evidence in man is still equivocal. Nonetheless, the family physician is obliged to inform patients of possible postoperative complications, but to avoid overinterpretation of a still controversial problem. PMID:20469361

Smith, R. K. L. Percival



Complications in a series of 1224 vasectomies.  


The assessment of a vasectomy technique should be based on the incidence of complications resulting from the procedure. Differing diagnostic criteria for defining complications and the belated occurrence of some adverse events, however, have made such appraisals difficult. This paper offers criteria for defining vasectomy-related problems and presents the results of a longterm study of 1224 vasectomies. The records of 1224 men who had undergone vasectomies by the same technique over a 4-year period were reviewed, and documented complications were tabulated and evaluated. Patients were referred residents of the lower mainland of British Columbia, and the majority were married. The group spanned many ages, races, and occupations. 12 Categories of potential complications were defined, of which 10 were actually encountered in the study group. Infection was defined as having had antimicrobial drugs prescribed, and regret was defined as having returned to discuss a reversal; all other complications were diagnosed based on a documented clinical diagnosis. Complications were documented in 124 cases (10.6%) an included 46 minor infections (3.8%), 2 serious infections (0.16%), 23 instances of epididymitis (1.9%), 16 cases of sperm granulomas (1.3%), and 4 minor hemorrhages (0.33%). Of 3 failures, only 1 (0.08%) was the result of recanalization. No serious hemorrhages or late failures were seen. Satisfactory results were believed to be related to surgical technique and the liberal use of antimicrobial drugs. The low recanalization rate was the result of treatment of the ends of the vas with multiple loops of polyglycolic acid ligature. PMID:1744603

Alderman, P M



Vasectomy surgical techniques: a systematic review  

PubMed Central

Background A wide variety of surgical techniques are used to perform vasectomy. The purpose of this systematic review was to assess if any surgical techniques to isolate or occlude the vas are associated with better outcomes in terms of occlusive and contraceptive effectiveness, and complications. Methods We searched MEDLINE (1966-June 2003), EMBASE (1980-June 2003), reference lists of retrieved articles, urology textbooks, and our own files looking for studies comparing two or more vasectomy surgical techniques and reporting on effectiveness and complications. From 2,058 titles or abstracts, two independent reviewers identified 224 as potentially relevant. Full reports of 219 articles were retrieved and final selection was made by the same two independent reviewers using the same criteria as for the initial selection. Discrepancies were resolved by involving a third reviewer. Data were extracted and methodological quality of selected studies was assessed by two independent reviewers. Studies were divided in broad categories (isolation, occlusion, and combined isolation and occlusion techniques) and sub-categories of specific surgical techniques performed. Qualitative analyses and syntheses were done. Results Of 31 comparative studies (37 articles), only four were randomized clinical trials, most studies were observational and retrospective. Overall methodological quality was low. From nine studies on vas isolation, there is good evidence that the no-scalpel vasectomy approach decreases the risk of surgical complications, namely hematoma/bleeding and infection, compared with incisional techniques. Five comparative studies including one high quality randomized clinical trial provided good evidence that fascial interposition (FI) increases the occlusive effectiveness of ligation and excision. Results of 11 comparative studies suggest that FI with cautery of the vas lumen provides the highest level of occlusive effectiveness, even when leaving the testicular end open. Otherwise, firm evidence to support any occlusion technique in terms of increased effectiveness or decreased risk of complications is lacking. Conclusions Current evidence supports no-scalpel vasectomy as the safest surgical approach to isolate the vas when performing vasectomy. Adding FI increases effectiveness beyond ligation and excision alone. Occlusive effectiveness appears to be further improved by combining FI with cautery. Methodologically sound prospective controlled studies should be conducted to evaluate specific occlusion techniques further. PMID:15157272

Labrecque, Michel; Dufresne, Caroline; Barone, Mark A; St-Hilaire, Karine



Vasectomy surgical techniques in South and South East Asia  

PubMed Central

Background Simple ligation of the vas with suture material and excision of a small vas segment is believed to be the most common vasectomy occlusion technique performed in low-resource settings. Ligation and excision (LE) is associated with a risk of occlusion and contraceptive failure which can be reduced by performing fascial interposition (FI) along with LE. Combining FI with intra luminal thermal cautery could be even more effective. The objective of this study was to determine the surgical vasectomy techniques currently used in five Asian countries and to evaluate the facilitating and limiting factors to introduction and assessment of FI and thermal cautery in these countries. Methods Between December 2003 and February 2004, 3 to 6 major vasectomy centers from Cambodia, Thailand, India, Nepal, and Bangladesh were visited and interviews with 5 to 11 key informants in each country were conducted. Vasectomy techniques performed in each center were observed. Vasectomy techniques using hand-held, battery-driven cautery devices and FI were demonstrated and performed under supervision by local providers. Information about interest and open-mindedness regarding the use of thermal cautery and/or FI was gathered. Results The use of vasectomy was marginal in Thailand and Cambodia. In India, Nepal, and Bangladesh, vasectomy was supported by national reproductive health programs. Most vasectomies were performed using the No-Scalpel Vasectomy (NSV) technique and simple LE. The addition of FI to LE, although largely known, was seldom performed. The main reasons reported were: 1) insufficient surgical skills, 2) time needed to perform the technique, and 3) technique not being mandatory according to country standards. Thermal cautery devices for vasectomy were not available in any selected countries. Pilot hands-on assessment showed that the technique could be safely and effectively performed by Asian providers. However, in addition to provision of supplies, introducing cautery with FI could be associated with the same barriers encountered when introducing FI in combination with LE. Conclusion Further studies assessing the effectiveness, safety, and feasibility of implementation are needed before thermal cautery combined with FI is introduced in Asia on a large scale. Until thermal cautery is introduced in a country, vasectomy providers should practice LE with FI to maximize effectiveness of vasectomy procedure. PMID:15916711

Labrecque, Michel; Pile, John; Sokal, David; Kaza, Ramachandra CM; Rahman, Mizanur; Bodh, SS; Bhattarai, Jeewan; Bhatt, Ganesh D; Vaidya, Tika Man



The psychological effects of vasectomy for American men  

ERIC Educational Resources Information Center

Reviewed evidence concerning the psychological effects of vasectomy for American men. Surveys of postoperative sexual behavior and satisfaction and/or happiness were cited, as were data from studies employing clinical interviews and/or psychological tests. (Author/SB)

Bloom, Larry J.; Houston, B. Kent



Vasectomy and subsequent cardiovascular disease in US physicians.  


Due to previous animal research suggesting accelerated atherosclerosis following vasectomy, we examined whether vasectomy increases the risk of subsequent cardiovascular disease (CVD), including myocardial infarction (MI), angina pectoris, coronary revascularization, and stroke, in the US Physicians' Health Study. Of 22,071 US male physicians participating in the study, aged 40 to 84 years at entry and free from cardiovascular disease and cancer, 21,028 reported on the 60-month questionnaire whether they had undergone vasectomy prior to randomization. Of the 4546 physicians with vasectomy, 1159 had undergone the procedure at least 15 years before entry. During 258,892 person-years of follow-up, we documented 773 cases of MI (719 nonfatal and 54 fatal), 1907 cases of angina pectoris or coronary revascularization, and 604 confirmed cases of ischemic or hemorrhagic stroke (566 nonfatal and 38 fatal). When compared to men without prior vasectomy, the multivariate relative risk (RR) of total MI adjusted for age and other coronary risk factors was 0.94 (95% confidence interval [CI], 0.77-1.14) among men with vasectomy. Risk estimates for fatal and nonfatal events did not appreciably differ from each other. For angina or coronary revascularization or both, the multivariate relative risk was 0.99 (0.88-1.12) and for total stroke the RR was 0.95 (0.75-1.21). For men who had undergone vasectomy 15 or more years previously, the multivariate relative risks were 0.98 (0.73-1.32) for total MI, 1.17 (0.87-1.57) for total stroke, and 1.12 (0.94-1.35) for angina/revascularization. These results provide reassuring evidence that vasectomy does not materially increase the risk of subsequent cardiovascular disease, even 15 or more years following the procedure. PMID:10382081

Manson, J E; Ridker, P M; Spelsberg, A; Ajani, U; Lotufo, P A; Hennekens, C H



Vasectomy: a two-tier follow-up.  


A follow-up study on males who had voluntarily undergone vasectomy was conducted in Tilburg, The Netherlands between 1970 and 1974. A group of 44 males was studied within 1 year after vasectomy (performed in 1970 or 1971). This group was studied again in a 2nd follow-up, 2-1/2 years after vasectomy and the results were compared. A 2nd group of 356 males (group 2) who had undergone vasectomy in 1972 or 1973 was studied between 6 and 18 months after sterilization, and the results were compared with those of group 1. Group 1 was mailed an open-ended questionnaire addressed to the husband and the wife within 1 year after vasectomy. After 2-1/2 years both groups were mailed a precoded questionnaire. There were no significant differences in composition between the groups. For group 1, reported experience with the vasectomy did not change appreciably between the 1st and 2nd study. There was only 1 significant difference between groups 1 and 2. Those males who, together with their wives, had been more intensively prepared for vasectomy by the team including an intensive interview with a psychologist preceding the operation for group 1, talk more often and more enthusiastically with others about their experiences and are more inclined to recommend vasectomy. Taking groups 1 and 2 together, ofa total of 267 respondents: 1) 67% reported that frequency of intercourse remained the same and 21% indicated that frequency had increased; 2) 40% reported that gratification in sexual relations stayed the same and 58% indicated gratification had increased; and 3) 70% reported that marital relations had remained the same and 27% indicated an improvement. PMID:10236503

Bergsma, J



Frequency and patterns of early recanalization after vasectomy  

PubMed Central

Background 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. Methods 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. Results 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. Conclusion Early recanalization, occurring within the first weeks after vasectomy, is more common than generally recognized. Its frequency depends on the occlusion technique performed. PMID:16984640

Labrecque, Michel; Hays, Melissa; Chen-Mok, Mario; Barone, Mark A; Sokal, David



Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and Mexico  

Microsoft Academic Search

BACKGROUND: Vasectomy is generally considered a safe and effective method of permanent contraception. The historical effectiveness of vasectomy has been questioned by recent research results indicating that the most commonly used method of vasectomy – simple ligation and excision (L and E) – appears to have a relatively high failure rate, with reported pregnancy rates as high as 4%. Updated

Yancy Seamans; Claudia M Harner-Jay



Open-ended vasectomy prevents pain, may enhance reversibility.  


Some researchers now recommend an "open-ended" vasectomy technique, and their studies have shown a reversal success rate of over 90%. In addition, the procedure apparently alleviates pressure buildup in the epididymis that can cause chronic pain in some men. Open-ended vasectomy, developed by Dr. Sherman Silber, is characterized by leaving the testicular side of the divided vas open, while the abdominal side is clipped or cauterized as usual. The importance of that technique is 2-fold, according to Silber. The resulting reduction in pressure prevents ruptures and leakage in the epididymis, vastly improving the patient's chances of successful reversal. It also reduces chronic orchitic pain, noted in about 10% of vasectomy patients. Silber notes that his open-ended procedure recorded an unacceptably high failure rate as it was first developed -- 4% if cautery was used to seal the abdominal lumen, dropping to 0.04% when a Hemoclip was applied. Since Silber's initial study in 1979, several physicians have explored the open-ended vasectomy technique and have reported good results. Dr. William M. Moss has performed 2050 vasectomies using his own modification of Silber's technique and had recorded only 2 failures. The Moss technique is sutureless, resulting in greater patient comfort, and it takes only 5 minutes to perform. Both Moss and Silber cited a reversal success rate of 90% or better for the open-ended technique, and Silber estimated the subsequent pregnancy rate for spouses of vasectomy reversal patients to be 83%. Initial concern over formation of painful sperm granuloma or sperm antibodies have proved unfounded under further study. Few men change their minds after vasectomy; only 1% will ultimately seek reversal. PMID:12340687



Post-Vasectomy Depression: A Case Report and Literature Review  

PubMed Central

Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent. A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family. Psychological complications of vasectomy have generally been studied under four heads: sexual dysfunction, effects on marital relationships, chronic post-operative pain, and other complications including anxiety and depression. These complications have generally been reported at higher rates in developing countries, and are linked to poor knowledge about the procedure and inadequate pre-operative counseling. The implications of the existing literature for the patient’s current complaints, and the mechanisms and risk factors involved, are discussed in the light of existing research. Suggestions for the prevention and treatment of post-vasectomy depression are also outlined. PMID:25553234

Shaik, Subahani



Organizing a public-sector vasectomy program in Brazil.  


Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems. This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system. It demonstrates that once the necessary operational and quality-of-care improvements were in place, and sufficient political and technical support existed to proceed, it was possible to establish low-cost, well-used, and sustainable vasectomy services free of charge. The findings show that careful attention to the development of strong technical competence and an informed choice process resulted in high user satisfaction. Focus-group discussions with men who underwent vasectomy indicate that they had no objection to being served in the context of a women's health center and that they act as opinion leaders who draw an increasing clientele to the service. PMID:11831050

Penteado, L G; Cabral, F; Díaz, M; Díaz, J; Ghiron, L; Simmons, R



Vasectomy and prostate cancer: the evidence to date.  


A 1993 editorial in "Fertility and Sterility," accompanying publication of two cohort studies by Giovannucci et al. indicating a positive association between vasectomy and prostate cancer, noted the observed association could have resulted from chance, bias, or a causal association. There is strong potential for bias in the selection of study participants and in the additional medical attention received by sterilized men. Men who undergo vasectomy may have different life-style characteristics than those who do not. Meta-analyses of prostate cancer risk have calculated higher odds ratios in studies judged to have inadequate selection of controls and possible detection bias than in more methodologically rigorous studies. Overall, a review of the research evidence reveals inconsistent study findings, weak strength of any observed association, and little biologic plausibility for a vasectomy-prostate cancer link. PMID:9696206

Peterson, H B; Howards, S S



Letter: Follow-up after vasectomy.  


A surgeon reporting results of 2000 vasectomies performed under local anesthesia over a 4-year period suggests that a single sperm count is sufficient to establish success or failure of the procedure. 1 sperm count was taken after 10 ejaculations or at least 10 weeks; patients were instructed to continue contraception until results were known. 75% of the patients complied between the 3rd and 64th postoperative weeks. 3 failures were detected in this group; 2 were found during reoperation to be the results of misidentifications of the vas and the 3rd has not yet undergone reoperation. Histology of the removed vas was performed in fewer than 10 patients. Requiring histology is all 2000 patients would have cost more that $20,000 and sperm counts would still have been necessary. Less than .5% of the samples showed significant numbers of motile or nonmotile sperm - these were the 3 failures and men over 40. No pregnancies have resulted when patients were instructed to discontinue contraception in the presence of a few nonmotile sperm. Slow clearance of nonmotile sperm is directly related to age, occurring in 1% of patients under 40 and in 50% of those over 40. Recanalization is seen as a very rare occurrence that can be distinguished from primary failure only by histology and reoperation. PMID:4758777

Errey, B



Electrocautery hailed as method of choice for vasectomy.  


A study of 2500 men who obtained vasectomies by electrocautery technique revealed that this method is 10 times more effective than standard ligation in preventing failures. Dr. George C. Denniston reported these study results during the conference of the Association of Planned Parenthood Professionals (APPP) in Los Angeles, identifying electrocautery as the method of choice on the basis of the study results. Denniston collected data concerning the 2500 vasectomies in a clinic setting over an 11-year period. 80% of the men were between 25-45 years, 39% under age 30, and 21% had no children. Complications were minimal. Patients experienced the following conditions after the procedure: ecchymosis (black and blue scrotum) was kept to a minimum by quick cautery of the skin edges; hematoma in 3% of the cases; and infection in 2% of cases. There was only 1 pregnancy in the entire series, but an additional pregnancy occurred shortly after the vasectomy when the patient experienced his 3rd or 4th ejaculation. No backup contraception was used. There were 5 technical failures, where sperm persisted after 15 ejaculations. When Denniston compared vasectomy by electrocautery with other techiques, Denniston found that the average failure rate for the standard ligation technique was between 1-3%. Denniston emphasized that 1 advantage of electrocautery is that all the clinician has to do is burn the lumen in a graded manner. He also noted that electrocautery lends itself to successful reanastomosis. Denniston suggested the following procedure for physicians who choose to perform vasectomy by electrocautery: isolate the area high; inject xylocaine, 1%; incise; bring out the vas; remove the sheaths; cut the vas once; cauterize the lumen of both of the cut ends, taking care to cauterize in a graded manner; cover the upper or distal end with surrounding fasica; drop the vas back; and close the incision. PMID:12265922



Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and Mexico  

PubMed Central

Background Vasectomy is generally considered a safe and effective method of permanent contraception. The historical effectiveness of vasectomy has been questioned by recent research results indicating that the most commonly used method of vasectomy – simple ligation and excision (L and E) – appears to have a relatively high failure rate, with reported pregnancy rates as high as 4%. Updated methods such as fascial interposition (FI) and thermal cautery can lower the rate of failure but may require additional financial investments and may not be appropriate for low-resource clinics. In order to better compare the cost-effectiveness of these different vasectomy methods, we modelled the costs of different vasectomy methods using cost data collected in India, Kenya, and Mexico and effectiveness data from the latest published research. Methods The costs associated with providing vasectomies were determined in each country through interviews with clinic staff. Costs collected were economic, direct, programme costs of fixed vasectomy services but did not include large capital expenses or general recurrent costs for the health care facility. Estimates of the time required to provide service were gained through interviews and training costs were based on the total costs of vasectomy training programmes in each country. Effectiveness data were obtained from recent published studies and comparative cost-effectiveness was determined using cost per couple years of protection (CYP). Results In each country, the labour to provide the vasectomy and follow-up services accounts for the greatest portion of the overall cost. Because each country almost exclusively used one vasectomy method at all of the clinics included in the study, we modelled costs based on the additional material, labour, and training costs required in each country. Using a model of a robust vasectomy program, more effective methods such as FI and thermal cautery reduce the cost per CYP of a vasectomy by $0.08 – $0.55. Conclusion Based on the results presented, more effective methods of vasectomy – including FI, thermal cautery, and thermal cautery combined with FI – are more cost-effective than L and E alone. Analysis shows that for a programme in which a minimum of 20 clients undergo vasectomies per month, the cost per CYP is reduced in all three countries by updated vasectomy methods. PMID:17629921

Seamans, Yancy; Harner-Jay, Claudia M



“If you do vasectomy and come back here weak, I will divorce you”: a qualitative study of community perceptions about vasectomy in Southern Ghana  

PubMed Central

Background Male involvement in contraceptive use is increasingly becoming a global reproductive health issue. Vasectomy is one of the two male modern contraceptive methods espoused by the National Family Planning Policy in Ghana. Despite these advocacies, there are reports of low patronage of this method in Ghana. This study adhering to RATS guidelines on qualitative research therefore explored the social and cultural factors that may be affecting the low vasectomy uptake in Southern Ghana. Methods The study was conducted in Sefwi Bibiani-Ahwiaso Bekwai (SBAB) District and Komenda-Edina-Eguafo-Abrem (KEEA) Municipal area in the Western and Central regions of Ghana respectively. Twelve Focus Group Discussions were held with both male and female community members. In-depth interviews were also carried out with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and health managers at both the district and regional levels. The discussions and interviews were recorded, transcribed verbatim and analysed using Nvivo 10. Results The study revealed that vasectomy was perceived as an act against God, which was punishable either by death or answerable on judgement day. Vasectomy was also perceived to be a form of castration, which can make men weak and incapable, thereby unable to satisfy their wives sexually, leading to marital conflicts. Women were more concerned about the negative effects of vasectomy on men. Cafalgin and panacin which are locally manufactured analgesics were perceived to have contraceptive abilities and therefore used by men as an alternative to modern contraceptive methods. Conclusions Stigma and the misconceptions in the community may be accounting for the low vasectomy uptake in Ghana despite several advocacy strategies. Women were highly influential in a man's decision on vasectomy. This calls for the need to increase health education to demystify the misconceptions about vasectomy. Vasectomy-related campaign messages should target both men and women. PMID:24885663



As U.S. Economy Worsened, Vasectomy Rates Rose, Study Finds  


... page, please enable JavaScript. As U.S. Economy Worsened, Vasectomy Rates Rose, Study Finds National data shows a ... Mundell Monday, October 20, 2014 Related MedlinePlus Page Vasectomy MONDAY, Oct. 20, 2014 (HealthDay News) -- During the ...


Acute effect of vasectomy on the function of the rat epididymal epithelium and vas deferens.  


Persistent infertility after apparently successful vasectomy reversal is common. One possible etiology is epididymal epithelial dysfunction resulting in improper sperm maturation after vasectomy reversal. The epididymal epithelium secretes a number of proteins that are thought to be required for the maturation of sperm. Ligation of the vas deferens during vasectomy may affect the synthesis of some of these proteins. In the present study, the function of the epididymal epithelium was assessed at early times after vasectomy (1, 4, and 7 days) by measuring the level of mRNA of 4 secreted proteins: Crisp-1, clusterin, osteopontin, and transferrin. In addition, the site of synthesis of these proteins was determined by immunocytochemistry. The results demonstrated that the expression of Crisp-1 and clusterin, representative epididymal secretory proteins, was largely unaffected by vasectomy. However, osteopontin mRNA increased in the vas deferens in response to vasectomy. Immunocytochemical localization of osteopontin suggested that both infiltrating immune cells and deferential luminal epithelium were responsible for this up-regulation. Transferrin expression was viewed as a marker for immune cells at the site of injury. However, both the caput epididymis and deferential epithelia were found to express transferrin, in addition to immune cells. In conclusion, there appear to be only minor changes in expression of genes encoding epididymal secretory proteins acutely after vasectomy, but, not surprisingly, there was evidence of an inflammatory response after vasectomy. PMID:16837732

Lavers, Ann E; Swanlund, David J; Hunter, Brian A; Tran, Michael L; Pryor, Jon L; Roberts, Kenneth P




Microsoft Academic Search

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.




Acute Effect of Vasectomy on the Function of the Rat Epididymal Epithelium and Vas Deferens  

Microsoft Academic Search

Persistent infertility after apparently successful va- sectomy reversal is common. One possible etiology is epididymal epithelial dysfunction resulting in improper sperm maturation after vasectomy reversal. The epididymal epithelium secretes a number of proteins that are thought to be required for the maturation of sperm. Ligation of the vas deferens during vasectomy may affect the synthesis of some of these proteins.




Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial [ISRCTN77781689  

Microsoft Academic Search

BACKGROUND: Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). METHODS: The trial was conducted between December 1999 and June

David Sokal; Belinda Irsula; Melissa Hays; Mario Chen-Mok; Mark A Barone



Effects of Vasectomy on Spermatogenesis and Fertility Outcome After Testicular Sperm Extraction Combined With ICSI  

Microsoft Academic Search

BACKGROUND: Each year 40 000 men have a vasectomy in the UK whilst another 2400 request a reversal to begin a second family. Sperm can now be obtained by testicular biopsy and subsequently used in assisted conception with ICSI. The study aims were to compare sperm yields of men post-vasectomy or with obstructive azoospermia (OA) of unknown aetiology with yields

C. M. McVicar; D. A. O’Neill; N. McClure; B. Clements; S. McCullough; S. E. M. Lewis



Relationship between time period after vasectomy and the reproductive capacity of sperm obtained by epididymal aspiration  

Microsoft Academic Search

BACKGROUND: It is not well defined whether the elapsed time after vasectomy has any influence on the outcome of IVF-ICSI using epididymal sperm. We analysed retrospectively the results of 151 ICSI cycles in which sperm of vasectomized men were used at different time periods after vasectomy. METHODS: Oocytes were obtained after a desensitizing ovarian stimulation protocol using GnRH agonist in

Vicente Abdelmassih; Jose P. Balmaceda; Jan Tesarik; Roger Abdelmassih


Organizing a Public-sector Vasectomy Program in Brazil  

Microsoft Academic Search

Although models of high-quality family planning services for men exist in Latin America, few if any have been organized within the complex and resource-constrained national public health systems. This study provides evidence from the Santa Barbara project in southern Brazil showing how vasectomy was introduced into the municipal health system. It demonstrates that once the necessary operational and quality-of-care improvements

Luis Guilherme Penteado; Francisco Cabral; Margarita Diaz; Juan Diaz; Laura Ghiron; Ruth Simmons



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


Thirteen hundred bilateral, partial vasectomies have been performed for sterilization, without a failure. The procedure utilizes (1) a small, single incision; (2) no sutures; (3) cautery of each vas deferens lumen with a hand-held, battery-operated, disposable, hot-wire cautery; and (4) sealing of the proximal vas deferens in its sheath with a single tantalum clip. No spermatic granulomas were noted using this technique. PMID:964395

Moss, W M



Effect of long-term vasectomy on seminiferous tubules in the guinea pig.  


The little previous work on the influence of vasectomy on the guinea pig testis has given controversial results. One group reports that the guinea pig suffers autoimmune orchitis while others claim damage may be mechanical. To clarify the issue, this study compares the morphology of seminiferous tubules 3 years after left unilateral vasectomy (8 guinea pigs) and control sham operation (6 animals). Grossly, left and right testes following left-sided vasectomy were similar to controls and not significantly different in weight. On histology, left and right experimental testes and the control material showed various degrees of seminiferous tubular degeneration, including intraepithelial vesicle formation, loss of germ cells and intraluminal macrophages. Although vesicle formation was striking in most testes, quantitative analysis indicated that it was more frequent in the ipsilateral testis following unilateral vasectomy. It seems that vasectomy had exacerbated an age-related phenomenon. Lymphocytic infiltration was seen in five of the left testes following vasectomy, in two of the corresponding right testes, but in none of the controls. Two vasectomized left testes, however, showed atrophic changes but no lymphocytic invasion. The results suggest that autoimmune orchitis follows vasectomy but that it may not be the primary cause of degeneration. Attempts to gain positive evidence for mechanical damage, however, were inconclusive. PMID:10398384

Aitken, H; Kumarakuru, S; Orr, R; Reid, O; Bennett, N K; McDonald, S W



Initiating a vasectomy training clinic in a family practice residency.  


The development of and initial experience with a vasectomy training clinic in a family practice residency program are presented. A literature review and faculty consensus resulted in the acceptance of a standardized technique in which the ends of the vas are cauterized and not tied. An appropriate time block per patient to allow for counseling and for teaching of the technique was 90 minutes. Patients were recruited by instituting reduced charges and advertising through the local Planned Parenthood office and county health service. A partial prepayment was required to reduce broken appointments. Review of the first 50 cases indicates a good resident experience, an appropriately low complication rate, and no failures. PMID:2753259

Eggertsen, S C; Leversee, J H; Nuovo, J



A clinical study of vasectomy failure and recanalization.  


An analysis was made of the 26 unsuccessful operations from the 2,197 vasectomies performed in a non-profit medical facility. Hhe operations were performed by 6 physicians and significant differences were found in the failure rates. In all instances the tissue removed proved to be vas deferens when examined histologically. Two factors seem to account for the differences of failure rates amoung the physicians; 1) the lenght of vas excised and 2) the character of thechnique. Phsicians with a high rate of success removed a significantly longer section of vas than physicians exhibiting higher failure rates. At least 15 mm. of vas should be excised to maximize the success of the procedure. Excised vas segments less than 15 mm. had up to a 25-fold greater incidence of failure. Although considered of secondary importance, good surgical technique subjectively measured by the minimal amount of accessory tissue attached to the excised vasa was also considered to aid in reducing the number of vasectomy failures. PMID:1113402

Kaplan, K A; Huether, C A



Factors affecting successful outcome from ICSI in men following previous vasectomy  

Microsoft Academic Search

There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic\\u000a sperm injection (ISCI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors\\u000a that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical\\u000a records of

Stephen J. Bromage; Jamie Douglas; Debbie A. Falconer; Brian A. Lieberman; Stephen R. Payne



Incidence of disease after vasectomy: a record linkage retrospective cohort study  

Microsoft Academic Search

OBJECTIVE--To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation. DESIGN--Retrospective cohort study using linked medical record abstracts. SETTING--Six health districts in Oxford region. SUBJECTS--13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for

H. Nienhuis; M. Goldacre; V. Seagroatt; L. Gill; M. Vessey



[Vasectomy and tubal ligation: medicopsychological aspects of voluntary sterilization].  


Various psychological aspects of voluntary surgical sterilization are examined. Women's own bodies are protected through sterilization from all the risks of pregnancy, but there is an altruistic element of vasectomy which may be perceived by men either positively or as a sacrifice or mutilition. The greater prevalence of female sterilization thus seems logical. Some psychologists view vasectomy as representing the realization of castration fantasies, but despite occurrence of cases which might seem to legitimate this view, most vasectomized men are married adults who have fathered several children and have otherwise proven their maturity. The status of voluntary sterilization appears to differ in the Third World, where rapid population growth threatens collective survival, and in developed countries whose growth rates are low or negative. Requests for reversal are increasingly frequent as women undergo sterilization at younger ages. Remarriage, a change of mind by the couple, or death of a child are the most frequently cited reasons for reversal requests. Reports of the psychological consequences of sterilization tend to vary in different studies, largely because of differences in the socioeconomic and cultural status of the populations studied and also perhaps because some studies are more superficial than others. In numerous questionnaire surveys mostly done in Anglo-Saxon countries, typically 90-99% of subjects have reported themselves satisfied with the results. The great majority report no regrets, an unchanged or improved marital relationship, and an increase in sexual pleasure. Less heterogeneous samples of persons undergoing sterilization for reasons other than simple contraceptive convenience have sometimes given less positive results. Age, economic status, number of children, marital relationship, educational level, religious and moral convictions, and history of medical or psychological problems can all affect satisfaction with sterilization. Men in developing countries who consent to vasectomy in return for some inducement such as a transistor radio may be less satisfied with the outcome. Indepth individual clinical psychological studies appear to indicate that the immediate aftermath of sterilization brings a minor emotional crisis, usually silent, in which grief is worked through at a not fully conscious level. The crisis is normal and resolves spontaneously. Following vasectomy, some men are reported to become obsessed with avoiding "feminine" activities such as washing dishes. More serious sexual and psychiatric complaints including functional somatic manifestations have also been observed, but it is not always possible to determine from case descriptions whether the patient was poorly selected for sterilization, whether the indication was inappropriate, or wheather there was a preexisting psychological disturbance. It has been suggested that on a deeper level, sterilization reactivates castration anxiety, represents self-punishment, or is imposed by castrating women, but in fact ignorance and superstition have probably influenced reactions to sterilization in some individuals. Routine psychological evaluations before vasectomy are unlikely to be done in sufficient depth to uncover latent problems or examine motivation in detail. Simple sociological criteria may be the most helpful in weeding out inappropriate candidates. PMID:12268238

Bourgeois, M



Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial [ISRCTN77781689  

PubMed Central

Background Randomized controlled trials comparing different vasectomy occlusion techniques are lacking. Thus, this multicenter randomized trial was conducted to compare the probability of the success of ligation and excision vasectomy with, versus without, fascial interposition (i.e. placing a layer of the vas sheath between two cut ends of the vas). Methods The trial was conducted between December 1999 and June 2002 with a single planned interim analysis. Men requesting vasectomies at eight outpatient clinics in seven countries in North America, Latin America, and Asia were included in the study. The men were randomized to receive vasectomy with versus without fascial interposition. All surgeons performed the vasectomies using the no-scalpel approach to the vas. Participants had a semen analysis two weeks after vasectomy and then every four weeks up to 34 weeks. The primary outcome measure was time to azoospermia. Additional outcome measures were time to severe oligozoospermia (<100 000 sperm/mL) and vasectomy failure based on semen analyses. Results We halted recruitment after the planned interim analysis, when 841 men had been enrolled. Fascial interposition decreased time to azoospermia (hazard ratio [HR], 1.35; P < 0.0001) and time to severe oligozoospermia (HR, 1.32; P < 0.0001) and reduced failures based on semen analysis by about half, from 12.7% (95% confidence interval [CI], 9.7 to 16.3) to 5.9% (95% CI, 3.8 to 8.6) (P < 0.0001). Older men benefited less from fascial interposition than younger men in terms of the speed of achieving azoospermia. However, the number of vasectomy failures was reduced to a similar degree in all age groups. Slightly more adverse events occurred in the fascial interposition group, but the difference was not significant. These failure rates may appear high to practitioners in countries such as the USA, but they are similar to results from other careful studies of ligation and excision techniques. Conclusion Fascial interposition significantly improves vasectomy success when ligation and excision is the method of vas occlusion. A limitation of this study is that the correlation between postvasectomy sperm concentrations and risk of pregnancy is not well quantified. PMID:15056388

Sokal, David; Irsula, Belinda; Hays, Melissa; Chen-Mok, Mario; Barone, Mark A



Knowledge, attitudes, and practice regarding vasectomy among residents of Hamilton County, Ohio, 1980.  

PubMed Central

A telephone survey of 1,172 Hamilton County, Ohio residents indicated that for ever-married people, 25.1 per cent of those aged 18-45 and 33.8 per cent of those 30-45 had been sterilized. Blacks and Whites had comparable levels of sterilization but, among Blacks, female sterilization was over eight times as common as vasectomy, while for Whites, the ratio was 1.2. Catholics had only one-half the sterilization rate of Protestants. Race, sex, income, and education were all related to knowledge and attitudes toward vasectomy. The need for more information was a major reason cited for not having a vasectomy. PMID:6689849

Huether, C A; Howe, S; Kelaghan, J



Cell-mediated immunity to homologous spermatozoa following vasectomy in the human male.  

PubMed Central

Cell-mediated immunity (CMI) to homologous spermatozoal antigens was studied in sixty-two males following vasectomy of a duration of 1-10 years. A group of twenty-two normal, fertile non-vasectomized males was also included in the study. The inhibition in the leucocyte migration test (LMT), in the presence of spermatozoal antigen, was taken as an index of CMI. Twenty of the sixty-two vasectomized males (32.2 percent) showed a positive LMT reaction. When the results were analysed with reference to the duration of vasectomy, it was noted that four cases each (22.2 percent), showed a positive LMT reaction in the groups 0-2 years, and 3.5 years. On the other hand twelve cases gave a positive reaction in the group 6-10 years (46.1 percent). It appears that the incidence of CMI to spermatozoa increases with the duration in vasectomy. PMID:991454

Nagarkatti, P S; Rao, S S



Vasectomy by electrocautery: outcomes in a series of 2,500 patients.  


The effectiveness of the electrocautery technique of vasectomy is compared with the more commonly used ligation technique. Twenty-five hundred cases of vasectomy by electrocautery are presented. The men were Americans who selected vasectomy over a period of 11 years. All cases were performed by one unvarying technique. The vas was cut, and the lumen was cauterized. One end was covered, and all bleeding sites were cauterized. The failure rate in this series was 0.24 percent. A review of the world literature shows that failure rates of the common ligation techniques ranged from 1 to 6 percent. It appears that the electrocautery technique has about one tenth the failures of the standard ligation technique. PMID:4009138

Denniston, G C



Flushing of distal vas during vasectomy: current status and review of literature.  


Vas irrigation during vasectomy, to effect immediate sterility or to shorten the interval between vasectomy and sterility, has received increasing attention in recent years. A review of the literature on vas irrigation is presented. Topics discussed include the effectiveness of various irrigants and irrigation methods, method and technical failures, and evidence of increased risks of recanalization, inflammation, tissue damage, and infection. Stored sperm and their location after vasectomy are explored. Suggested mechanisms for the action of irrigants are reviewed, and another mechanism is proposed. Variations in study results and our incomplete understanding of vas and seminal vesicle physiology during ejaculation (compounded by individual variations) require more investigation before large clinical trials are initiated. PMID:388800

Mumford, S D; Davis, J E



Effects of vasectomy on seminal plasma alkaline phosphatase in male alpacas (Vicugña pacos).  


Azoospermia is a common finding in male alpacas which present for infertility. The challenge is to differentiate azoospermia of testicular origin from non-testicular origin. In several species, alkaline phosphatase (AP) concentrations in seminal plasma have been used as a diagnostic marker of contributions of the testis and epididymis to the ejaculate. The purpose of this study was to determine whether AP assay could differentiate testicular from non-testicular azoospermia in male alpacas. An experimental model of bilateral outflow obstruction (pre-scrotal vasectomy) was used in 22 male alpacas, aged 2-9 years. No reproductive history was available. Animals were submitted for electroejaculation (EE) under general anaesthesia and vasectomy performed. Five weeks later, animals were submitted for EE. Vasectomy was not successful in one animal, which was removed from analysis. AP levels were compared in seminal plasma in the pre- and post-vasectomy samples. The mean ± SEM concentration of AP in pre-vasectomy seminal plasma was 504.29 ± 166.45 U/l (range 10-2910); the post-vasectomy levels were 252.48 ± 81.77 U/l (range 0-1640; p = 0.06). In 71.4% of animals, AP levels decreased, varying from 18% to 100% reduction. Results of this study suggest that AP is not produced exclusively by the testis and epididymis in alpacas and that AP assay is not a valid diagnostic test for determination of origin of azoospermia; the gold standard for diagnosis of origin of azoospermia remains testicular biopsy. PMID:23790090

Pearson, L K; Campbell, A J; Sandoval, S; Tibary, A



Factors affecting successful outcome from ICSI in men following previous vasectomy.  


There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ICSI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner's behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension. PMID:17609963

Bromage, Stephen J; Douglas, Jamie; Falconer, Debbie A; Lieberman, Brian A; Payne, Stephen R



Effects of vasectomy on the blood-testis barrier of the hamster  

Microsoft Academic Search

Summary. The effects of vasectomy on the blood\\\\p=n-\\\\testis and blood\\\\p=n-\\\\epididymal barriers to 3H2O, (3H)inulin, and (14C)urea were examined by study of the radio- activity appearing in micropuncture samples of fluids from the seminiferous tubules and cauda epididymidis. By 4 months after vasectomy, there were changes in the blood\\\\p=n-\\\\seminiferous tubule barrier to (3H)water and (14C)urea (increased entry) and in the blood\\\\p=n-\\\\epididymal

T. T. Turner; D. A. D'Addario; S. S. Howards



Fluid movement in the lumen of the rat epididymis: effect of vasectomy and subsequent vasovasostomy.  


Intraluminal fluid movement rate was measured in four regions of the rat epididymis. The fastest flow occurred in the proximal caput epididymis (18.5 +/- 3.7 mm/hour) and the slowest in the distal cauda (2.5 +/- 0.5 mm/hour). Vasectomy significantly reduced caput fluid flow rates unless a sperm granuloma was present at the vasectomy site. Thirty days after vasovasostomy, caput fluid movement remained reduced in animals unless a granuloma was present. Failures of this or other aspects of epididymal biology to return to normal after vasovasostomy could play a role in the frequent infertility which persists after the operation. PMID:2254175

Turner, T T; Gleavy, J L; Harris, J M



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


A battery-powered, bipolar electrocoagulator has been specifically developed for sealing the cut ends of the divided vas at vasectomy. With a minimum of electric power, the electrocoagulator destroys only the mucosa and one or two muscle cell layers of the vas, which leads to optimal fibrosis of the cut ends. This instrument has been used in more than 1000 vasectomies without a known failure and with a minimum of complications. An analysis of these cases is reported with emphasis upon the method's success in sealing the vas. PMID:658480

Schmidt, S S; Free, M J



Endocarditis caused by Staphylococcus warneri on a normal aortic valve following vasectomy.  


Endocarditis caused by Staphylococcus warneri and necessitating valve replacement occurred in a previously healthy 32-year-old patient following vasectomy. No sign of an underlying valvular defect was noted during the operation. S. warneri is a recently identified species of coagulase-negative staphylococci. Endocarditis caused by coagulase-negative staphylococci is uncommon in young, healthy patients with normal heart valves and has not previously been described as a complication of vasectomy. Similarly, infections caused by S. warneri have not previously been described in humans. PMID:6744166

Dan, M; Marien, G J; Goldsand, G



Clinical and Consumer Trial Performance of a Sensitive Immunodiagnostic Home Test That Qualitatively Detects Low Concentrations of Sperm Following Vasectomy  

PubMed Central

Purpose Compliance with post-vasectomy semen analysis could be improved with the availability of a simple, rapid and accurate home test. SpermCheck Vasectomy®, a highly sensitive lateral flow immunochromatographic diagnostic device, was designed to detect extreme oligospermia or azoospermia in men after vasectomy. We report the results of clinical and consumer testing of SpermCheck. Materials and Methods A prospective, noncomparative observational study assessed the ability of SpermCheck Vasectomy to predict post-vasectomy sperm counts obtained using a hemacytometer procedure based on standard World Health Organization methodology. Consumer studies evaluated ease of use. Results A cohort of 144 post-vasectomy semen samples was tested in the clinical trial. SpermCheck was 96% accurate in predicting whether sperm counts were greater or less than a threshold of 250,000 sperm per ml, a level associated with little or no risk of pregnancy. Sensitivity was 93% (95% CI 79% to 98%) and specificity was 97% (91% to 99%). The positive predictive value of the test was 93% (79% to 98%), and most importantly the negative predictive value was 97% (91% to 99%). The test gave a positive result 100% of the time at sperm concentrations of 385,000/ml or greater. Consumer studies with 109 lay volunteers showed that SpermCheck was easy to use. Volunteers obtained the correct or expected test result in every case and the correct response rate on a 20 question survey about the test was 97%. Conclusions SpermCheck Vasectomy, a simple and reliable immunodiagnostic test that can provide evidence of vasectomy success or failure, offers a useful alternative to improve compliance with post-vasectomy sperm monitoring. It is currently the only Food and Drug Administration approved test for this purpose. PMID:18930494

Klotz, Kenneth L.; Coppola, Michael A.; Labrecque, Michel; Brugh, Victor M.; Ramsey, Kim; Kim, Kyung-ah; Conaway, Mark R.; Howards, Stuart S.; Flickinger, Charles J.; Herr, John C.



Prevailing Cultural Attitudes about Vasectomy: A Possible Explanation of Postoperative Psychological Response  

Microsoft Academic Search

Informational feedback from social encounters has been hypothesized to influence self-concept and personality functioning. Recent experimental and other research studies demonstrate this effect, and therefore suggest that prevalent cultural atti- tudes about couples who elect vasectomy for contraception, if predominantly derogatory, could initiate or reinforce adverse personality changes. Two cultural subgroups, thought to represent common cultural attitudes, ascribed fewer favor-



Vasectomy by epithelial curettage without suture or cautery: a pilot study in humans  

PubMed Central

Curettage of the epithelium of the vas deferens might be a safe and effective method of male sterilization. We conducted a pilot study of vasectomy by epithelial curettage with a novel microcurette called the Vas-X in 12 normal men requesting elective sterilization. Seminal fluid analysis was obtained monthly after the procedure for 6 months. Pain was assessed by questionnaire. Three months after the procedure, all men attained sperm concentrations of less than 0.2 million sperm per mL, and seven were azoospermic. Post-procedural pain was minimal. Nine men ultimately achieved and maintained azoospermia; however, 4 to 6 months after the procedure, sperm concentrations increased in three of the 12 subjects, necessitating repeat vasectomy. Microscopic examination of the vas deferens from these failures revealed re-canalization. Vasectomy by epithelial curettage can result in effective sterilization; however, 1/4 of the subjects were not effectively sterilized by the procedure due to re-canalization of the vas deferens. Epithelial curettage will require further refinement to determine if it is a viable form of vasectomy. PMID:20154700

Amory, John K.; Jessen, John W.; Muller, Charles; Berger, Richard E.



A randomized trial of vas occlusion versus vasectomy for male contraception.  


Vas occlusion and vasectomy for contraception were compared in a trial with 79 patients, median age 36. Operation time, consumption of analgesics in the 1st postoperative week, and postoperative complications including wound infection, hematoma, and epididymitis were recorded. Sperm counts were performed monthly and in all patients a final sperm count was requested after 6 months. 77 patients became sterile, 1 failure occurring within 3 months in each group. In 1 vasectomized patient recanalization occurred after development of a sperm granuloma and in 1 vas-occluded patient clips had been placed on nonductal structures. There was no intergroup difference in consumption of analgesics or with regard to postoperative complications. Median operation times for vas occlusion and vasectomy were 11 and 14 minutes, respectively. The material is too small to evaluate rates of operative failures for the 2 methods, but the performance of val occlusion was a little speedier than vasectomy, the need for disection and tissue handling being minimized. It is concluded that vas occlusion by clips without transection deserves further evaluation as an alternative to vasectomy for male contraception. PMID:6346477

Clausen, S; Lindenberg, S; Nielsen, M L; Gerstenberg, T C; Praetorius, B



Vasectomy by epithelial curettage without suture or cautery: a pilot study in humans.  


Curettage of the epithelium of the vas deferens might be a safe and effective method of male sterilization. We conducted a pilot study of vasectomy by epithelial curettage with a novel microcurette called the Vas-X in 12 normal men requesting elective sterilization. Seminal fluid analysis was obtained monthly after the procedure for 6 months. Pain was assessed by questionnaire. Three months after the procedure, all men attained sperm concentrations of less than 0.2 million sperm per mL, and seven were azoospermic. Post-procedural pain was minimal. Nine men ultimately achieved and maintained azoospermia; however, 4 to 6 months after the procedure, sperm concentrations increased in three of the 12 subjects, necessitating repeat vasectomy. Microscopic examination of the vas deferens from these failures revealed re-canalization. Vasectomy by epithelial curettage can result in effective sterilization; however, 1/4 of the subjects were not effectively sterilized by the procedure due to re-canalization of the vas deferens. Epithelial curettage will require further refinement to determine if it is a viable form of vasectomy. PMID:20154700

Amory, John K; Jessen, John W; Muller, Charles; Berger, Richard E



The association between vasectomy and prostate cancer: a systematic review of the literature.  


The absence of a plausible biologic model, methodologic problems, and lack of consistency between the results of different studies have created skepticism about any association between vasectomy and prostate cancer. To clarify further the possibility of such a link, a systematic review of the empirical literature published in 1988-96 was conducted. 14 such studies (5 cohort and 9 case-control) were identified, 11 of which found an excess risk of prostate cancer in men who had undergone vasectomy. Relative risks ranged from 0.44 (95% confidence interval (CI), 0.1-4.0) and 6.70 (95% CI, 2.1-21.6). The risk was statistically significant in 6 studies. The weighted relative risk obtained using the age-adjusted results of the individual studies was 1.23 (95% CI, 1.01-1.49). However, both the statistical tests and the qualitative analysis detected heterogeneity between the studies. Possible sources of this heterogeneity include type of design, study base, presence of detection bias, and inadequate selection of controls. Moreover, the sensitivity analysis indicated that the detected effect depends to a great extent on studies that are more vulnerable to bias (i.e., case-control and hospital-based studies) and those that have internal validity problems. Further, the funnel plot demonstrated the possible existence of publication bias. Finally, when the relative risk was recalculated to exclude early stage tumors (located by active detection in vasectomy cases), the previously found association between vasectomy and prostate cancer disappeared. It is concluded that the available empiric evidence is of low quality because of multiple sources of bias that favor the overestimation of the effect of vasectomy on prostate cancer risk. These validity problems, along with the lack of a biologic model to explain the association, strongly suggest the association is not causal. PMID:9696205

Bernal-Delgado, E; Latour-Pérez, J; Pradas-Arnal, F; Gómez-López, L I



Earlier testing after vasectomy, based on the absence of motile sperm.  


Between 1975 and 1992, a private physician performed 3178 vasectomies at the Cronulla Private Medical Clinic in Cronulla, New South Wales, Australia, and examined ejaculation specimens of 2260 of the cases either after 10 ejaculations or 4 to 14 weeks after vasectomy. He reviewed the postvasectomy testing results of those with immobile sperm and compared these results with those based on complete azoospermia. There were only 5 failures (0.16%) caused by either incorrectly performed vasectomy (1 case) or spontaneous recanalization (4 cases). A pregnancy revealed 1 failure (late recanalization and reappearance of motile sperm). Just 1.5% still had motile sperm during the first postvasectomy test. Further, the sperm count of these 33 men was less than 1 million sperm/ml and motility was either 5% or less. 9 weeks was the longest postvasectomy period with motile sperm still present. Sperm counts for specimens with no motile sperm varied from 1 to 33 million sperm/ml at 100 high power field, but the count for most cases was less than 1 million sperm/ml. Just 5 cases had 16 to 33 million nonmotile sperm. 19% of the men who returned for a sperm count 14 weeks after vasectomy still had some nonmotile sperm. Since nonmotile sperm cannot go through the cervical mucus or penetrate and fertilize the ovum, the physician gave the men with nonmotile sperm clearance, which was earlier than if he had waited for azoospermia. Therefore, testing can take place 4 weeks after vasectomy rather than after a set number of ejaculations, and if the specimens have no motile sperm within 12 hours of collection, the health provider can grant clearance. Further collection and publication of postvasectomy testing results are needed. PMID:8425641

Edwards, I S



Robotic intra-abdominal vasectomy reversal: A new approach to a difficult problem  

PubMed Central

The management of obstructive azoospermia resulting from intra-abdominal vasal obstruction poses a formidable surgical challenge. A number of surgical methods have been described to address this problem, including both open and laparoscopic approaches to mobilize and sometimes even re-route the abdominal vas deferens prior to performing a re-anastamosis. We present the first report, to our knowledge, of robotic intra-abdominal vasectomy reversal used to repair obstructive azoospermia resulting from prior laparoscopic vasectomy. In doing so, we summarize the techniques described previously in the literature and build upon this body of surgical experience by combining robotic-assisted laparoscopic mobilization of the vas with robotic vasovasostomy. We believe this novel approach for repairing intra-abdominal vasal defects minimizes morbidity, while at the same time obviating the need for the operating microscope, and thus represents a practical alternative to existing techniques. PMID:25024801

Barazani, Yagil; Kaouk, Jihad; Sabanegh, Edmund S.



General and anomalous sperm disappearance characteristics found in a large vasectomy series.  


There is no accepted standard for the time after vasectomy before infertility is achieved. To help address this question, the records of 5,233 vasectomy patients who had had at least 12 ejaculations and had completed semen tests were reviewed. Seventy-five percent were able to fulfill a designated criterion for success by 4 months postoperatively, nearly 90% by 6 months, and nearly 99% by 1 year. Also found were a number of individual anomalies, including five instances of transient reappearance of sperm, four late spontaneous reversals after proof of success, and one late "delayed success" after evidence of failure. Patients can be reassured by the overall efficacy of male sterilization, but physicians also may wish to be aware of the possibility of capriciously intermittent-fitful-sperm. PMID:2707463

Alderman, P M



British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002)  

PubMed Central

The British Andrology Society guidelines for the assessment of post vasectomy semen samples recommend that initial assessment is undertaken 16 weeks post vasectomy and after the patient has produced at least 24 ejaculates. The laboratory should examine a freshly produced seminal fluid specimen by direct microscopy and if no sperm are seen the centrifugate should be examined for the presence of motile and non-motile spermatozoa. It is recommended that the clinician should give clearance after the production of two consecutive sperm free ejaculates. In cases of persistent identification of non-motile spermatozoa the referring clinician should advise the patient regarding the cessation of other contraceptive precautions. Surgeons are responsible both preoperatively and postoperatively for the counselling of couples regarding complications and the possibility of late recanalisation after clearance. PMID:12401817

Hancock, P; McLaughlin, E



Laparoscopic vasectomy in African savannah elephant (Loxodonta africana); surgical technique and results.  


Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications. PMID:24437080

Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine



The use of URYX for reversible vasectomy in a rabbit model.  


URYX is a biocompatible polymer of ethylene vinyl alcohol dissolved in a dimethyl sulfoxide (DMSO) carrier to allow injection of a very low-viscosity fluid into tissue. Once the material comes into contact with body tissue or fluid, the DMSO rapidly dissipates from the polymer, which results in a precipitate of a coherent solid mass. The purpose of the present study was to determine whether URYX can effectively occlude the vas deferens and whether patency can be restored by redissolving the URYX in vivo using the solvent DMSO. Eight male New Zealand White rabbits (age range, 25-41 weeks; mean age, 33.9 +/- 7.5 weeks; mean weight, 4.0 +/- 0.2 kg) were used in 2 experiments (E1 and E2). In E1, 3 rabbits underwent unilateral vasectomy, and the contralateral vas was injected with either 0.05 or 0.10 mL of URYX, to determine the amount of URYX required to cause obstruction. Two animals underwent bilateral vasectomy, to serve as controls. In E2, 3 animals underwent bilateral URYX injection and were compared with the bilateral vasectomy control rabbits used in E1. After 1 month of initial bilateral URYX treatment, all animals in E2 underwent attempted unilateral reversal with 1.5 mL of DMSO injected into 1 occluded vas deferens. Two end points were evaluated-a clinical end point assessed by semen analyses and a pathological end point assessed by histological analysis of treated tissues, to assess for safety. A 1.5-cm infrapubic incision was made to expose both vasa in anesthetized rabbits. The vasal injection of URYX was performed with a 30-gauge needle. Vasectomy was performed by excision of a 1-cm segment of the vas deferens and subsequent ligation with a 6-0 prolene suture. Semen was collected using an artificial vagina 2-3 times/wk before and 1 month later, after injection treatments and vasectomy. Manual sperm counts were performed. All animals were sacrificed, and tissues (distal vas, injection site, proximal vas, cauda epididymis, caput epididymis, and testis) were harvested and examined for the presence of URYX. The inflammatory response of the wall and adventitia of the vas deferens was given a score (0-15) based on the sum of grades (0 = none, 1 = mild, 2 = moderate, and 3 = severe) for the following categories: foreign body giant cell reaction, granulation tissue, lymphocytes, eosinophils, and scarring, as evaluated by a single pathologist (J.M.). Vasal injection with 0.05 mL of URYX was not sufficient to cause occlusion. Both animals injected with 0.1 mL of URYX were effectively occluded. The injection of occluded vasa with DMSO did not dissolve the URYX plug in the vas lumen. There was no significant difference in vasal inflammatory response scores between vasal units treated with URYX only and vasal units in the vasectomy model. Vasal units subjected to URYX followed by DMSO demonstrated greater inflammatory response scores than vasal units treated with URYX followed by normal saline, URYX alone, or vasectomy. Epididymal and testicular histology remained unaffected in all vasal units in E1. The vasal units in E2 subjected to URYX followed by normal saline showed no histological abnormalities of the epididymis and testis. However, those vasal units subjected to URYX followed by DMSO in E2 showed evidence of adhesions, necrosis, and degenerating cells in the epididymis and a focal foreign body giant cell reaction in the testis. The bilateral vasal injection of URYX can result in azoospermia in the rabbit model. Reversal with subsequent DMSO injection was not achieved. A minimal inflammatory response of the vas deferens was observed with URYX injection alone; however, DMSO following URYX injection resulted in increased vasal inflammation, in addition to epididymal and testicular changes. PMID:15223843

Naughton, Cathy K; Myles, Jonathan; Thomas, Anthony J



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


Vasectomy techniques and failure rates vary among surgeons, and the criteria for failure are not often clearly defined. To help establish a yardstick for comparative purposes, a series of 8879 consecutive vasectomies performed with uniform technique over 24 years was reviewed. A subgroup of 5331 men who had returned for at least two postoperative semen tests--the study group--was used for follow-up analysis. Failures were defined as early or late and also were categorized as overt or technical according to the numbers, motility, or persistence of the remaining spermatozoa. There were 97 failures of all types, including 32 (0.60%) early and overt failures and 61 (1.14%) technical failures that involved the persistence of small numbers of spermatozoa, possibly of no significance. Four (0.08%) late overt failures were also seen; each of these was discovered as a result of a pregnancy, and each occurred at least four years after two azoospermic test results. Of the 97 failures, four were recognized as due to missed vasa deferentia, and the remainder were attributed to recanalization. Whether improved and reproducible failure rates can be consistently obtained by other techniques is not yet clear. PMID:3367490

Alderman, P M



Application of optical coherence tomography and high-frequency ultrasound imaging during noninvasive laser vasectomy  

NASA Astrophysics Data System (ADS)

A noninvasive approach to vasectomy may eliminate male fear of complications related to surgery and increase its acceptance. Noninvasive laser thermal occlusion of the canine vas deferens has recently been reported. Optical coherence tomography (OCT) and high-frequency ultrasound (HFUS) are compared for monitoring laser thermal coagulation of the vas in an acute canine model. Bilateral noninvasive laser coagulation of the vas was performed in six dogs (n=12 vasa) using a Ytterbium fiber laser wavelength of 1075 nm, incident power of 9.0 W, pulse duration of 500 ms, pulse rate of 1 Hz, and 3-mm-diameter spot. Cryogen spray cooling was used to prevent skin burns during the procedure. An OCT system with endoscopic probe and a HFUS system with 20-MHz transducer were used to image the vas immediately before and after the procedure. Vasa were then excised and processed for gross and histologic analysis for comparison with OCT and HFUS images. OCT provided high-resolution, superficial imaging of the compressed vas within the vas ring clamp, while HFUS provided deeper imaging of the vas held manually in the scrotal fold. Both OCT and high HFUS are promising imaging modalities for real-time confirmation of vas occlusion during noninvasive laser vasectomy.

Cilip, Christopher M.; Allaf, Mohamad E.; Fried, Nathaniel M.



"Vasectomy" (interrupting the vas deferens), a simplified procedure using a midline incision.  


A simple technique for doing vasectomies using local anesthesia is d escribed. A single, small median anterior incision is made. The vas is easily identified and a loop brought up into the incision. It is cleared of surrounding tissues and an area clamped off. Cotton ligatures are applied above and below the area to be sectioned. After sectioning, the lower end is folded over and tied. The procedure is repeated on the other side. The cut ends if the vasa are then replaced into the scrotum and the skin incision closed. Tincture of benzoin is applied to the suture line. A suspensory bandage is added. Skin sutures are removed after 4 days. Finally, semen is tested for sperm. Complications or failures are not reported. PMID:12255515

Perrill, C V



Macrophages of the sperm granuloma 3 months after vasectomy in the Albino Swiss rat.  


This study documents the appearance and arrangement of the macrophages of the sperm granuloma 3 months after vasectomy in the Albino Swiss rat. We found, as have others, that the macrophages form a distinct layer in the granuloma wall, external to the central mass of extravasated spermatozoa. Those closest to the spermatozoa showed much phagocytosis. Many had two, three, or more nuclei. The largest macrophages, giant cells of the foreign body and Langhans types, were generally farther from the sperm mass, but retained evidence of phagocytic activity in the form of sperm fragments. Macrophages, either mono- or multinucleate, frequently showed numerous surface microridges that interdigitated with those of neighboring cells. The microridges varied in length, but were of uniform thickness and cytoplasmic content and were rarely branched. Monocytes were frequently observed, indicating continuing significant recruitment of cells of the macrophage series to the granuloma. We also noted mononucleate cells in the connective tissue external to the macrophage layer. Their cytology suggested they were macrophages, but they showed much less phagocytic activity than those of the main macrophage layer and had distinctive aggregations of moderately electron-dense droplets. PMID:10873219

Tait, C M; McGinn, J S; Milne, E W; Bennett, N K; McDonald, S W



A follow-up study of vasectomy clients in East Pakistan.  


135 married vasectomy adopters at least 3 months postoperative in 3 districts in East Pakistan were interviewed in the third quarter of 1968. About 3/5 of the men reported no complications. Among those reporting complications about 3/4 suffered from simple pain, about 1/2 from swelling, and 2/5 from physical weakness. 9 out of 10 men reported receiving postoperative instructions from their physicians; 99% of these men reported close following of the instructions. Fewer of those who received and followed advice reported postoperative complications than those who received no advice (39.7% vs. 47.1%, n=133). Of the 135 men in the study 38% reported changes in marital life: decreased sexual desire (29%), increased sexual desire (9%), and physical weakening (2%). 3 wives were found to be pregnant after the operation, but whether the operations were failures is uncertain. According to the men 69% of the wives were satisfied with the operation, 14% were dissatisfied, 8% were unaware of the operation, and 5% had feelings unknown to the husbands. Among husbands whose wives were happy and unhappy with the operation 98% and 74%, respectively, were themselves happy with the operation (p less than .005). 54% of the men told others about their operations; almost all of these recommended the operation. The physician should given postoperative advice. Weekly follow-up of patients should occur. PMID:12304786

Quddus, A H; Ratcliffe, J W; Croley, H T



Utero-tubal embryo transfer and vasectomy in the mouse model.  


The transfer of preimplantation embryos to a surrogate female is a required step for the production of genetically modified mice or to study the effects of epigenetic alterations originated during preimplantation development on subsequent fetal development and adult health. The use of an effective and consistent embryo transfer technique is crucial to enhance the generation of genetically modified animals and to determine the effect of different treatments on implantation rates and survival to term. Embryos at the blastocyst stage are usually transferred by uterine transfer, performing a puncture in the uterine wall to introduce the embryo manipulation pipette. The orifice performed in the uterus does not close after the pipette has been withdrawn, and the embryos can outflow to the abdominal cavity due to the positive pressure of the uterus. The puncture can also produce a hemorrhage that impairs implantation, blocks the transfer pipette and may affect embryo development, especially when embryos without zona are transferred. Consequently, this technique often results in very variable and overall low embryo survival rates. Avoiding these negative effects, utero-tubal embryo transfer take advantage of the utero-tubal junction as a natural barrier that impedes embryo outflow and avoid the puncture of the uterine wall. Vasectomized males are required for obtaining pseudopregnant recipients. A technique to perform vasectomy is described as a complement to the utero-tubal embryo transfer. PMID:24637845

Bermejo-Alvarez, Pablo; Park, Ki-Eun; Telugu, Bhanu P



Pregnancy after vasovasostomy for vasectomy reversal: a study of factors affecting long-term return of fertility in 282 patients followed for 10 years.  


The aim of this study was to determine the eventual fertility of those patients following vasectomy reversal who have no pressure-induced secondary epididymal blockage. These patients underwent simple vasovasostomy because at the time of the reversal surgery there were sperm present in large numbers in the vas fluid. It was possible to obtain long-term follow-up on 326 early patients who underwent vasectomy reversal 8-10 years ago. Two hundred and eighty-two of those patients had sperm in the vas fluid. These patients were studied for pregnancy rate and post-operative semen parameters in relation to presence or absence of sperm in the vas fluid at the time of vasectomy reversal, duration of time since vasectomy, pre-operative serum antisperm antibody titers, the influence of varicocoele and quantitative evaluation of testicular biopsy. All of the 44 patients with no sperm in the vas fluid remained azoospermic following vasovasostomy. Of the 282 patients with sperm in the vas fluid, 228 (81%) eventually impregnated their wives. Twenty-four patients with sperm in the vas fluid (9%) were azoospermic and did not impregnate their wives. Of the 258 patients who had sperm patency, the pregnancy rate was 88%. The number of mature spermatids per tubule in the testis correlated closely with the post-operative sperm count in patent cases. Quantitative evaluation of the testicular biopsy revealed normal spermatogenesis, even in patients with azoospermia or severe oligospermia post-operatively. Technical failures were due to blockage either at the vasovasostomy site, or epididymal blockage unrecognized at the time of vasovasostomy.2+perm count had a minimal impact on the PMID:2715309

Silber, S J



The acceptability, efficacy and safety of quinacrine non-surgical sterilization (QS), tubectomy and vasectomy in 5 provinces in the Red River Delta, Vietnam: a follow-up of 15,190 cases  

Microsoft Academic Search

Objectives: To compare the safety, efficacy and acceptability of quinacrine sterilization (QS), tubectomy and vasectomy in Vietnam. Methods: This study was initiated in January 1998 and completed in February 2000. A sample of 9 districts in 5 provinces, where the prevalence of QS was known to be high, was selected. Every person sterilized in these 9 districts between January 1,

D. T. Hieu; T. T. Luong; P. T. Anh; D. H. Ngoc; L. Q. Duong



Intraluminal occlusion of the seminal duct by laser and Histoacryl: Two non-invasive alternatives for vasectomy  

NASA Astrophysics Data System (ADS)

Introduction and objective: Vasectomy is a well-established method in family control. Even though it is a safe and low risk operation, this surgery is invasive and difficult to reverse. Therefore the aim of this study was to investigate new non-invasive methods for occlusion of the seminal duct. Material and Methods: Seminal duct tissue was obtained from patients (n=30) suffering from prostate cancer and therefore undergoing prostatectomy. In a first set of experiments, the seminal duct was occluded by intraluminal application of Histoacryl® (Braun Aesculap AG, Tuttlingen, Germany). In a 2nd set of experiments, endoluminal laser induced occlusion was performed. Four different laser wavelengths (1940nm, 1470nm, 1064nm, 940nm) and different sets of laser parameters (e.g. power, exposure duration, fibre diameter, energy applied) were compared. Effectiveness of occlusion of the seminal duct was proven by post-treatment irrigation flow measurement, as well as by morphological analyses. To evaluate a potential damage of the surrounding tissue, external temperature was measured using a thermometer during laser application. Results: Intraluminal application of Histoacryl® induced an immediate and complete occlusion of the seminal duct. The underlying connective tissue maintained its functional integrity after this treatment. By laser light application to a Histoacryl® block, a hole could be created into the block thus indicating the possibility of recanalization. Treatment with laser energy resulted in shrinkage of the ductal lumen. The laser application generally caused necrosis in the epithelium and induced formation of vacuoles in the underlying connective tissue. As described for endoluminal varicose treatment, this distinct local reaction might result in an intense inflammation leading to a functional occlusion of the vas deferens. Conclusions: Both laser-induced occlusion and application of Histoacryl® are fast and simple techniques which may be able to achieve a functional occlusion of the seminal duct. The application of Histoacryl® additionally may be easily reversible by laser treatment.

Freitag, B.; Sroka, R.; Koelle, S.; Becker, A. J.; Khoder, W.; Pongratz, T.; Stief, C. G.; Trottmann, M.



Quantitation of seminal factor IX and factor IXa in fertile, nonfertile, and vasectomy subjects: a step closer toward identifying a functional clotting system in human semen.  


Coagulation factor (F) IX is a zymogen of the plasma serine proteases, one that plays an essential role in the regulation of normal blood coagulation. Congenital defects of FIX synthesis or function cause hemophilia B (originally called hemophilia C). Factor IX is activated by Tissue Factor (TF):FVII/FVIIa complex and FXIa. Subsequent to its activation, FIXa combines with FVIIIa on the platelet surface and activates FX to FXa. Human semen forms a semi-solid gelatinous coagulum, which then liquefies within 5-20 minutes in vitro. In spite of evidence demonstrating the importance of the seminal coagulation and liquefaction process in terms of global fertility and despite the fact that the seminal coagulum is composed of fibrin-like material, it has always been addressed from the perspective of High Molecular Weight Seminal Vesicle (HMW-SV) proteins (Semenogelin I and II) and their cleavage by prostate-specific antigen rather than the conventional hemostatic factors. In this study and as part of our continuing investigation of human seminal clotting factors, we report here on seminal FIX and FIXa in normal, subfertile, and vasectomized subjects. Factors IX and FIXa were studied in a total of 119 semen specimens obtained from subfertile (n=18), normally fertile (n=34), and fertile sperm donors (n=27) and vasectomy subjects (n=40). Seminal FIX and FIXa levels were also measured in a group defined by normality in several parameters derived from the World Health Organization fertility criteria and termed "pooled normal semen parameters." Both FIX and FIXa were quantifiable in human semen. There was a wide individual variation in FIX and FIXa levels within groups. Despite the group size, statistically significant associations with fertility-related parameters were infrequent. There is a positive correlation between FIX and its activation product, FIXa (n=36; r=0.51; P <.05). Factor IXa elevation in the high sperm-clump group was significant (P <.05), and days of abstention correlated with FIXa levels (n=63; r=0.3; P <.05). The key finding of the present study is that both FIX and FIXa are present in concentrations that are not dissimilar to plasma levels and that are apparently functional, as the activated form is also present. This fact, taken with other reports of coagulation factors in semen, raises the likelihood that a functional set of hemostatic coagulation proteins exists in semen, potentially to interact with the HMW-SV proteins and the prostate-specific antigen system. PMID:15611579

Lwaleed, Bashir A; Greenfield, Robert S; Hicks, James; Birch, Brian R; Cooper, Alan J



Comparative Effects of Vasectomy Surgery and Buprenorphine Treatment on Faecal Corticosterone Concentrations and Behaviour Assessed by Manual and Automated Analysis Methods in C57 and C3H Mice  

PubMed Central

Establishing effective cage-side pain assessment methods is essential if post-surgical pain is to be controlled effectively in laboratory animals. Changes to overall activity levels are the most common methods of assessment, but may not be the most appropriate for establishing the analgesic properties of drugs, especially in mice, due their high activity levels. Use of drugs that can affect activity (e.g. opioids) is also a problem. The relative merits of both manual and automated behaviour data collection methods was determined in two inbred mouse strains undergoing vasectomy following treatment with one of 2 buprenorphine dose rates. Body weights and the effects of surgery and buprenorphine on faecal corticosterone were also measured. Surgery caused abnormal behaviour and reduced activity levels, but high dose buprenorphine caused such large-scale increases in activity in controls that we could not establish analgesic effects in surgery groups. Only pain-specific behaviour scoring using the manual approach was effective in showing 0.05 mg/kg buprenorphine alleviated post-vasectomy pain. The C57 mice also responded better to buprenorphine than C3H mice, indicating they were either less painful, or more responsive to its analgesic effects. C3H mice were more susceptible to the confounding effects of buprenorphine irrespective of whether data were collected manually or via the automated approach. Faecal corticosterone levels, although variable, were higher in untreated surgery mice than in control groups, also indicating the presence of pain or distress. Pain-specific scoring was superior to activity monitoring for assessing the analgesic properties of buprenorphine in vasectomised mice. Buprenorphine (0.01 mg/kg), in these strains of male mice, for this procedure, provided inadequate analgesia and although 0.05 mg/kg was more effective, not completely so. The findings support the recommendation that analgesic dose rates should be adjusted in relation to the potential severity of the surgical procedure, the mouse strain, and the individual animals' response. PMID:24098748

Wright-Williams, Sian; Flecknell, Paul A.; Roughan, Johnny V.



The use of vasectomy in stray cat population control  

E-print Network

. While anesthetized, the cats were vaccinated with a rabies vaccine approved for use in cats, given a subcutaneous injection of ivermectin to control intestinal parasites and ear mites, and licensed using an ear implant in the left ear. The tip...

Mahlow, Jane Caryl



Key Statistics from the National Survey of Family Growth: Vasectomy  


... NCHS Home Surveys and Data Collection Systems Key Statistics from the National Survey of Family Growth V ... Survey of Family Growth Staff Division of Vital Statistics National Center for Health Statistics 3311 Toledo Road ...


Semen Analysis Test  


... is having trouble becoming pregnant , or after a vasectomy to determine if the operation was successful When ... fertility problem or after you have had a vasectomy Sample Required? A semen sample collected in a ...


How Effective Is Male Contraception?  


... men, methods of contraception include male condoms and sterilization (vasectomy). Male condoms. This condom is a thin sheath ... are disposable after a single use. 1 , 2 Vasectomy ( va-SEK-tuh-mee ) is a surgical procedure ...


Percutaneous Sperm Retrieval in Secondary Azoospermia  

Microsoft Academic Search

Introduction: Males presenting for assisted reproduction after vasectomy have a high chance of normal spermatogenesis and of successful surgical sperm retrieval. We aimed to evaluate simple percutaneous methods of retrieving sperm for intracytoplasmic sperm injection in males with secondary azoospermia due to previous vasectomy. Patients and Methods: We analyzed a series of post-vasectomy males who presented for sperm retrieval between

S. J. Bromage; D. A. Falconer; B. A. Lieberman; B. Shafar; S. R. Payne



Bringing men to the table: sterilization can be for him or for her.  


Sterilization, male and female combined, is the most common use of contraception in the United States. Despite the lower risk, higher cost-efficacy, and high efficacy of vasectomy compared with female sterilization, more US women rely on female sterilization than male sterilization. Reasons for low use of vasectomy include lack of knowledge and misconceptions about the procedure, lack of access, provider bias, and patient preferences. This article will provide a basic overview of male and female sterilization, an exploration of vasectomy barriers, and ways obstetrician-gynecologists can increase vasectomy uptake including regular recommendation of vasectomy to patients in long-term committed relationships considering sterilization. PMID:25314085

Shih, Grace; Zhang, Ying; Bukowski, Kyle; Chen, Angela



Quantitation of Seminal Factor IX and Factor IXa in Fertile, Nonfertile, and Vasectomy Subjects: A Step Closer Toward Identifying a Functional Clotting System in Human Semen  

Microsoft Academic Search

Coagulation factor (F) IX is a zymogen of the plasma serine proteases, one that plays an essential role in the regulation of normal blood coagulation. Congenital defects of FIX synthesis or function cause hemophilia B (originally called hemophilia C). Factor IX is activated by Tissue Factor (TF):FVII\\/FVIIa complex and FXIa. Subsequent to its activation, FIXa combines with FVIIIa on the



Vas deferens A model used to establish sympathetic cotransmission  

E-print Network

neuromodulation. It has also been used to study sympathetic reinnervation following vasectomy and castration, particularly in nerves supplying the circular muscle layer. Functional evidence for the participation

Burnstock, Geoffrey



Microsoft Academic Search

Vasovasostomy after sterilisation vasectomy is the most frequently performed microsurgical intervention in refertilizing surgery. Causes for obstruction other than vasectomy such as juvenile hernia repair and other kinds of surgery affecting the seminal cord appear to be rare. The pre-operative diagnostic approach follows the rules of conventional diagnostics in male infertility. The significance of the intra-operative evaluation of aspirates from

I. Schroeder-Printzen; Th. Diemer; W. Weidner



Is it Reporting Bias Doubled the Risk of Prostate Cancer in Vasectomised Men in Mumbai, India?  

Microsoft Academic Search

Background: Vasectomy is a common method of family planning in India and worldwide. The objective of the present study was to assess the association of vasectomy with prostate cancer in a low risk population of a developing country. A population based case control study was conducted in Mumbai, India, for this purpose. Methods: Included in this study were microscopically proved

Lizzy Sunny



State Infertility Insurance Laws  


... tubes that are not a result of voluntary sterilization; or Abnormal male factors contributing to the infertility. ... or other assisted reproductive techniques, reversal of a tubal ligation, a vasectomy, or any other method of sterilization. ...


Birth control and family planning  


... to have children in the future. They include vasectomy and tubal ligation. These procedures can sometimes be reversed if a ... 26. Jensen JT, Mishell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Lentz GM, Lobo RA, ...


32 CFR 732.15 - Unauthorized care.  

Code of Federal Regulations, 2011 CFR

...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...



32 CFR 732.15 - Unauthorized care.  

Code of Federal Regulations, 2013 CFR

...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...



32 CFR 732.15 - Unauthorized care.  

Code of Federal Regulations, 2012 CFR

...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...



32 CFR 732.15 - Unauthorized care.  

Code of Federal Regulations, 2010 CFR

...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...



32 CFR 732.15 - Unauthorized care.  

Code of Federal Regulations, 2014 CFR

...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...



42 CFR 9.5 - Chimpanzee ownership, fees, and studies.  

Code of Federal Regulations, 2010 CFR

...Chimpanzees transferred to the sanctuary sites must be permanently incapable of reproduction, for example, by vasectomy, tubal ligation, or another reliable procedure; (2) Complete histories must accompany each chimpanzee. Any chimpanzee...



A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition  

PubMed Central

Background Vasectomy techniques have been the subject of relatively few rigorous studies. The objective of this analysis was to compare the effectiveness of two techniques for vas occlusion: intraluminal cautery versus ligation and excision with fascial interposition. More specifically, we aimed to compare early failure rates, sperm concentrations, and time to success between the two techniques. Methods We compared semen analysis data from men following vasectomy using two occlusion techniques. Data on intraluminal cautery came from a prospective observational study conducted at four sites. Data on ligation and excision with fascial interposition came from a multicenter randomized controlled trial that evaluated the efficacy of ligation and excision with versus without fascial interposition. The surgical techniques used in the fascial interposition study were standardized. The surgeons in the cautery study used their customary techniques, which varied among sites in terms of type of cautery, use of fascial interposition, excision of a short segment of the vas, and use of an open-ended technique. Men in both studies had semen analyses two weeks after vasectomy and then approximately every four weeks. The two outcome measures for the analyses presented here are (a) time to success, defined as severe oligozoospermia, or <100,000 sperm/mL in two consecutive semen analyses; and (b) early vasectomy failure, defined as >10 million sperm/mL at week 12 or later. Results Vasectomy with cautery was associated with a significantly more rapid progression to severe oligozoospermia and with significantly fewer early failures (1% versus 5%). Conclusion The use of cautery improves vasectomy outcomes. Limitations of this comparison include (a) the variety of surgical techniques in the cautery study and differences in methods of fascial interposition between the two studies, (b) the uncertain correlation between sperm concentrations after vasectomy and the risk of pregnancy, and (c) the use of historical controls and different study sites. PMID:15509302

Sokal, David; Irsula, Belinda; Chen-Mok, Mario; Labrecque, Michel; Barone, Mark A



Male or female sterilization: a comparative study.  


The study compares 709 males and 546 females recruited from a well-defined geographic area and sterilized during a 5-year period at the same hospital. Medical records were reviewed and questionnaires sent out. Widespread satisfaction with the sterilization was found. The sterilized women had experienced contraceptive side effects and failures more often than the men. Only 70% of the laparoscopic sterilizations could be carried out during a 1-day admission, 25% of the women complained about long-term sequelae, and there were 1% failures. The vasectomies were carried out on an outpatient basis, there were few postoperative symptoms, and 0.5% failures were recorded. Female sterilization was at least four times as expensive as vasectomy. It is concluded that vasectomy is generally to be preferred to female sterilization, and that the preoperative guidance should involve both man and wife. PMID:2920844

Kjersgaard, A G; Thranov, I; Rasmussen, O V; Hertz, J



Presterilization Interviewing: An Evaluation  

ERIC Educational Resources Information Center

The role of interviewing in diffusing possible harmful side effects of sterilization operations was evaluated in an acute general hospital. Two simultaneous field experiments were conducted with 50 vasectomy couples and 50 tubal-ligation couples. There were no significant differences between the interview and control groups. (Author)

Carey, Raymond G.



DCTD — Developmental Therapeutics Program (DTP)

DTP’s Biological Testing Branch oversees animal-production facilities that produce inbred, outbred, and hybrid strains of rats and mice. This program provides researchers nationwide with genetically defined, pathogen-free laboratory animals, as well as animal-related services such as jugular vein cannulations, vasectomies, ovariectomies, and castrations.


Share | Like Lawyer Directory  

E-print Network

Share | Like Lawyer Directory Legal Answers Law Blogs Supreme Court more Sign In Enter. A statute of Oklahoma provides for the sterilization, by vasectomy or salpingectomy, of "habitual criminals" -- an habitual criminal being defined therein as any person who, having been convicted two or more times


Sexually transmitted diseases and other urogenital conditions as risk factors for prostate cancer: a case–control study in Wayne County, Michigan  

Microsoft Academic Search

Objective To investigate associations between prostate cancer and sexually transmitted diseases (STDs), prostatitis, benign prostatic hyperplasia (BPH), and vasectomy in a population-based case–control study in Wayne County, Michigan, among African American and white men aged 50–74 years.

Divya A. Patel; Cathryn H. Bock; Kendra Schwartz; Angela S. Wenzlaff; Raymond Y. Demers; Richard K. Severson



Use of analgesic drugs for pain management in sheep  

Microsoft Academic Search

Awareness of pain and its effects is increasing within the veterinary profession, but pain management in food animals has been neglected. Sheep seldom receive analgesics despite various conditions, husbandry practice and experimental procedures being known to be painful, e.g. footrot, mastitis, vaginal prolapse, castration, vasectomy, penis deviation, and laparoscopy. The evidence supporting use of analgesic drugs in this species is

I Lizarraga; JP Chambers




Microsoft Academic Search

Summary. Unilateral castration and unilateral vasectomy both bring about a reduction in the androgen-dependent activity of the RNA poly- merase enzymes of the ipsilateral lobes of the prostate and seminal vesicles compared to that of the equivalent organs on the contralateral side. After unilateral orchidectomy (i.e. the epididymis was not removed with the testis), the ipsilateral lobes of the prostate



Use of analgesic drugs for pain management in sheep  

Microsoft Academic Search

Awareness of pain and its effects is increasing within the veterinary profession, but pain management in food animals has been neglected. Sheep seldom receive analgesics despite various conditions, husbandry practice and experimental procedures being known to be painful, e.g. footrot, mastitis, vaginal prolapse, castration, vasectomy, penis deviation, and laparoscopy. The evidence supporting use of analgesic drugs in this species is

I Lizarraga; JP Chambers



A comparison of vas occlusion techniques: cautery more effective than ligation and excision with fascial interposition  

Microsoft Academic Search

BACKGROUND: Vasectomy techniques have been the subject of relatively few rigorous studies. The objective of this analysis was to compare the effectiveness of two techniques for vas occlusion: intraluminal cautery versus ligation and excision with fascial interposition. More specifically, we aimed to compare early failure rates, sperm concentrations, and time to success between the two techniques. METHODS: We compared semen

David Sokal; Belinda Irsula; Mario Chen-Mok; Michel Labrecque; Mark A Barone





Worldwide, sterilization (tubal sterilization and vasectomy) is used by more people than any other method of contraception. All techniques of tubal sterilization in widespread use in the United States have low risks of surgical complications. Although tubal sterilization is highly effective, the risk of pregnancy varies by age and method of occlusion. Pregnancies can occur many years after the procedure, and when they do, the risk of ectopic gestation is high. There is now strong evidence against the existence of a post-tubal ligation syndrome of menstrual abnormalities. Although women who have undergone tubal sterilization are more likely than other women to undergo hysterectomy subsequently, there is no known biologic basis for this relationship. Although sterilization is intended to be permanent, expressions of regret and requests for reversal are not uncommon and are much more likely to occur among women sterilized at young ages. Tubal sterilization has little or no effect on sexual function for most women. Vasectomy is less likely than tubal sterilization to result in serious complications. Minor complications, however, are not uncommon. Vasectomy does not increase the risk of heart disease, and available evidence argues against an increase in the risk of prostate cancer, testicular cancer, or overall mortality. Whether a postvasectomy pain syndrome exists remains controversial. Although the long-term effectiveness of vasectomy is less well-studied than that for tubal sterilization, it seems likely to be at least as effective. Intrauterine devices and progestin implants are long-acting, highly effective alternatives to sterilization. PMID:18165410

Peterson, Herbert B



Identifying and preventing pain during and after surgery in farm animals  

Microsoft Academic Search

Pain research in farm animals has focused on routine husbandry procedures such as dehorning; much less known about the pain associated with the other surgeries such as those required for displaced abomasum and caesarean delivery. We review the literature on pain in farm animals due to non-routine procedures including laporatomy, caesarean sections, ovariectomy and ovariohysterectomy, displaced abomasums, cannulations, vasectomy and

Kristen A. Walker; Todd F. Duffield; Daniel M. Weary


Time to azoospermia may be longer than often assumed.  


A vasectomy involves severing the vasa deferentia to keep sperm from going from the testicles to the urethra during ejaculation. Various techniques are then used to close the vas. Vasectomy, however, takes weeks to become effective since sperm remains in a man's reproductive tract long after the procedure. Recent research findings suggest that it may take longer than previously thought for sperm to disappear completely and that some men rebound to high sperm counts after sperm counts decline. Couples are therefore often advised to use another contraceptive method until 20 ejaculations or 12 weeks have passed. However, in a recently completed study by FHI and AVSC International, 44 of 198 men did not achieve azoospermia during 24 weeks of follow-up after their vasectomies. There was also more variability than had been expected in the time and number of ejaculations before men reached azoospermia. Most of the 44 men nonetheless had sperm counts by 12 weeks probably low enough to prevent pregnancy. Another group of 18 men in the same study were considered to be vasectomy failures. 16 had low sperm counts or no sperm during the early period of follow-up, but later rebounded to higher counts. These findings suggest that the vas may grow back together in some men. PMID:12321062

Finger, W R



Microsurgical vasovasostomy.  


Up to 6% of men who have undergone vasectomy will ultimately elect for reversal in the form of vasovasostomy or vasoepididymostomy for various reasons. Vasovasostomy performed to regain fertility is a technique that has undergone numerous advances during the last century, including the use of microsurgical equipment and principles to construct a meticulous anastomosis. It is important during vasovasostomy to ensure good blood supply to the anastomosis as well as to build as a tension-free anastomosis. Visual inspection to ensure healthy mucosa and inner muscularis as well as atraumatic handling of tissues is helpful. With vasovasostomy, it is essential to create a watertight anastomosis to prevent secondary scar formation. The microdot technique of vasovasostomy allows for markedly discrepant lumens to be brought together more precisely. Thereby, the planning is separated from suture placement, which prevents dog-ears and avoids subsequent leaks. In the age of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), it becomes even more important to clarify outcomes after vasectomy reversals, as patients now have a choice between surgical sperm retrieval coupled with IVF/ICSI versus vasectomy reversal. Little data on long-term outcomes for vasectomy reversals exist. Therefore, further research in this field needs to evaluate the rate of late failures and the predictors of late failures. PMID:23147468

Herrel, Lindsey; Hsiao, Wayland



Microsurgical vasovasostomy  

PubMed Central

Up to 6% of men who have undergone vasectomy will ultimately elect for reversal in the form of vasovasostomy or vasoepididymostomy for various reasons. Vasovasostomy performed to regain fertility is a technique that has undergone numerous advances during the last century, including the use of microsurgical equipment and principles to construct a meticulous anastomosis. It is important during vasovasostomy to ensure good blood supply to the anastomosis as well as to build as a tension-free anastomosis. Visual inspection to ensure healthy mucosa and inner muscularis as well as atraumatic handling of tissues is helpful. With vasovasostomy, it is essential to create a watertight anastomosis to prevent secondary scar formation. The microdot technique of vasovasostomy allows for markedly discrepant lumens to be brought together more precisely. Thereby, the planning is separated from suture placement, which prevents dog-ears and avoids subsequent leaks. In the age of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), it becomes even more important to clarify outcomes after vasectomy reversals, as patients now have a choice between surgical sperm retrieval coupled with IVF/ICSI versus vasectomy reversal. Little data on long-term outcomes for vasectomy reversals exist. Therefore, further research in this field needs to evaluate the rate of late failures and the predictors of late failures. PMID:23147468

Herrel, Lindsey; Hsiao, Wayland



Family planning performance at a major hospital in Sri Lanka.  


862 men attending the family health clinic, General Hospital, Kurunegala, Sri Lanka for sterilization over the October 1, 1982-March 1983 period were interviewed to study the characteristics of the men attending the clinic and to assess the popularity of vasectomy over other methods of family planning. For the study to be more comprehensive, the figures of the family planning activities of the hospital from 1977-82 also were examined. 438 (55.5%) of the study subjects were paddy cultivators. 71 of the men were in the 16-25 age group, 422 in the 26-35 age group, 272 in the 36-45 age group, and 97 in the 46 and older age group. 725 (85%) of the men were literate. Middle income groups comprised the major segment of men in this series. In 544 (63.1%) the vasectomy was motivated by friends and relatives; only 15 (2.0%) were motivated by health staff. 821 of the men (95.3%) belonged to the 16-39 age group. A table summarizes the relationship between age of the last living child and vasectomy performance. For 279 of the men, the age of their last living child was less than 1 year; it was 1-2 years for 218 men, 2-3 years for 180 men, and 3 or more years for 185 men. Study observations indicate that a consensus is becoming established about the role played by the male partner in family planning. The incentive scheme, acceptability and safety of the method, and a change in life styles should be considered. In the 862 vasectomies performed, there were no major complications or failures in contraception. Some pertinent factors for the favorable trend in vasectomy at this clinic are: health education talks delivered by a trained staff nurse at this clinic, outpatient department, and wards of the hospital; motivation activities of the community development social workers in the field; this clinic being the leading clinic of the limited number of institutions in Kurunegala conducting regular male sterilization clinics, and personality characteristics of the medical officer, staff, and the facilities available at the clinic. The middle months and the latter part of the year were the most popular periods at this clinic. These months represent the nonharvesting season. The study shows that the small family norm has been preferred by the majority; only 111 had more than 3 living children. Better education, better communication, and better approach methods may improve vasectomy acceptance rates. PMID:6680335

Tennakoon, S



ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 46, September 2003. (Replaces technical bulletin number 222, April 1996).  


Bilateral tubal sterilization and vasectomy are both safe and effective permanent methods of contraception; more than 220 million couples worldwide use them as their contraceptive method of choice. Sterilization continues to be the most commonly used contraceptive method in the United States, with 11 million U.S. women relying on the method. Approximately 700,000 tubal sterilizations and 5000,000 vasectomies are performed in the United States annually. The purpose of this document is to review the evidence for the safety and effectiveness of sterilization in comparison with other forms of contraception, as well as evidence of the likelihood that a woman will regret having had a sterilization procedure. PMID:12962966

Pollack, Amy



Correlations between two markers of sperm DNA integrity, DNA denaturation and DNA fragmentation, in fertile and infertile men  

Microsoft Academic Search

Objective: To evaluate two different assays of human sperm DNA integrity, DNA denaturation (DD) and DNA fragmentation (DF), and to correlate these with standard semen parameters.Design: Prospective, observational study.Setting: University infertility clinic.Patient(s): Forty consecutive semen samples from 33 nonazoospermic men presenting for infertility evaluation and 7 fertile men presenting for vasectomy.Intervention(s): Assessment of sperm concentration, motility, morphology, DD and DF.Main

Armand Zini; Ryszard Bielecki; Donna Phang; Maria Teresa Zenzes



Early microrecanalization of vas deferens following biodegradable graft implantation in bilaterally vasectomized rats  

Microsoft Academic Search

We evaluated a biodegradable graft for reconstruction of rat vasa deferentia with long obstructed or missing segments. A total of 47 Sprague-Dawley rats underwent bilateral vasectomy and were divided into groups according to length of the vas deferens affected (0.5, 1, 1.5 cm). After 8 weeks, poly-(D,L-lactide) (PDLA) grafts were used to reconnect the vas deferens. Grafts and adjoining vasa

Christopher M. Simons; Barry R. De Young; Thomas S. Griffith; Timothy L. Ratliff; Erin Jones; Surya K. Mallapragada; Moshe Wald



[Male fertility disorders. An actual and practical review].  


Because of both external and individual factors, nowadays more men seek clarification and consultation about their fertility. This article reviews the current diagnostic work-up of subfertile men and the evidence based treatment options. Also testicular biopsy and cryopreservation of sperm or testicular tissue are addressed. Finally, the issues of vasectomy reversal and aplasia of the vas deferens are discussed. The paper emphasizes practical issues and practicability in office urology. PMID:19421802

Denil, J



Relationship between epidemiological features and aetiology of male infertility as diagnosed by a comprehensive infertility service provider  

Microsoft Academic Search

This study examined the relationship between demographic features and aetiological causes of male infertility. Primary infertility was the presentation in 78% of patients. The incidence of varicocele was the highest (31%), whereas only 4.6% had vasectomy reversal and 7.4% of men were diagnosed with idiopathic infertility. Using the chi-squared test, there was no significant difference in the incidence of different

Nabil Aziz; Ashok Agarwal; Kiran P Nallella; Anthony J Thomas Jr



Maintenance of sexual function in a castrated man treated with ovarian steroids  

Microsoft Academic Search

Sexual function, mood states, and endocrine levels were studied in a 48-year-old man who had been castrated bilaterally because of severe post-vasectomy orchialgia and who habitually uses oral estrogen and progestin. He reported satisfactory sexual behavior with a usual coital frequency of at least twice per week while on treatment with Premarin® and Provera®. Though his nocturnal penile tumescence (recorded

Julian M. Davidson; Carlos Camargo; Erla R. Smith; Marie Kwan



Surgical sperm retrieval and intracytoplasmic sperm injection as treatment of obstructive azoospermia  

Microsoft Academic Search

Male genital tract obstructions may result from infections, previous\\u000a inguinal and scrotal surgery (vasectomy) and congenital bilateral absence\\u000a of the vas deferens (CBAVD). Microsurgery can sometimes be successful in\\u000a treating the obstruction. In other cases and in cases of failed surgical\\u000a intervention, the patient can be treated by microsurgical or percutaneous\\u000a epididymal sperm aspiration (MESA, PESA) or testicular sperm extraction

G. R. Dohle; L. Ramos; M. H. E. C. Pieters; D. D. M. Braat; R. F. A. Weber



Use of an optical clearing agent during noninvasive laser coagulation of the canine vas deferens, ex vivo and in vivo  

NASA Astrophysics Data System (ADS)

Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to the scrotal skin to reduce both the laser power necessary for successful noninvasive laser vasectomy and the probability of scrotal skin burns. A mixture of DMSO/glycerol was noninvasively delivered into the scrotal skin using a Madajet. Near-infrared laser radiation with a range of average powers (7.0-11.7 W) was delivered in conjunction with a range of cryogen spray cooling rates (0.20-0.33 Hz) to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify the strength of vas closure. A 30-min application of the OCA improved skin transparency by 26 +/- 5 %, reducing the average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP = 291 +/- 31 mmHg) to 7.0 W with OCA (BP = 292 +/- 19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82 +/- 28 mmHg) significantly below typical ejaculation pressures (136 +/- 29 mmHg). Application of an optical clearing agent reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by approximately 25%. This technique may result in the use of a less expensive laser system and eliminate the formation of scrotal skin burns during the procedure.

Cilip, Christopher M.; Ross, Ashley E.; Jarow, Jonathan P.; Fried, Nathaniel M.



Application of an optical clearing agent during noninvasive laser coagulation of the canine vas deferens  

NASA Astrophysics Data System (ADS)

Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to scrotal skin to reduce laser power necessary for successful noninvasive laser vasectomy and eliminate scrotal skin burns. A mixture of dimethyl sulfoxide and glycerol was noninvasively delivered into scrotal skin using a pneumatic jet device. Near-infrared laser radiation was delivered in conjunction with cryogen spray cooling to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify strength of vas closure. A 30-min application of OCA improved skin transparency by 26+/-3%, reducing average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP=291+/-31 mmHg) to 7.0 W with OCA (BP=292+/-19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82+/-28 mmHg) significantly below typical ejaculation pressures (136+/-29 mmHg). Application of an OCA reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by ~25%. This technique may result in use of a less expensive laser and eliminate the formation of scrotal skin burns during the procedure.

Cilip, Christopher M.; Ross, Ashley E.; Jarow, Jonathan P.; Fried, Nathaniel M.



A randomized, controlled, multicenter contraceptive efficacy clinical trial of the intravas device, a nonocclusive surgical male sterilization  

PubMed Central

Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device (IVD) implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy (NSV). IVDs were categorized into two types: IVD-B has a tail used for fixing to the vas deferens (fixed wing) whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A (n = 487), IVD-B (n = 485) or NSV (n = 487) groups and underwent operation. Follow-up included visits at the 3rd–6th and 12th postoperative months. The assessments of the subjects involved regular physical examinations (including general and andrological examinations) and semen analysis. The subjects’ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests. There were no significant differences in pregnancy rates (0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV) among the three groups (P > 0.05). The cumulative rates of complications at the 12th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method. PMID:24589454

Lu, Wen-Hong; Liang, Xiao-Wei; Gu, Yi-Qun; Wu, Wei-Xiong; Bo, Li-Wei; Zheng, Tian-Gui; Chen, Zhen-Wen



Contraceptive sterilization: trends, options, and surprising new data.  


In the US, 24% of women aged 15-50 rely on female or male sterilization for contraception. While all methods of sexual sterilization are highly effective, new data indicate that the risk of pregnancy after female sterilization varies according to type of procedure performed and the woman's age, but at 18.5/1000 procedures the risk is higher than previously believed. About 30% of all tubal sterilization failures result in ectopic pregnancy, with the greatest risk occurring 2-3 years after the procedure. Female sterilization can be performed at a time unrelated to conclusion of pregnancy or during the postpartum or postabortion periods using the minilaparotomy or laparoscopy surgical approach and surgical ligation or mechanical or electrical occlusion. Location of the vasa deferentia for occlusion in vasectomy can be achieved through two small incisions or with the no-scalpel method. Various methods are used to achieve occlusion. With a first-year pregnancy rate of only 0.15%, vasectomy is superior to female sterilization in terms of efficacy, safety, procedural complexity, and cost. The disadvantages of female sterilization include regret, the rare occurrence of surgical complications, a small risk of death (4/100,000), an increased risk of subsequent hysterectomy among younger women undergoing tubal ligation, and menstrual pain. Tubal sterilization, however, may protect against ovarian cancer. The few disadvantages associated with vasectomy include the small risk of immediate complications and regret. Because of the permanent nature of sterilization, effective counseling is important and should include presentation of information about the reversible, longterm contraceptive methods available to women. PMID:12292544

Burkman, R T



Male contraception: history and development.  


Although the twentieth century has seen great strides in the development of female contraception, not a single new agent has been introduced as an approved method for common use for male contraception. Condoms (considered uncomfortable by some) and vasectomy (a permanent invasive procedure) are the only options provided to men, leaving an undue burden on women to bear contraceptive responsibility. Significant developments have, however, been made with regard to hormonal and nonhormonal contraception, and minor, reversible, procedural contraception. This article reviews the currently available, soon to be available, and theoretically possible methods of male contraception. PMID:24286773

Kogan, Paul; Wald, Moshe



Human robotic assisted bilateral vasoepididymostomy and vasovasostomy procedures: initial safety and efficacy trial  

NASA Astrophysics Data System (ADS)

Our goal was to develop a robotic approach for vasoepididymostomy (RAVE) and vasovasostomy (RAVV) using a 4 arm High Definition Platform (Intuitive Surgical, CA) and present our human in-vivo results. All 3 RAVV procedures were successful and one patient had 102 million motile sperm/ml of ejaculate at 1 month post-op. The RAVE procedure patient only had a few non-motile sperm at 6 month follow up in his ejaculate. The use of robotics seems to offer advantages in terms of ergonomics and suture control. Further evaluation is needed to assess the clinical potential of robotics in vasectomy reversal.

Parekattil, Sijo J.; Cohen, Marc S.; Vieweg, Johannes W.



Metal clips can prevent problem posed by accumulation of sperm.  


IN 500 outpatient vasectomies using metal clips to close the ends of the vas deferens, there were no failures or spermatic granulomas. The report of A.J. Bennett to the American Fertility Society compared the results of this study to the 2-15% incidence of symptomatic granulomas reported in most studies. He attributed this to the use of metalclips to occlude both ends of the vas deferens, which prevent sloughing of the tips of the vas with subsequent leakage of sperm and formation of a granuloma. In the 6-month follow-up, 2.6% complications were observed, of which 2 were serious. PMID:12277701



Vasovasostomy and predictors of vasal patency: a systematic review.  


About 3-6% of vasectomized men requested vasectomy reversal, for various reasons. Vasal patency (VP) is an important surrogate outcome of vasectomy reversal. This article reviews the impact of surgical skills, surgical approaches, intraoperative vasal fluid characteristics and the length of obstructive interval on VP. Based on the best available evidence, the rate of patency is related to the operative frequency of the surgeons, with better results obtained by surgeons who perform the operations at least 10 times annually. Microsurgical vasovasostomy is the preferred technique for durable good results. One-layer vasovasostomy and two-layer vasovasostomy seem to be equal with regard to VP. The rate of patency following vasovasostomy in the convoluted vas and vasovasostomy in the straight vas is comparable. The patency rate is high in men with clear intraoperative vasal fluid in at least one vas. VP is still high among patients with a long obstructive interval. In conclusion, surgical skills and intraoperative vasal fluid characteristics are the most important predictors of VP. Postoperative semen quality and the age of the female partner determine the chance of spontaneous conception in these couples. PMID:22452615

Elzanaty, Saad; Dohle, Gert R



A comparison of ABAcard(®) p30 and RSID™-Semen test kits for forensic semen identification.  


The screening and confirmatory tests available to a forensic laboratory allow evidence to be examined for the presence of bodily fluids. With the majority of evidence being submitted involving sexual assaults, it is important to have confirmatory tests for the identification of semen that are straightforward, quick, and reliable. The purpose of this study was to compare two commonly used semen identification kits utilized by forensic laboratories: ABAcard(®) p30 and Rapid Stain Identification of Human Semen (RSID™-Semen). These kits were assessed with aged semen stains, fresh and frozen post-vasectomy semen, post-coital samples collected on different substrates, post-vasectomy semen mixed with blood, saliva, and urine, a series of swabs collected at increasing time intervals after sexual intercourse, and multiple non-semen samples. The test kits were compared on the basis of sensitivity, specificity, and the cost and time effectiveness of each protocol. Overall, both semen identification tests performed well in the studies. Both kits proved specificity for identifying semen, however the ABAcard(®) p30 test surpassed the RSID™-Semen test in sensitivity, cost per test, and simplified test protocol. PMID:24237835

Boward, Emily S; Wilson, Stacey L




PubMed Central

The rate of non-compliance with the post-vasectomy semen examination procedure at the Centre Hospitalier de l'Université Laval (CHUL) between October 1, 1985 and March 31, 1987 was 21%, one of the highest in the literature. The purpose of our study was to determine the causes of this situation. The socio-demographic profile obtained from the computerized files of 50 patients who did not comply with the procedure was comparable to that of the 183 patients who did comply. A telephone survey of 43 non-compliant patients was carried out. In 70% of the responses to an open question on the reasons for non-compliance, the subject cited on his own negligence. In response to the closed questions, the constraints involved in the semen examination procedure were cited most often (49%). In the responses to both open and closed questions, a lack of information was cited least often. There is not a distinctive profile among vasectomy patients at the CHUL that would make it possible to predict compliance. Despite the fact that it would be difficult to improve the factors associated with patient negligence, it might be possible to increase compliance by following up more closely and lessening the constraints. PMID:21249056

Labrecque, Michel; Hamel, Jean-Francois; Prévost, Jean-François; Warren, Louis



Cost Effectiveness of Contraceptives in the United States  

PubMed Central

Background The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer’s perspective. Methods A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates, and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. Results Any contraceptive method is superior to “no method”. The three least expensive methods were the copper-T IUD ($647), vasectomy ($713) and LNG-20 IUS ($930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy, and plan disenrollment rates. Conclusion The copper-T IUD, vasectomy, and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy, and time horizon are influential factors that determine the overall value of a contraceptive method. PMID:19041435

Trussell, James; Lalla, Anjana M.; Doan, Quan V.; Reyes, Eileen; Pinto, Lionel; Gricar, Joseph



[Sterilization of men].  


Male sterilization is the most effective method of contraception next to female sterilization, provided that operative technical errors are avoided and postoperative spermiogram testing is conducted. Primary failures of operative technique, which can lead to legal litigation between patient and doctor, are a) that one side is correctly cut, but on the other side, instead of the vas, a vas-like structure is cut, and b) instead of re-sectioning both the right and left sides, the same vas is cut twice at different points. Simple vasotomy (a single cut) and simple vasectomy with ligation of the vas ends are both unreliable methods. The only reliable operative procedure is vasectomy (removal of a segment of the vas) and tying the vas ends back on themselves (using nonabsorbable material), after previous electrocoagulation of the inner coat of the vas. Statistics show that about 1 in 400 cases remains fertile. [Failure is due to 1) misidentification of at least one vas, or 2) spontaneous recanalization following formation of a sperm granuloma.] Another error with serious consequences is the failure of the physician to inform the patient that even after a correctly performed sterilization sperm may appear in the ejaculate for several months. Other forms of contraception should be used until two control tests confirm a reading of azoospermia in ejaculate taken after a week of abstinence. PMID:6489845

Klosterhalfen, H



Testicular Nitric Oxide and Thiobarbituric Acid Reactive Substances Levels in Obstructive Azoospermia: A Possible Role in Pathophysiology of Infertility  

PubMed Central

Objective. The aim of the study is to evaluate the levels of nitrite/nitrate and thiobarbituric acid reactive substances (TBARS) and their relationship with seminal parameters in experimental obstructive azoospermic rats to explain the possible mechanism of impaired sperm quality in obstructive azoospermia. Methods. A total of 10 male Spraque-Dawley rats underwent bilateral vas resection and ligation (Group-1 = vasectomy group). The findings were compared with control group (Group-2 = sham group, n = 10). Animals were sacrificed 8 weeks after surgery. Testes were removed and used for the evaluation of nitrate/nitrite and TBARS levels and for histology. Epididymal-aspirated seminal plasma was used for semen count and morphological analysis according to the Kruger criteria. Results. Testicular tissue nitrate/nitrite and TBARS levels were 35.7 ± 3.1 ?mol/g protein and 3.7 ± 0.1 nmol/g protein in Group-1, and 19.3 ± 0.7 ?mol/g protein and 3.1 ± 0.1 nmol/g protein in Group-2, respectively. Both parameters showed statistical differences between the two groups. Testicular tissue nitrate/nitrite and TBARS levels showed negative and statistically significant correlations with sperm motility and morphology. Conclusions. The present study showed that testicular nitrate/nitrite and TBARS levels were increased in obstructive azoospermia. For that reason, we concluded that antioxidant treatment can be recommended to patients before sperm extraction for artificial reproduction due to obstructive infertility after vasectomy reversal. PMID:16951488

Ba?ar, M. Murad; Kisa, Üçler; Tu?lu, Devrim; Yilmaz, Erdal; Ba?ar, Halil; Ça?layan, Osman; Batislam, Ertan



Male involvement in family planning.  


The prevailing focus of birth control programs on women's methods is a result of the prevailing attitude that the purpose of birth control measures is to protect women from excessive child bearing while allowing men to have their pleasure and escape the consequences of their actions. Male methods of contraception, such as coitus interruptus and condoms, although they have historically played a far greater role than women's methods, are denigrated as being unreliable or associated with extramarital sex respectively. Family planning clinics promote diaphragms, cervical caps, or pills in preference to condoms or coitus interruptus. Only 8% of the world contraceptive budget is spent on male methods. In the UK, family planning services are available free -- to women. If men choose sterilization, they are expected to pay for it themselves. Nevertheless, the increasing popularity of vasectomy shows that men are willing to accept responsibility for birth control. Male involvement needs to be promoted through small-scale studies and social marketing technics away from the medical setting, and condoms and vasectomy services must be available. The pill has placed the responsibility for birth control on the woman, but the responsibility must be shared, no matter which partner initiates the contraceptive precaution. The importance of behavioral factors is shown by the fact that most contraceptive failures are due to human error. PMID:12282033

Spencer, B



Optical coherence tomography vs. high-frequency ultrasound during noninvasive laser coagulation of the canine vas deferens  

NASA Astrophysics Data System (ADS)

A noninvasive approach to vasectomy may eliminate male fear of complications related to surgery and increase its acceptance. Noninvasive laser thermal occlusion of the canine vas deferens has recently been reported. In this study, optical coherence tomography (OCT) and high-frequency ultrasound (HFUS) are compared for monitoring laser thermal coagulation of the vas in an acute canine model. Bilateral noninvasive laser coagulation of the vas was performed in 6 dogs (n=12 vasa) using a Ytterbium fiber laser wavelength of 1075 nm, incident power of 9.0 W, pulse duration of 500 ms, pulse rate of 1 Hz, and 3-mm-diameter spot. Cryogen spray cooling was used to prevent skin burns during the procedure. An OCT system with endoscopic probe and a HFUS system with 20-MHz transducer were used to image the vas immediately before and after the procedure. Vasa were then excised and processed for gross and histologic analysis for comparison with OCT and HFUS images. OCT provided high-resolution, superficial imaging of the compressed vas within the vas ring clamp, while HFUS provided deeper imaging of the vas held manually in the scrotal fold. Both OCT and high HFUS are promising imaging modalities for real-time confirmation of vas occlusion during noninvasive laser vasectomy.

Cilip, Christopher M.; Allaf, Mohamad E.; Fried, Nathaniel M.



Acceptability of contraception for men: a review.  


Methods of contraception for use by men include condoms, withdrawal and vasectomy. Prevalence of use of a method and continuation rates are indirect measures of acceptability. Worldwide, none of these "male methods" accounts for more than 7% of contraceptive use although uptake varies considerably between countries. Acceptability can be assessed directly by asking about intended (hypothetical) use and assessing satisfaction during/after use. Since they have been around for a very long time, there are very few data of this nature on condoms (as contraceptives rather than for prevention of infection), withdrawal or vasectomy. There are direct data on the acceptability of hormonal methods for men but from relatively small clinical trials which undoubtedly do not represent the real world. Surveys undertaken among the male general public demonstrate that, whatever the setting, at least 25% of men - and in most countries substantially more - would consider using hormonal contraception. Although probably an overestimate of the number of potential users when such a method becomes available, it would appear that hormonal contraceptives for men may have an important place on the contraceptive menu. Despite commonly expressed views to the contrary, most women would trust their male partner to use a hormonal method. PMID:20933119

Glasier, Anna



Recent advances in male infertility research.  


Recent developments in the following areas of andrology are highlighted: varicocele; biochemical markers of epididymal function; genitourinary tract infection; evaluation of sperm motility; capacity for sperm fertilization; and the immunologic consequences of vasectomy. Discussion of the varicocele effect focuses on detection of thesubclinical varicocele, spermatic venography, Leydig cell functon, experimental models, and percutaneous venous treatment modalities. The size of the varicocele bears no relationship to its subsequent effects on spermatogenesis. Consequently, the "subclinical" varicocele, which is not palpable, becomes an important entity in the infertile patient. Use of a Doppler ultrasonic stethoscope for the detection of the nonpalpable varicocele and use of scrotal thermography have been reported although caution is advised with these techniques. The stress pattern is a nonspecific response of the germinal epithelium to a stimulus or the lack of a stimulus. Genitourinary infection or endocrinopathy can also cause an increased number of ejaculated immature sperm. Spermatic vein ligation is not justified in an infertile patient with a seminal stress pattern but without clinial evidence of a varicocele. Varicocelectomy also is unjustified in a patient with a palpable asymptomatic varicocele in the absence of a stress pattern. Venography in patients with varicocele should be reserved for individuals in whom persistence of a palpable or subclinical varicocele and abnormal semen parameters are observed following spermatic vein legation. It is also a research tool and can prove helpful in providing more information about testicular venous drainage. It may provide a vehicle for percutaneous treatment of the varicocele. Recent attention has been directed to a possible correlation between the presence of varicocele, Leydig cell function, and testosterone synthesis. The seminal stress pattern has been successfully produced in monkeys by a 90% constriction of the left renal vein between the vena cava and spermatic vein. The results indicated a bilateral testicular effect based on testicular biopsies. The conventional treatment for varicoceles is surgery. Recently, there have been reports of percutaneous, fluoroscopic treatment of these lesions. Originally considered to be a passive conduit for sperm transport, it is now evident that the epididymis is actively involved in the maturation of spermatozoa. The applicability of epididymal markers will be based primarily on the relative ease of determination in a clinical laboratory. Several newer methods for determining sperm motility -- turbidimetric techniques, laser light scattering techniques, and photographic tracking of sperm movement -- have been reported in an effort to increase objectivity, provide accurate records of sperm motilit, and study patterns of sperm movement and the effects of various exogenous agents. Vasectomy results in sperm antibody production. The presence of circulating sperm antibodies after vasectomy raises the possibility of systemic effects. PMID:7010747

Caldamone, A A; Cockett, A T



Evaluation of Canada goose sterilization for population control.  

USGS Publications Warehouse

We evaluated the vasectomy of 72 male Canada geese as a method to control growing populations of nuisance geese in Westchester County, New York. Thirty-three of the vasectomized males paired with a female and were located during ?1 breeding seasons; 7 treated males were not seen following surgery. The remaining 32 males were never observed paired with a female during the breeding season. Of 56 nesting attempts by the 33 pairs in ?1 breeding seasons, 84% of the nests were unsuccessful. Fidelity to nest sites during the second and third breeding seasons occurred for 17 of the 18 vasectomized males and their females that were observed for ?2 seasons. The results suggest that male sterilization may reduce productivity of nuisance Canada geese providing one carefully selects areas and flocks suitable for this type of control.

Converse, Kathryn A.; Kennelly, James J.



Reproductive choices for men.  


The condom is a latex rubber sheath worn over the erect penis during sexual intercourse, designed to prevent conception and the transmission of sexually transmitted diseases (STDs). Any one condom is meant to be used for only one complete act of intercourse. This method is highly recommended for sexually active adolescents. Should a condom tear during intercourse, the woman should seek emergency contraception to avoid pregnancy. A spermicide should be applied immediately to help reduce the likelihood of STD and HIV transmission. Vasectomy involves excising the vas deferens, severing the route through which sperm passes from the testes and conferring a permanent method of male contraception. Withdrawal involves interrupting sexual intercourse prior to ejaculation, while periodic abstinence refers to not engaging in sexual intercourse during a woman's ovulation period. The calendar, temperature, Billings, and sympto-thermal methods may be used to determine a woman's fertile period. PMID:12292583

Barry, T M



[Urological diseases most frequently involved in medical professional liability claims].  


Clinical safety and medical professional liability are international major concerns, especially in surgical specialties such as urology. This article analyzes the claims filed at the Council of Medical Colleges of Catalonia between 1990 and 2012, exploring urology procedures. The review of the 173 cases identified in the database highlighted the importance of surgical procedures (74%). Higher frequencies related to scrotal-testicular pathology (34%), especially testicular torsion (7.5%) and vasectomy (19.6%), and prostate pathology (26 %), more specifically the surgical treatment of benign prostatic hyperplasia (17.9%). Although urology is not among the specialties with the higher frequency of claims, there are special areas of litigation in which it is advisable to implement improvements in clinical safety. PMID:24913755

Vargas-Blasco, César; Gómez-Durán, Esperanza L; Arimany-Manso, Josep; Pera-Bajo, Francisco



Fournier's gangrene: the need for early recognition and radical surgical débridement.  


Fournier's gangrene, a specific form of necrotizing fasciitis, predominantly affects the male genitals, perineum and perianal region. Most frequently Fournier's gangrene is caused by the synergistic action of aerobic and anaerobic microorganisms and leads to early septicaemia with a high mortality. The case histories of three patients with Fournier's gangrene are presented to illustrate the importance of early recognition and radical surgical débridement as essential objectives for therapeutic success. In the first patient, who died of Fournier's gangrene after a vasectomy, appropriate therapy was significantly delayed due to late recognition of the condition. The second patient presented with a rapidly progressive fasciitis secondary to a perianal abscess; immediate excision of all necrotic tissue was successfully performed. The third patient developed gangrene from an urogenital infectious focus, which was primarily treated by insufficient incisional and drainage therapy. Only after radical débridement his general condition rapidly improved. PMID:1787906

de Roos, W K; van Lanschot, J J; Bruining, H A



Exploratory rigid laparoscopy in an African elephant (Loxodonta africana).  


In March 2009, a 25-yr-old captive female African elephant (Loxodonta africana) underwent an exploratory laparoscopy after several weeks of diarrhea, submandibular and ventral edema, and swelling on medial and lateral aspects of all feet. Although there have been recent advances in laparoscopic vasectomies in free-ranging African elephants in South Africa utilizing specially designed rigid laparoscopes and insufflation devices, this was the first attempt at using these same techniques for an exploratory purpose. The elephant was sedated in a static restraint chute and remained standing for the duration of the procedure. Laparoscopy provided visibility of the dorsal abdomen, enabled collection of reproductive tract biopsies and peritoneal fluid samples, and allowed for instillation of antibiotics and crystalloid fluids directly into the abdominal cavity. Abdominal exploration, collection of tissue samples, and local therapy is possible via standing laparoscopy in megavertebrates. PMID:25632688

Sweet, Julia; Hendrickson, Dean A; Stetter, Mark; Neiffer, Donald L



Malignant mesothelioma of the tunica vaginalis testis: a malignancy associated with recurrent epididymitis?  


A 53-year-old Taiwanese male had several episodes of left epididymitis with hydrocele refractory to antibiotic treatment. Partial epididymectomy plus preventive vasectomy were planned, and, incidentally, an ill-defined nodule was found lying on the tunica vaginalis near the epididymal head. The pathological diagnosis was malignant mesothelioma of the tunica vaginalis testis. Radical orchiectomy with wide excision of the hemi-scrotal wall was performed. So far, there is no evidence of recurrence after more than 3 years of follow-up. Malignant tumor should be considered in the case of recurrent epididymitis refractory to empirically effective antibiotic treatment. Although the nature of this tumor is highly fatal, the malignancy can possibly be cured by early and aggressive surgical treatment. PMID:23140511

Yen, Ching-Heng; Lee, Chun-Te; Su, Chung-Jen; Lo, Hua-Cheng



[Is there a place for tubal ligation in modern contraception?].  


About 30% of women with completed family planning choose tubal ligation as a method of contraception. Contraceptive safety of tubal ligation, with a Pearl index of 0.18, is comparable to those of OC or modern intrauterine devices (IUD). Pregnancies that occur after tubal ligation are often ectopic, especially in young women. There is currently no evidence that tubal ligation causes menstrual abnormalities. The risk of breast cancer, cancer of the endometrium or cervix is not elevated after tubal ligation, whereas the risk of ovarian cancer is even reduced. The risk of post-sterilization regret is higher when the operation was performed in women with children aged younger than 30 years. Tubal ligation is recommendable for women over 35 years of age with completed family planning, especially if contraindications for the use of OC or IUD exist. In general, vasectomy should always be discussed as a possible alternative. PMID:12499754

von Mering, Ruth; Merki, Gabriele S; Keller, Paul J



Social and Logistical Barriers to the Use of Reversible Contraception among Women in a Rural Indian Village  

PubMed Central

Women in a small coastal village in western India were asked to explain their preference for female sterili-zation over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modern reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain. PMID:18686557

Hall, Mary Ann Kirkconnell; Stephenson, Rob B.; Juvekar, Sanjay



The influence of staining procedure on differential round cell analysis in stained smears of human semen.  


Giemsa and Bryan-Leishman smear staining techniques have been quantitatively evaluated for their ability to determine round cells in human semen. Samples of fertile and vasectomy ejaculates were compared against counts obtained from semithin Araldite sections stained with toluidine blue. TEM studies and immunogold staining of the Pradite section permitted identification and quantitation of nucleated cell profiles. Differential counts from each of the three stains on the same set of semen samples were compared using regression analysis. Counts of seminiferous tubule elements from stain to stain correlated well (r > 0.9). Numerical analyses indicated, however, that leucocytes were commonly misidentified. The r values for neutrophils were less than 0.8 and as low as 0.55 for lymphocytes. These low correlations presumably were due to failures to distinguish between these cells and seminiferous tubule elements. PMID:8724436

Williams, M A; Wick, A; Smith, D C



Voluntary and involuntary sterilization: medical, ethical, legal and religious aspects.  


Surgical voluntary sterilization has become one of the most widely used methods of contraception, with vasectomy and tubal sterilization being the most commonly employed techniques, associated with a low failure, morbidity, mortality, and long-term sequelae rate. As sterilization is related with the elimination of the possibility for procreation, a number of ethical, legal and religious issues have arisen, leading often to personal misjudgements, legal disputes, and failures in applying family planning. Involuntary sterilization is currently not practiced, except in cases of severely mentally retarded people, who are unable to appreciate the consequences of their acts or care for their children and who may have a high likelihood of propagating hereditary disease. PMID:10534935

Fasouliotis, S J; Schenker, J G



Comparative risks and costs of male and female sterilization.  

PubMed Central

Couples who are considering elective sterilization should compare the risks and costs of male and female sterilization procedures as part of the decision process. Morbidity, mortality, failure rates, and short-term costs associated with male and female sterilization procedures were estimated from data available in previous case series. Male sterilization procedures were found to have zero attributable deaths and significantly less major complications when compared to female sterilization procedures. No less than 14 deaths a year can be attributed to female sterilization procedures in the US. Male and female sterilization procedures have efficacy rates that are not significantly different from each other. The short-term costs of female sterilization are 3.0 to 4.1 times that of vasectomy. PMID:3976963

Smith, G L; Taylor, G P; Smith, K F



The means of contraception: the state of the art.  


For each of the following methods, a description, means of application, and effectiveness expressed in theoretical and in use/failure rate is given: 1) douching, 2) breast-feeding, 3) withdrawal, 4) condoms, 5) diaphragm, 6) spermicidal foams and jellies, 7) IUD, 8) rhythm, 9) sterilization, and 10) interception (''morning-after'' remedies). The methods which will probably be available within 5 years are described: 1) C-film, 2) vaginal ring, 3) reversible tubal ligation, 4) reversible vasectomy, 5) 20-year copper IUD, 6) silastic capsules of progestin implanted under the skin, 7) prostaglandin use in delayed menstruation, and 8) vaccine to prevent implantation. Failure rates are taken from Contraceptive Technology 1976-1977. PMID:12229613

Kome, P



A dynamic family planning and health campaign.  


Any successful development program that combines family planning, nutrition, and parasite control such as the integrated project, must include effective information, education, and communication (IEC) components. The Population an Community Development Association (PDA), the largest nonprofit organization in Thailand provides a network of family planning service delivery composed of volunteer distributors including midwives, school techers and shopkeepers. Reliability and accessibility are the 2 important elements. A concerted media campaign which exposes people to condoms and other contraceptives helps desensitize an otherwise "too personal" issue. The problem which confronts family planning communication is how to counteract the sensuous messages form advetisers while focusing on mundane topics such as maternal and child health, responsible parenthood, and family budgets. The PDA has tried to use the same attractions to promote family planning. It distributes promotional items such as T-shirts, pens towels and cigarette lighters bearing family planning messages. In addition to the use of television and radio, PDA also utilizes every possible channel of communication. Approaches include: the Youth-to-Youth Program; informational exhibits; video-mobile vans which visit schools and factories; and the holding of PDA's vasectomy festivals. Informational exhibits on family planning and health care use a variety of audio-visual methods. Video is an effective communication medium. The PDA video material ordinarily consists of family dramas illustrating good and bad family planning practices. By holding vasectomy festivals, PDA provides a media-attracting forum to educate the public and promote vasectomey as the most effective birth control method. Mass media campaigns must be linked with fieldwork outreach. PMID:12314464



Acceptability of a transdermal gel-based male hormonal contraceptive in a randomized controlled trial?, ??, ?  

PubMed Central

Objective Fifty percent of pregnancies in the United States are unintended despite numerous contraceptive methods available to women. The only male contraceptive methods, vasectomy and condoms, are used by 10% and 16% of couples, respectively. Prior studies have shown efficacy of male hormonal contraceptives in development, but few have evaluated patient acceptability and potential use if commercially available. The objective of this study is to determine if a transdermal gel-based male hormonal contraceptive regimen, containing testosterone and Nestorone® gels, would be acceptable to study participants as a primary contraceptive method. Study Design As part of a three-arm, 6-month, double-blind, randomized controlled trial of testosterone and nestorone gels at two academic medical centers, subjects completed a questionnaire to assess the acceptability of the regimen. Of the 99 men randomized, 79 provided data for analysis. Results Overall, 56% (44/79) of men were satisfied or extremely satisfied with this gel-based method of contraception, and 51% (40/79) reported that they would recommend this method to others. One third of subjects (26/79) reported that they would use this as their primary method of contraception if it were commercially available today. However, men with concerns about sexually transmitted disease were significantly less satisfied than men without such concerns (p=0.03). Conclusions A majority of the men who volunteered to participate in this trial of an experimental male hormonal contraceptive were satisfied with this transdermal male hormonal contraceptive. If commercially available, a combination of topical nesterone and testosterone gels could provide a reversible, effective method of contraception that is appealing to men. Implications A substantial portion of men report they would use this transdermal male contraceptive regimen if commercially available. This method would provide a novel, reversible method of contraception for men, whose current choices are limited to condoms and vasectomy. PMID:24981149

Roth, Mara Y.; Shih, Grace; Ilani, Niloufar; Wang, Christina; Page, Stephanie T.; Bremner, William J.; Swerdloff, Ronald S.; Sitruk-Ware, Regine; Blithe, Diana L.; Amory, John K.



Structure and autonomic innervation of the human vas deferens: a review.  


The motor innervation of the smooth muscle coat of the human vas deferens is predominantly noradrenergic in type while a less dense and differently distributed presumptive cholinergic innervation is also in evidence, although the precise role of the latter is undetermined. Immunohistochemical studies have confirmed the presence of catecholamine-synthesizing enzymes tyrosine hydroxylase (TH) and dopamine beta hydroxylase (DbetaH) in the majority of fine, varicose intramuscular nerves, about two-thirds of which also contain neuropeptide Y (NPY). Minor populations of noradrenergic nerves contain enkephalin (ENK), galanin (GAL), somatostatin (SOM), or nitric oxide synthase (NOS). The presumptive cholinergic intramuscular nerves contain vasoactive intestinal polypeptide (VIP) and NPY. The subepithelial nerves of the vas deferens are assumed to have a secretomotor function and are rich in acetylcholinesterase and NPY, many also containing either VIP or NOS. The muscle coat of the human vas deferens is poorly differentiated until after birth, the intramuscular nerves in the fetus being relatively thick and non-varicose. Development of a subepithelial nerve plexus lags behind that in the muscle coat but its density in the neonatal vas deferens resembles that seen in the adult. Observations on specimens of human vas deferens obtained at vasovasostomy carried out 1 to 15 years after vasectomy have shown a marked reduction in the density of noradrenergic nerves in the muscle coat of the testicular portion while that in the urethral portion remains unaltered. Furthermore, the subepithelial secretomotor nerves degenerate in the testicular portion. These long-term changes in the pattern of innervation of the vas deferens consequent upon vasectomy may have profound effects upon the outcome of vasovasostomy with respect to subsequent sperm maturation, transport, and viability. PMID:9817549

Dixon, J S; Jen, P Y; Gosling, J A



Use of epididymal sperm for assisted reproduction in men with acquired, irreparable obstructive azoospermia.  


Microsurgical epididymal sperm aspiration (MESA) and in vitro fertilization (IVF) is primarily offered to men with congenital absence of the vas deferens (CAVD). However, the IVF capacity of these epididymal sperm is low ( < 15%) and unpredictable. In this study, IVF and intracytoplasmic sperm injection (ICSI) results in patients with non-congenital, irreparable obstructive azoospermia were analysed. Thirty-three patients were evaluated for a total of 37 cycles of MESA and IVF. Most had obstruction secondary to failed vasectomy reversal and to epididymal blockage. The overall fertilization rate was 30% with regular IVF and 26% with ICSI, and six clinical pregnancies were obtained. Both rates are significantly higher than the IVF rate previously reported with sperm from men with CAVD (13%, P < 0.00001). In men with non-congenital obstructive azoospermia, a significant difference was found in the average sperm count (56.9 x 10(6) v. 12.3 x 10(6), P < 0.04) and total motile count (16.6 x 10(6) v. 1.6 x 10(6), P < 0.01) respectively for patients who achieved IVF and those who did not. It is concluded that (a) the real IVF capacity of human epididymal sperm is 30%, or 42%, if calculated only for patients who achieved fertilization, (b) this higher rate is an indirect support of the hypothesis that sperm from men with CAVD have intrinsic biochemical defects, related to cystic fibrosis mutations, responsible for their low and unpredictable IVF rate, and (c) MESA and IVF can be offered at the same time or as an alternative to patients requesting vasectomy reversal. PMID:8711218

Patrizio, P; Ord, T; Balmaceda, J P; Asch, R H



[Surgical therapy of obstructive azoospermia: microsurgery].  


Microscopic procedures for therapy of obstructive azoospermia or of vasectomy reversals have resulted in accurate reapproximation of ductal structures. The success of vasovasostomy appears to be influenced by the length of time that has passed since the vasectomy was performed or the obstruction become. Failures of vasovasostomy may be attributed to anastomotic stenosis, sperm antibodies, epididymal dysfunction, or an unrecognized epididymal tubule blowout with subsequent obstruction. The latter condition should by suspected when, at the time of the initial vasovasostomy, there is lack of fluid containing spermatozoa in the cut end of the testicular portion of the vas. Chronic intratubular pressure may cause an epididymal blowout, with subsequent spermatic granuloma and obstruction in the epididymal tubule, that may also be related to a congenital disorder or a postinflammatory condition. Spermatozoa gain maturation and the capacity for motility as they move from the caput to the cauda of the epididymis as possible. Microsurgery allows direct microtubular anastomosis between the epididymal tubule and the cut end of the vas. Some conditions are not amenable to conventional surgical techniques, such obstructed azoospermia due to congenital bilateral absence of the vas deferens or to severe damage to the reproductive ducts. To treat these patients surgeons have devised reservoirs (artificial spermatoceles) to collect spermatozoa to be used for artificial insemination. An alternative treatment method for obstructed azoospermia is to obtain sperm from the epididymis with the use of an operating microscope. Although sperm have been obtained the poor sperm motility requires either in vitro fertilization or GIFT. The technique looks promising, although improved techniques to enhance the motility of the collected sperm will ultimately yield better results. PMID:9026246

Fenice, O; Austoni, E; Giudice, V



Failure rates of contraceptive methods.  


A discussion of the measures used to determine the failure rates of contraceptive methods precedes the presentation of a table that presents the theoretical and use failure rates for the following contraceptive methods: condom; coitus interruptus; diaphragm; IUD; oral contraceptive combined; oral contraceptive, progestogen only; vasectomy; tubal ligation; spermicidal foam; depo-provera; chance; lactation for 12 months; and the symptothermal method of natural family planning. A commonly used measure of contraceptive effectiveness is the Pearl Index. It measures the percentage of sexually active women who become pregnant while using a method for 1 year and can be expressed as either the minimum failure rate (theoretical failure rate) or as a maximum failure rate (use failure rate). Whether an individual or a couple operates at the minimum or maximum failure rate or somewhere in-between is dependent on: the basic contraceptive priorities of the method; the information provided by the practitioner for its use; and the extent of the user's compliance with the instructions. Theoretical failure rate is defined as the method's failure rate when the user receives correct instructions and follows these instructions conscientiously. The use failure rate is defined as the method's failure rate in actual use which includes: the user receiving incorrect instructions as to method use; the user forgetting to use the method sometimes or not using the method correctly. Theoretical failure rates listed in the table are: condom, 0.4-1.6; diaphragm, 2; IUD, 1-3; combined OC, 0.1; progestogen only OC, 1-2; vasectomy 0.1; tubal ligation 0.04; spermicidal foam, 3; depo-provera, 1; lactation for 12 months, 25; coitus interruptus, 9; and the symptothermal method -- variant A, 1.5; variant B, 3.39; and variant C, 11.2. PMID:12263458

Mclure, Z



Use of a domestic Korean black goat (Capra hircus coreanae) with its chest crayon-harnessed in detecting estrus of Himalayan tahrs (Hemitragus jemlahicus).  


The reliability of a Korean black goat (Capra hircus coreanae) to detect estrus in Himalayan tahrs (Hemitragus jemlahicus) for an artificial breeding program was investigated. Estrus in six female Himalayan tahrs was synchronized using fluorogestone acetate (FGA) sponges. Thirteen days later, 200 IU of PMSG and 100 IU of hCG were injected before removing the sponges and simultaneously injecting 5 mg of PGF2? the next day. Penetration of the cervical canal and the thickness and location of red crayon marks were examined 40 ˜ 43 h later. Two females treated with sponges containing 60 or 45 mg of FGA had estrogen levels of 8.7 and 11.1 pg/mL, respectively. No red marks were found on the backs of these two tahrs. The remaining females had higher levels of estradiol, and the red crayon marks were clearly shown. The cervical folds of these tahrs were readily penetrated and the insemination gun was smoothly inserted into the uterine body. In conclusion, a Korean domestic goat with its chest crayon-harnessed was successfully used to detect estrus of Himalayan tahrs. This technique might be utilized as a part of breeding programs for wild goats and avoid the need for a vasectomy of conspecific males. PMID:24690603

Yong, Hwanyul; Lee, Eunsong



Use of a domestic Korean black goat (Capra hircus coreanae) with its chest crayon-harnessed in detecting estrus of Himalayan tahrs (Hemitragus jemlahicus)  

PubMed Central

The reliability of a Korean black goat (Capra hircus coreanae) to detect estrus in Himalayan tahrs (Hemitragus jemlahicus) for an artificial breeding program was investigated. Estrus in six female Himalayan tahrs was synchronized using fluorogestone acetate (FGA) sponges. Thirteen days later, 200 IU of PMSG and 100 IU of hCG were injected before removing the sponges and simultaneously injecting 5 mg of PGF2? the next day. Penetration of the cervical canal and the thickness and location of red crayon marks were examined 40~43 h later. Two females treated with sponges containing 60 or 45 mg of FGA had estrogen levels of 8.7 and 11.1 pg/mL, respectively. No red marks were found on the backs of these two tahrs. The remaining females had higher levels of estradiol, and the red crayon marks were clearly shown. The cervical folds of these tahrs were readily penetrated and the insemination gun was smoothly inserted into the uterine body. In conclusion, a Korean domestic goat with its chest crayon-harnessed was successfully used to detect estrus of Himalayan tahrs. This technique might be utilized as a part of breeding programs for wild goats and avoid the need for a vasectomy of conspecific males. PMID:24690603

Yong, Hwanyul



Wolf management in the 21st century: From public input to sterilization  

USGS Publications Warehouse

Human-population increase and land development portend increasing conflict with large predators. Concurrently, changes and diversification of human attitudes are bringing increased disagreement about wildlife management. Animal-rights advocacy resulting from urbanization of human populations conflicts with traditional wildlife management. These forces focus more on wolves than on other wildlife because of strong public and media interest in wolves. Thus wolf management in the future will come under even greater public scrutiny, involve more public input, and may have greater restrictions imposed on it. This will lead to increased complexity in wolf management including more zoning, more experimentation with lethal and non-lethal capture techniques and alternate methods of alleviating damage to pets, livestock, and large ungulate herds, and greater public and private subsidy of wolf damage. One form of non-lethal control of wolf populations that may hold some promise is direct sterilization of males to reduce the biotic potential of the wolf population. Experimental vasectomy of five wild male wolves from four packs in Minnesota indicates that sterile males will continue to hold mates and territories, which would be necessary if sterilization is to be a viable technique for assisting with population control. If sterile males held territories but failed to produce pups, such territories might contain only about a third the number of wolves as fertile pack territories. Because wolves are long-lived in unexploited populations and their territories are large, direct sterilization of relatively few animals each year might significantly reduce populations.

Mech, L.D.; Fritts, S.H.; Nelson, M.E.



Adolescents and sex.  


Adolescent health problems in the Philippines are identified as follows: adolescent unwanted pregnancy, early marriage, abortion and sometimes death, sexually transmitted disease (STD), AIDS, inadequate knowledge about sex and reproduction (population education), taboos, inadequate resources directed to youth, and personnel insufficiently trained for gender sensitive and adolescent sensitive counseling. A recent University of the Philippines Population Institute survey reported that only 10% of urban respondents and 8.1% of rural respondents considered virginity to be unimportant. 33% in urban and 29% in rural areas consent to premarital sex if the couple were "in love" and there was a promise of marriage. Premarital sex is increasing, but was lower among those who grew up with their parents. Population education is compulsory but teachers are ill equipped, unknowledgeable about the latest technology, and biased. Human reproduction is taught but family planning methods are frequently ignored. The topic is taboo between parents and children. Acquisition of knowledge is haphazard at best. Government resources are directed to adult reproductive women. Emphasis needs to be placed on the importance and proper use of pills, condoms, IUDs, and diaphragms. Vasectomy and tubal ligation should be readily available. Youth should be taught rhythm, basal body temperature, and Billings ovulation methods. Misconceptions should be debunked. Sex education, STD prevention, and counseling for adolescents are available in only 5 centers in the Philippines, as reported by the International Center on Adolescent Fertility; this is adequate to serve the almost 50% of the population 18 years. PMID:12285922

Castro, C; Palomar Castro, Y



Induction of Contraception by Intraepididymal Sclerotherapy  

PubMed Central

Purpose The objective of the present study was to evaluate the efficacy of a sclerosing solution for inducing epididymal occlusion in male rats. Materials and Methods Male Sprague-Dawley rats were divided into two groups: an injection group (n=20) and control group (n=20). Before injecting the sclerosing agent, seminal vesiculectomy and sperm identification using electrostimulation were performed in all of the rats. In the injection group, 0.2 mL of 0.1% sodium tetradecyl sulfate solution was injected into the epididymis. In the sham group, only the identification of the epididymis was performed. At 4 and 12 weeks after the injection, semen was collected by electrostimulation and evaluated to assess the contraceptive effect. Epididymis was evaluated by hematoxylin and eosin (H&E) staining. Results After 4 and 12 weeks, semen collection was performed in the two groups. Sperms were not observed in the injection group, while there was no change in the sperms in the sham group. H&E staining showed the obstruction of epididymal tubules and an accumulation of inflammatory cells in the injection group. Conclusions This study showed that the sclerosing agent induced sterilization in male rats. This result suggests that the injection method can replace vasectomy as a contraceptive method. However, a further study of large animals and a clinical study are needed. Further, the long-term effectiveness of this method needs to be studied. PMID:25237657

Park, Hyoung Keun; Paick, Sung Hyun; Kim, Hyeong Gon; Lho, Yong Soo



Family planning technical services in China.  


Family planning is a basic state policy in China. Its aim is to control population growth and to enhance population quality. Technical services are the key measures for implementing the family planning policy. In order to ensure that people use safe, effective, and appropriate contraceptive methods based on the government's commitment, China has established countrywide family planning service networks down to the township level. The people can access various and convenient contraceptive services. In urban areas, all contraceptive services are free. The contraceptive prevalence rate in 2007 was 84.6%, the percentage of intrauterine device (IUD) was 52.3%, that of female sterilization was 32.3%, and that of vasectomy was 6.1%. This means that more than 90% of married childbearing couples were using long-term contraceptives. At the same time, the government gives priority to supporting research on contraceptive technology. Studies' results have provided scientific evidence for development, introduction, and expansion of contraceptive methods, and also for establishment and revision of the technical guidelines. Great efforts have been made in promoting "human-oriented and client-centered" services during the recent ten years. Remarkable success has been achieved in improving the quality of technical services. PMID:21191833

Wu, Shang-Chun



Evidence based contraceptive choices.  


People who attend for contraceptive advice have usually formulated an idea of the type of contraceptive that will suit them best. They may wish to use a method that is long, short or medium acting. These are defined as follows: Long-acting method requires renewal no more frequently than every 3 months (e.g. injectable or intrauterine). Short-acting method used daily or with every act of intercourse (e.g. pills, condoms) Medium-acting method requires renewal weekly or monthly (e.g. ring, patch). For men the choice is limited to condoms or vasectomy. Some women do not wish to use hormonal preparations or have an intrauterine device (IUD) or implant inserted. There may also be cultural influences making certain methods of contraception unacceptable. Each of these factors influences the final decision of which method of contraception is decided upon. In addition to taking a full medical and sexual history to identify any risks to the individual's health, which might be increased by a particular contraceptive, time must be spent discussing the options available. It is important to ensure that there is a full understanding of the advantages and disadvantages of each method. The most successful contraceptive method is likely to be the one that the woman (or man) chooses, rather than the one the clinician chooses for them. Access for women to contraception can be improved by having convenient clinic times and service developments such as nurse prescribing and Patient Group Directions. PMID:16707277

Scott, Alison; Glasier, Anna



Antisperm antibodies detected by mixed agglutination reaction and immunobead test are not associated with chronic inflammation and infection of the seminal tract.  


The association between chronic inflammatory/infectious diseases of the male reproductive tract and the presence of antisperm antibodies (ASA) in semen is still controversial. We compared the results of the mixed agglutinin reaction (MAR) test and immunobead test for detecting ASA type IgG and IgA in 133 patients attending our special outpatient department for andrological infections and evaluated the differences in the detection rate of ASA. Patients were divided into three groups: a study group that included 79 patients with symptomatic nonacute inflammatory/infectious diseases of the seminal tract, a control group (n = 44) and a third group of men with a history of successful vasectomy reversal (n = 10). The two tests correlated in a statistically significant manner for the detection of IgG and IgA in all groups. The overall positive detection rate of clinical significant levels of IgG and IgA was 2.5% and 1.3% (respectively) in the patients with inflammation/infection of the seminal tract. No statistical significant difference in the detection rate of ASA levels between the inflammatory/infectious group and the controls was detected. The results of the MAR test and immunobead test have a statistical significant correlation and their results provide evidence that there is no association between inflammatory/infectious diseases of the male reproductive tract and the presence of ASA in semen. PMID:18727732

Marconi, M; Nowotny, A; Pantke, P; Diemer, T; Weidner, W



Early sexual maturity in male hamadryas baboons (Papio hamadryas hamadryas) and its reproductive implications.  


We present data on sexual maturity in young hamadryas baboon males (Papio hamadryas hamadryas) and its reproductive consequences in a large captive baboon colony. Hamadryas baboons live in a multilevel social system, with one-male units (OMUs) as the smallest social entity. Male leaders of OMUs are believed to monopolize matings within their OMUs; hence mating is believed to be polygynous and monandrous. In a captive colony of hamadryas baboons, we found evidence that young males less than 4 years old fathered at least 2.5% of 121 offspring born subsequent to vasectomy of all adult males, and males aged 4-5 years fathered at least 16.5% of the offspring. Additional evidence that these young males are able to sire offspring came from a morphological comparison of sperm from hamadryas males of different ages. The sperm of a 48-month-old hamadryas baboon were morphologically indistinguishable from viable sperm from adult males, whereas sperm from a 45-month-old male showed some aberrations. If successful copulations by adolescent males constitute a regular pattern even in free-ranging hamadryas baboons, a hamadryas male's chances to reproduce would not be limited to his role as an OMU leader as previously assumed, and a male's reproductive career would consist of two phases: the adolescent phase, and the OMU leader male phase. PMID:16331661

Zinner, Dietmar; Krebs, Ellen; Schrod, Annette; Kaumanns, Werner



Role of metabolomic analysis of biomarkers in the management of male infertility.  


Metabolomics is the systematic study of metabolites as small-molecule biomarkers that represent the functional phenotype in a cell, tissue or organism. Detection of crucial disturbances in the concentration of metabolites by metabolomic profiling of key biomarkers can be beneficial in the management of various medical conditions, including male-factor infertility. Recent studies have demonstrated the potential role of this rapid, noninvasive analysis in the investigation of infertile men. Differences in the concentration of oxidative stress biomarkers (-CH, -NH, -OH and ROH) have been found to be uniquely associated with semen plasma of healthy men compared with patients with idiopathic infertility, varicocele and vasectomy reversal. Furthermore, NMR spectra have shown significant differences in citrate, lactate, glycerylphosphorylcholine and glycerylphosphorylethanolamine among semen samples of men with spermatogenesis failure, obstructive azoospermia, oligoasthenoteratozoospermia and healthy donors. Evidence has also shown the value of (31)P-magnetic resonance spectroscopy in differentiating patients with testicular failure and ductal obstruction by utilizing phosphomonoester and beta-adenosine triphosphate as biomarkers. In addition, metabolomics has shown promise in assisted reproductive techniques. Recent studies involving spectroscopic measurements of follicular fluid and embryo culture media have revealed an association between biomarkers of oxidative stress and pregnancy outcome of oocytes and embryos. PMID:17620044

Deepinder, Fnu; Chowdary, Hyndhavi T; Agarwal, Ashok



The etiology of prostate cancer: what does the epidemiology suggest  

SciTech Connect

The two most important demographic characteristics of prostate cancer in Los Angeles are the high rates among blacks, which are two times those among whites and four times those among Asians, and the rapid increase in rates with age after age 40. Despite the high rates among blacks, a birth cohort analysis indicates that mortality rates among black men born after 1900 have decreased. In this report, epidemiologic and experimental evidence supporting each of three etiologic hypotheses--industrial exposure to cadmium, sexual transmission by an infectious agent, and endocrine factors--are reviewed. Evidence from descriptive data in Los Angeles suggests that only a small portion of cases might be attributable to industrial exposures. In a cohort study of Catholic priests, we found no deficit of prostate cancer mortality, strong evidence against sexual transmission of the disease. Experimental evidence and a limited amount of human data support an endocrine hypothesis. Preliminary results of a case-control study of prostate cancer are presented, but these results are unable to distinguish among these hypotheses further. This study finds a substantial protective effect of vasectomy, an event that is accompanied by reduced prostatic function and size, but this result is thus far statistically insignificant.

Ross, R.K.; Paganini-Hill, A.; Henderson, B.E.



Sperm survival versus degradation in the Mammalian epididymis: a hypothesis.  


A long-standing problem in epididymal physiology is the fate of unejaculated spermatozoa in the cauda epididymidis under conditions such as congenital absence of the vas deferens, long-term vasectomy, or castration. There is no convincing evidence for significant absorption of spermatozoa, defective or otherwise, by spermiophagy or dissolution in the epididymis of normal animals. Spermiophagy by epithelial cells or intraluminal macrophages may take place if the duct ruptures and granulomas form (e.g., after experimental ligation), although there is no quantitative information on the rate of sperm removal by this means. In one animal model (the rabbit), the epididymis is unusually resistant to granuloma formation and has provided unique insights into a phenomenon that is suggested to be present in all species. Spermatozoa retained in the rabbit cauda epididymidis by placing ligatures on the vas deferens and corpus epididymidis degenerate after several weeks but do not decrease significantly in numbers. After castration, however, they die very rapidly and >90% disappear. It is hypothesized that, in the normal androgen-maintained epididymis, degradative pathways are present in the luminal fluid that are constitutively inhibited by survival signals emanating from the epithelium. In the absence of androgen, the intraluminal mileau changes and death signals predominate that activate degradative pathways via the ubiquitin-proteasome system, DNAses, etc., to mediate dissolution of sperm organelles and nucleoprotein. It is suggested that the latter condition is the default situation and is only prevented by the stimulatory action of androgens on the epididymal epithelium. PMID:15215193

Jones, Roy



Robotic-assisted laparoscopic surgery: recent advances in urology.  


The aim of the present review is to summarize recent developments in the field of urologic robotic surgery. A nonsystematic literature review was performed to retrieve publications related to robotic surgery in urology and evidence-based critical analysis was conducted by focusing on the literature of the past 5 years. The use of the da Vinci Surgical System, a robotic surgical system, has been implemented for the entire spectrum of extirpative and reconstructive laparoscopic kidney procedures. The robotic approach can be applied for a range of adrenal indications as well as for ureteral diseases, including benign and malignant conditions affecting the proximal, mid, and distal ureter. Current evidence suggests that robotic prostatectomy is associated with less blood loss compared with the open surgery. Besides prostate cancer, robotics has been used for simple prostatectomy in patients with symptomatic benign prostatic hyperplasia. Recent studies suggest that minimally invasive radical cystectomy provides encouraging oncologic outcomes mirroring those reported for open surgery. In recent years, the evolution of robotic surgery has enabled urologic surgeons to perform urinary diversions intracorporeally. Robotic vasectomy reversal and several other robotic andrological applications are being explored. In summary, robotic-assisted surgery is an emerging and safe technology for most urologic operations. The acceptance of robotic prostatectomy during the past decade has paved the way for urologists to explore the entire spectrum of extirpative and reconstructive urologic procedures. Cost remains a significant issue that could be solved by wider dissemination of the technology. PMID:24993800

Autorino, Riccardo; Zargar, Homayoun; Kaouk, Jihad H



[Voluntary surgical sterilization in Greater Metropolitan Campinas, São Paulo State, Brazil, before and after legal regulation of the procedure].  


This cross-sectional study compared the provision of surgical sterilization in public health services in Greater Metropolitan Campinas, São Paulo State, Brazil, and the characteristics of women and men who underwent sterilization before and after its legal regulation. Structured and pre-tested questionnaires were applied to 398 women, 15 directors of municipal family planning programs, and 15 coordinators of basic health units. Eight municipalities in Greater Metropolitan Campinas provided tubal ligation and nine performed vasectomy. Approximately half reported following the guidelines of the prevailing family planning legislation. There were no significant differences before or after legal regulation in terms of the characteristics of women and men sterilized or the waiting time for surgery. Most tubal ligations were still performed in combination with cesarean sections (the additional payment for sterilization had decreased, but the difference was not significant). There is strong evidence that in Greater Metropolitan Campinas the changes expected from legal regulation of surgical sterilization did not materialize. Although progress has been made, several distortions still need to be corrected. PMID:18157333

Carvalho, Luiz Eduardo Campos de; Osis, Maria José Duarte; Cecatti, José Guilherme; Bento, Silvana Ferreira; Manfrinati, Márcia B



Use of analgesic drugs for pain management in sheep.  


Awareness of pain and its effects is increasing within the veterinary profession, but pain management in food animals has been neglected. Sheep seldom receive analgesics despite various conditions, husbandry practice and experimental procedures being known to be painful, e.g. footrot, mastitis, vaginal prolapse, castration, vasectomy, penis deviation, and laparoscopy. The evidence supporting use of analgesic drugs in this species is reviewed here. Opioid agonists are of dubious efficacy and are short acting. ??-agonists such as xylazine are good, short-lived analgesics, but induce hypoxaemia. Non-steroidal anti-inflammatory drugs (NSAID) such as ketoprofen provide long-lasting analgesia, but not as marked as that from ??-agonists; they should be more widely used for inflammatory pain. Local anaesthetics reliably block pain signals, but may also induce motor blockade. Balanced analgesia using more than one class of drug, such as an ?? agonist (e.g. medetomidine) and N-methyl-D-aspartate antagonist (e.g. ketamine), with the combination selected for the circumstances, probably provides the best analgesia for severe pain. It should be noted that there are no approved analgesic drugs for use in sheep and therefore the use of such drugs in this species has to be off-label. This information may be useful to veterinary practitioners, biomedical researchers, and regulators in animal welfare to develop rational analgesic regimens which ultimately may improve the health and welfare of sheep in both farming and experimental conditions. PMID:22352925

Lizarraga, I; Chambers, J P



Male contraception: another Holy Grail.  


The idea that men should participate in family planning by playing an active role in contraception has become more acceptable in recent years. Up to the present the condom and vasectomy have been the main methods of male contraception. There have been and continue to be efforts to develop an acceptable hormonal contraceptive involving testosterone (T) suppression. However the off target affects, delivery of the analogs and the need for T replacement have proven difficult obstacles to this technology. Research into the development of non-hormonal contraception for men is progressing in several laboratories and this will be the subject of the present review. A number of promising targets for the male pill are being investigated. These involve disruption of spermatogenesis by compromising the integrity of the germinal epithelium, interfering with sperm production at the level of meiosis, attacking specific sperm proteins to disrupt fertilizing ability, or interfering with the assembly of seminal fluid components required by ejaculated sperm for acquisition of motility. Blocking contractility of the vas deferens smooth muscle vasculature to prevent ejaculation is a unique approach that prevents sperm from reaching the egg. We shall note the lack of interest by big pharma with most of the support for male contraception provided by the NIH. PMID:24368213

Murdoch, Fern E; Goldberg, Erwin



[Guizhou officials punished for birth control failures].  


More than 100 party and municipal officials in a Guizhou Province city underwent castration to take the blame for their laxity in enforcing birth control. According to the Guizhou Daily dated June 22 reaching here Wednesday, party officials at Zhijin City who were supposed to see that couples were not to have more than 1 child failed to enforce this limit and consequently the rate of natural population increase in the area had become the highest in the province. When the provincial government criticized the officials, they hastily conducted self-criticism and more than 100 of them underwent vasectomy or tubal ligation in May, the paper said. The mass sterilization prompted more than 1700 married people to undergo similar surgery in a span of only 40 days, according to the Guizhou Daily. The strict birth control measures enforced by the Chinese Government have caused some resentment among the farmers. Recently, a group of farmers attacked a party official who tried to force a pregnant woman to undergo abortion, seriously injuring him. A man divorced his wife because she chose abortion against his wish. PMID:12338074



The economic value of contraception: a comparison of 15 methods.  

PubMed Central

OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Images FIGURE 1 FIGURE 2 PMID:7702112

Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S



Strengthening Primary Level Health Service Delivery: Lessons from a State in India  

PubMed Central

The main aim of the study was to assess primary health centers (PHCs) in terms of availability of assured services, facility of primary management of selected cases, surgeries, maternal and newborn health care services, and child health care services with respect to Indian Public Health Standards (IPHS). Data were collected from service providers (medical officerin-charge) at PHCs through well-structured questionnaire developed by referring the IPHS for PHCs prescribed by the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. The study was conducted at five districts (i.e. Bundi, SawaiMadhopur, Kota, Tonk, and Karauli) of Rajasthan state of India. All 148 PHCs of these five districts were included in the study. Findings depict that more than 90% of the study PHCs showed availability of services such as outpatient department (OPD), antenatal check up (ANC), postnatal check up (PNC), management of reproductive tract infections/sexual transmitted infection (RTI/STI), immunization, and treatment of diarrhea. However, services such as emergency services (24 h), primary management of fractures, surgery of cataract, medical termination of pregnancy (MTP) services, management of low-birth-weight babies, facility for tubectomy and vasectomy, and facility for internal examination for gynecological conditions were poor at PHCs of the study districts, which need to be addressed for further strengthening of primary health centers. PMID:24479021

Sodani, Prahlad Rai; Sharma, Kalpa



Male contraception.  


To share contraceptive measures between partners is a goal which should be reached in the future. The possibilities on the male side are still limited in comparison with the techniques available for women. During the last 20 years many efforts have been undertaken to study and evaluate possible methods for fertility control in the male, based on interaction with the hormonal axis, sperm maturation and sperm transport. The requirements for such a method in the male are the same as in female: high efficacy, little or almost no side-effects, high practicability and compliance and the possibility for easy reversibility in a high percentage of men. Despite their increasing acceptability worldwide, the existing male methods, condom and vasectomy, do not fully meet these requirements and therefore a search for alternative male methods is warranted. At present, the following medical approaches to male fertility control have been tested or are under consideration: (i) selective inhibition of FSH: antibodies, inhibin; (ii) inhibition of pituitary-gonadal axis: steroids such as testosterone, progestin-testosterone combinations, LHRH analogues with and without testosterone substitution; and (iii) selective inhibition of spermatogenesis by gossypol, a phenolic compound from cotton plant. Whether one of these methods will reach the desired goal for male fertility control has yet to be determined. PMID:3281961

Frick, J; Aulitzky, W



Factors predicting overall success: a review of 747 microsurgical vasovasostomies  

PubMed Central

Objectives Advances in surgical techniques have improved the outcome of microsurgical vasovasostomy (VV). We performed a retrospective analysis of surgical procedures to determine outcomes and predictors of VV success, to develop Kaplan–Meier Curves for predicting VV outcomes and to evaluate the use of ?-glucosidase (AG) to predict outcomes. Patients and Methods We undertook a retrospective analysis of 747 modified 1-layer microsurgical VV procedures performed between 1984 and 2000. Obstructive interval, partner status, social status preoperatively and method of vasal obstruction, vasal fluid quality and sperm granuloma intraoperatively were compared with outcome results. Parameters evaluated at follow-up included semen analysis, AG concentration in ejaculate fluid and pregnancy rates. Results The overall patency rate was 86% and pregnancy rates were 33% and 53% at 1 and 2 years after primary VV, respectively. Preoperative factors associated with successful outcome and pregnancy included shorter obstructive interval and same female partner (p < 0.05). Intraoperative factors predicting success included the use of surgical clips instead of suture at vasectomy, the presence of a sperm granuloma, the presence and quality of vasal fluid, and the presence and quality of sperm in vasal fluid. Further, increased AG in the postoperative semen predicted improved patency and pregnancy outcomes. Conclusion This study confirms the effectiveness of VV for vasectomized men who wish to father children. It also demonstrates that preoperative and intraoperative factors are predictive of the VV outcome. Postoperative AG is also a useful marker of patency and it appears to predict pregnancy outcome. PMID:18542824

Bolduc, Stéphane; Fischer, Marc Anthony; Deceuninck, Genevieve; Thabet, Michel



Racial variation in tubal sterilization rates: The role of patient-level factors  

PubMed Central

Objective To assess racial differences in attitudes and knowledge about sterilization. Design Cross-sectional survey Setting Questionnaires were mailed to participants’ home addresses Patients 193 women aged 18–45 who had undergone tubal sterilization. Intervention(s) None Main Outcome Measure Attitudes and knowledge about tubal sterilization and awareness of contraceptive alternatives Results We received 193 completed surveys (64% response rate). AA woman were more likely to have a family member who had undergone tubal sterilization, to report that their mothers influenced their sterilization decisions, and to report that prior unintended pregnancy and desire to avoid insertion of a foreign object were very important factors in their decision to choose sterilization over other methods. Compared to white women, AA women more often thought that sterilization reversal could easily restore fertility (62 % vs 36%); that a woman’s sterilization would reverse itself after 5 years (60% vs 23%); and that a man cannot ejaculate after vasectomy (38% vs 13%). Fewer AA women had ever heard of intrauterine contraception (90% vs 98%). Racial differences in knowledge remained statistically significant after adjusting for socioeconomic confounders. Conclusions Misinformation about sterilization and limited awareness of contraceptive alternatives among AA women may contribute to racial disparities in tubal sterilization rates. PMID:20579640

Borrero, Sonya; Abebe, Kaleab; Dehlendorf, Christine; Schwarz, Eleanor Bimla; Creinin, Mitchell D.; Nikolajski, Cara; Ibrahim, Said



Anesthesia of male axis deer (Axis axis): evaluation of thiafentanil, medetomidine, and ketamine versus medetomidine and ketamine.  


Thiafentanil oxalate, previously known as A-3080, is a synthetic opioid used for chemical immobilization of a variety of nondomestic hoofstock species. This study compared the combination of thiafentanil oxalate, medetomidine, and ketamine (TMK; 0.09 +/- 0.02 mg/kg, 0.01 +/- 0.003 mg/kg, and 1.36 +/- 0.33 mg/kg, respectively) with the combination of medetomidine and ketamine (MK; 0.09 +/- 0.02 mg/kg and 3.48 +/- 0.55 mg/kg, respectively) for anesthetization of 17 captive male axis deer (Axis axis) for vasectomy. Nine deer received TMK and eight deer received MK via projectile syringe during the months of January and February, 2005. Mean induction and arousal times, vital signs, and arterial blood gas values were monitored and compared. All animals received supplemental oxygen during the surgical procedure. Animals receiving TMK were reversed with naltrexone (100 mg/mg thiafentanil) and atipamazole (5 mg/mg medetomidine). Animals receiving MK were reversed with atipamazole (5 mg/mg medetomidine). Two MK animals and three TMK animals required supplementation with ketamine i.v. immediately upon handling. Six of the nine animals immobilized with TMK required intubation for positive-pressure ventilation. Two of these six animals also required isoflurane to maintain anesthesia. Mean induction time was 3.5 +/- 2.0 min in the TMK group, and 9.8 +/- 6.7 min in the MK group. Despite shorter mean induction times, animals anesthetized with TMK experienced unpredictable inductions, apnea, muscle rigidity, limb movement, and significant respiratory and metabolic lactic acidosis. MK resulted in smoother inductions, better respiratory function, and less adverse metabolic disturbances, and thus was considered superior to TMK for anesthesia in captive axis deer at the dosages tested. PMID:17315436

Smith, Kristine M; Powell, David M; James, Stephanie B; Calle, Paul P; Moore, Robert P; Zurawka, Heidi S; Goscilo, Sabrina; Raphael, Bonnie L



Observing principles of medical ethics during family planning services at Tehran urban healthcare centers in 2007  

PubMed Central

Background: Family planning has been defined in the framework of mothers and children plan as one of Primary Healthcare (PHC) details. Besides quantity, the quality of services, particularly in terms of ethics, such as observing individuals’ privacy, is of great importance in offering family planning services. Objective: A preliminary study to gather information about the degree of medical ethics offered during family planning services at Tehran urban healthcare centers. Materials and Methods: A questionnaire was designed for study. In the first question regarding informed consent, 47 clients who were advised about various contraception methods were asked whether advantages and disadvantages of the contraceptive methods have been discussed by the service provider. Then a certain rank was measured for either client or method in 2007. Finally, average value of advantage and disadvantage for each method was measured. In questions about autonomy, justice and beneficence, yes/no answers have been expected and measured accordingly. Results: Health care providers have stressed more on the advantages of pills and disadvantages of tubectomy and have paid less attention to advantages of injection ampoules and disadvantages of pills in first time clients. While they have stressed more on the advantages and disadvantages of tubectomy and less attention to advantages of condom and disadvantages of vasectomy in second time clients. Clients divulged their 100% satisfaction in terms of observing turns and free charges services. Observance degree of autonomy was 64.7% and 77.3% for first time and second- time clients respectively. Conclusion: Applying the consultant’s personal viewpoint for selecting a method will breach an informed consent for first and second time clients. System has good consideration to justice and no malfeasance.

Motevallizadeh, Saeed; Malek Afzali, Hossein; Larijani, Bagher



General practitioner notes as a source of information for case-control studies in young women. UK National Case-Control Study Group.  

PubMed Central

STUDY OBJECTIVE--The UK National Case-Control Study was carried out to investigate the relationship between oral contraceptive use and breast cancer risk. This study investigates whether general practitioner notes could be used as the sole data source for epidemiological studies of young women and what the effect would be on non-response and recall bias. DESIGN--Case-control study with data on gynaecological, obstetric, and contraceptive history collected at interview and from general practitioners' notes. Information from these two sources was compared. SETTING--This was a population-based study. PARTICIPANTS--Altogether 755 women with breast cancer aged under 36 years at diagnosis, each with an age-matched control, participated in the study. Response rates at interview were 72% and 89% for cases and controls but GP data were available for 90% of the 1049 case and first-selected control pairs. MAIN RESULTS--There was generally good agreement between the two data sources with respect to obstetric history and gynaecological procedures (hysterectomy, oophorectomy, and tubal ligation). The use of intra-uterine devices, or diaphragm, and partner's vasectomy were not reliably recorded in the GP's notes. The overall results of the UK study would have been qualitatively the same with respect to the relationship between oral contraceptive use and breast cancer risk if GP notes only had been used, in spite of the fact that only about half of all oral contraceptive usage was recorded in the notes. Response rates would have been higher, recall bias eliminated, and the cost of the study halved. CONCLUSIONS--When planning case-control studies in young women, the possibility of using GP notes as the primary data source should be considered. Lack of data on potential confounding factors is a possible drawback to such use. The practice of destroying GP's notes shortly after the death of patients seriously restricts the possibility of using these notes when studying rapidly fatal conditions. PMID:8138777

Chilvers, C E; Pike, M C; Taylor, C N; Hermon, C; Crossley, B; Smith, S J



Testicular obstruction: clinicopathological studies.  

PubMed Central

Genital tract reconstruction has been attempted in subfertile men with obstructive azoospermia (370 patients) or unilateral testicular obstruction (80 patients), and in vasectomised men undergoing reversal for the first (130 patients) or subsequent (32 patients) time. Histopathological changes in the obstructed testes and epididymes, and immunological responses to the sequestered spermatozoa have been studied to gain insight into possible causes of failure of surgical treatment. The results of surgery have been assessed by follow-up sperm counts and occurrence of pregnancies in the female partners. The best results were obtained with vasectomy reversal (patency 90%, pregnancy 45%), even after failed previous attempts (patency 87%, pregnancy 37%). Epididymovasostomy gave good results with postinfective caudal blocks (patency 52%, pregnancy 38%), while postinfective vasal blocks were better corrected by total anatomical reconstruction (patency 73%, pregnancy 27%) than by transvasovasostomy (patency 9%, no pregnancies). Poor results were obtained with capital blocks (patency 12%, pregnancy 3%), in which substantial lipid accumulation was demonstrated in the ductuli efferentes; three-quarters of these patients had sinusitis, bronchitis or bronchiectasis (Young's syndrome). There is circumstantial evidence to suggest that this syndrome may be a late complication of mercury intoxication in childhood. After successful reconstruction, fertility was relatively reduced in those men who had antibodies to spermatozoa, particularly amongst the postinfective cases. Similarly, impaired fertility was found in men with unilateral testicular obstruction and antibodies to spermatozoa. Mononuclear cell infiltration of seminiferous tubules and rete testis was noted occasionally, supporting a diagnosis of autoimmune orchitis; although rare, this was an important observation as the sperm output became normal with adjuvant prednisolone therapy. Images Figure 4 Figure 6 Figure 7 Figure 10 Figure 11 Figure 12 Figure 14 PMID:2241062

Hendry, W. F.; Levison, D. A.; Parkinson, M. C.; Parslow, J. M.; Royle, M. G.



Reduced recombination associated with the production of aneuploid sperm in an infertile man: a case report.  


Studies using gene-linkage analysis have suggested that abnormal recombination during meiosis may lead to the production of aneuploid gametes; however, there is little direct evidence of a link between the two in human males. We analysed spermatocytes in the pachytene stage from a man with extremely high aneuploidy rates in his sperm. Testicular tissue specimens of the infertile man and two vasectomy reversals were processed with immuofluorescent techniques to visualize synaptonemal complex and recombination foci and fluorescent in situ hybridization on spermatocytes and sperm with probes for chromosomes 13, 21, 18, X and Y. We observed no recombination between sex chromosomes in the infertile man, while in two controls, we observed recombination rates of 79.3 and 81.0% between the sex chromosomes. This was associated with a total sex aneuploidy rate of 41.61% in testicular sperm of the infertile man (0.44 and 0.62% in two controls). Recombination on chromosome 21 was reduced in the infertile man, with 10.62% of spermatocytes showing no recombination (0 and 1.67% in two controls), as well as chromosome 13, with 53.98% having < or =1 recombination foci (22.05 and 21.67% in two controls). This was associated with increased aneuploidy for those chromosomes. Chromosome 18 aneuploidy was slightly increased, although there was no apparent decrease in recombination. These results provide the first evidence of both recombination and non-disjunction abnormalities in the same individual. This is also the only reported case of an infertile man who shows no recombination between the sex chromosomes, despite the formation of the sex body. PMID:16373411

Ma, S; Ferguson, K A; Arsovska, S; Moens, P; Chow, V



Hormonal contraception in men.  


All major advances in the development of hormonal methods of contraception over the past 40 years have been exclusively female orientated with male hormonal contraception forever "just around the corner". Despite this, the last few years have seen a significant increase in the pace of research and increased involvement from the pharmaceutical industry. This is essential if the progress derived from the public sector is to be translated into a real product for widespread use. Current male methods of contraception, condoms and vasectomy, are relied on by 30% of couples throughout the world but there have been no new male contraceptive methods introduced in the last century. There is currently an increasing emphasis on male involvement in family planning, and evidence both that some men would be keen to shoulder this responsibility and that their partners would trust them to do so. There are several potential novel approaches to male contraception, but the hormonal one is the only one at the stage of clinical research. This method is based on the normal regulation of spermatogenesis by the pituitary gonadotrophins: suppression of gonadotrophin secretion results in a reduction in the rate of spermatogenesis, and azoospermia, the absence of sperm from the ejaculate, can be achieved. Current approaches are now getting close to the ideal of inducing azoospermia in all men. This approach also results in suppression of testicular testosterone production, thus androgen 'add-back' is an essential component of a contraceptive regime. Many different steroids and delivery methods -oral, buccal, transdermal, subcutaneous implants- are under exploration at present, each with their own advantages and drawbacks. The use of synthetic androgens is also starting to be explored: these have the potential advantage of offering tissue-specific actions. PMID:16178786

Walton, Melanie; Anderson, Richard A



Seminal Factor VIII and von Willebrand Factor: a possible role of the conventional clotting system in human semen?  


Factor (F) VIII circulates in blood complexed with von Willebrand Factor (vWF). Deficiency or defect accounts for haemophilia A and vWF disease. In blood, FVIII functions as a co-factor for FIXa in the activation of FX. Human semen coagulates and liquefies in a process that resembles and has some links with the conventional haemostatic process. A study elsewhere has detected traces, but not measurable levels, of FVIII coagulant activity (FVIII:C). In the present study we have assessed FVIII antigen (FVIII:Ag), FVIII:C and vWF antigen (vWF:Ag) levels in 159 semen specimens obtained from sub-fertile (n = 21), normally fertile (n = 38), fertile donors (n = 32), and vasectomized men (n = 57). Seminal FVIII:Ag levels were also measured in a group defined by several parameters derived from the World Health Organization (WHO) fertility criteria, termed "pooled normal semen parameters" (PNSP). Factor VIII:Ag levels were compared with conventional fertility parameters. In addition, both FVIII:C and vWF:Ag were assessed in a separate group of normal individuals (n = 11). Factor VIII:Ag, FVIII:C and vWF were present and quantifiable in human semen. Factor VIII:Ag levels were significantly lower in vasectomy subjects compared with donors (p = 0.01) or PNSP group (p = 0.01). Several trends taken together suggest an associations between FVIII:Ag and semen quality. Parallel investigations demonstrate FV, FVII, FVIIa, FIX, FIXa, FXa, FXI, FXII, tissue factor (TF) and tissue factor pathway inhibitor (TFPI) in semen. The present report therefore provides further evidence for the presence of a functioning clotting system in human semen. PMID:15679619

Lwaleed, Bashir A; Greenfield, Robert; Royle, Eric; Birch, Brian; Cooper, Alan J



Early microrecanalization of vas deferens following biodegradable graft implantation in bilaterally vasectomized rats.  


We evaluated a biodegradable graft for reconstruction of rat vasa deferentia with long obstructed or missing segments. A total of 47 Sprague-Dawley rats underwent bilateral vasectomy and were divided into groups according to length of the vas deferens affected (0.5, 1, 1.5 cm). After 8 weeks, poly-(D,L-lactide) (PDLA) grafts were used to reconnect the vas deferens. Grafts and adjoining vasa deferentia were excised 8 and 12 weeks later and evaluated microscopically. At 8 weeks, microscopic changes included a robust inflammatory response around the grafts. All grafts were still intact but in the early stages of degradation. No microtubules, indicative of vas deferens recanalization, were identified. One specimen showed evidence of healing and neovascularization at the interface zone between the vas deferens and the graft. At 12 weeks, grafts were further degraded but still present. Microscopic evaluation showed decreased inflammation. Seven specimens showed neovascularization at the interface zone; two of these showed distinct epithelialized vas deferens microcanals at the graft edges. One specimen showed a microcanal spanning the entire 0.5-cm graft. A time period of 8 weeks is not ample enough for vas deferens regeneration in the setting of a biodegradable PDLA graft; however, early evidence of re-growth was seen at 12 weeks. A longer healing time should permit further biodegradation of the graft, as well as re-growth and possible eventual reconnection of the vas deferens, allowing passage of sperm. These findings suggest a potential role for biodegradable grafts in the reconstruction of vas deferens with long obstructed segments. PMID:19349949

Simons, Christopher M; De Young, Barry R; Griffith, Thomas S; Ratliff, Timothy L; Jones, Erin; Mallapragada, Surya K; Wald, Moshe



Prevention of anaphylactic reactions to anaesthetic drugs.  


Although screening tests to prevent anaphylaxis during anaesthesia have been advocated, such tests are unlikely to have significant impact on reducing the incidence of anaphylaxis during anaesthesia. This is due to the low prevalence of the disease, the diversity of drugs used in anaesthesia and the incidence of false positive and negative tests. The suggested risk factors of allergy, i.e. atopy, asthma, family history, female sex, previous exposure, vasectomy, use of zinc protamine sulfate insulin and allergy to cosmetics, eggs, fish and non-anaesthetic drugs are not valid. Although all have theoretical or real associations with anaphylaxis during anaesthesia the majority of patients with such a history undergo uneventful anaesthesia. Fruit allergy, anaphylaxis to cephalosporins and penicillin, barbiturate allergy, gelatin allergy and allergy to metabisulphite and eggs require consideration in avoiding particular drugs. The incidence of anaesthetic anaphylaxis can be reduced by avoiding latex exposure in patients with spina bifida or latex allergy, and preventing second reactions in patients with a history of anaphylaxis, or major undiagnosed or undocumented adverse events during anaesthesia. Determining the cause of an adverse event and the drug responsible, and adequately communicating those findings can reduce second reactions. Avoiding neuromuscular blocking drugs (NMBDs) in patients who have reacted to an NMBD, and use of non-intravenous techniques should also reduce the incidence of second reactions. Desensitisation, and blocking with monovalent quaternary ammonium compounds may allow improved safety of NMBDs and pretreatment with antihistamines and corticosteroids may block or ameliorate the severity of reactions, but there is currently little evidence to support their routine use. PMID:15144233

Fisher, Malcolm M; Doig, Gordon S



Subcompartmentalization of HIV-1 quasispecies between seminal cells and seminal plasma indicates their origin in distinct genital tissues.  


The mononuclear cells and plasma components of semen from HIV-infected subjects have been shown to contain HIV-1. However, there is very little information as to whether distinct HIV-1 population are present in these two seminal compartments or as to their tissue of origin. Phylogenetic analysis of nucleotide sequences of the C2-V5 region of the HIV-1 gp120 from HIV-1 RNA isolated from seminal cells and seminal plasma of five subjects indicates that the HIV-1 population derived from seminal plasma was distinct from that present in seminal cells. Such subcompartmentalization of HIV-1 between seminal cells and seminal plasma was detected as early as 3 months after seroconversion and persisted up to 38 months following seroconversion. Furthermore, comparison of HIV-1 sequences between testis and prostate tissues showed distinct HIV-1 populations in these tissue compartments. In situ real-time (Taqman) PCR analysis of prostate and testis tissues indicated that T lymphocytes were the predominant cells infected with HIV-1 in both of these tissues. Since seminal plasma is derived from prostate and most of the seminal cells originate from the rete testis and epididymis, these results are consistent with the idea that HIV-1 in seminal plasma is derived from the prostate, while HIV-1-infected cells in semen originate mostly from the rete testis and epididymis. These findings provide for the first time evidence of subcompartmentalization of HIV-1 in male genital organs and suggest that intervention strategies such as vasectomy may not prevent sexual transmission. PMID:12487815

Paranjpe, Shirish; Craigo, Jodi; Patterson, Bruce; Ding, Ming; Barroso, Paulo; Harrison, Lee; Montelaro, Ronald; Gupta, Phalguni



Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda  

PubMed Central

Background Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives. Methods A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti. Results Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation. Conclusion Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services. PMID:24597502



Advances in Male Contraception  

PubMed Central

Despite significant advances in contraceptive options for women over the last 50 yr, world population continues to grow rapidly. Scientists and activists alike point to the devastating environmental impacts that population pressures have caused, including global warming from the developed world and hunger and disease in less developed areas. Moreover, almost half of all pregnancies are still unwanted or unplanned. Clearly, there is a need for expanded, reversible, contraceptive options. Multicultural surveys demonstrate the willingness of men to participate in contraception and their female partners to trust them to do so. Notwithstanding their paucity of options, male methods including vasectomy and condoms account for almost one third of contraceptive use in the United States and other countries. Recent international clinical research efforts have demonstrated high efficacy rates (90–95%) for hormonally based male contraceptives. Current barriers to expanded use include limited delivery methods and perceived regulatory obstacles, which stymie introduction to the marketplace. However, advances in oral and injectable androgen delivery are cause for optimism that these hurdles may be overcome. Nonhormonal methods, such as compounds that target sperm motility, are attractive in their theoretical promise of specificity for the reproductive tract. Gene and protein array technologies continue to identify potential targets for this approach. Such nonhormonal agents will likely reach clinical trials in the near future. Great strides have been made in understanding male reproductive physiology; the combined efforts of scientists, clinicians, industry and governmental funding agencies could make an effective, reversible, male contraceptive an option for family planning over the next decade. PMID:18436704

Page, Stephanie T.; Amory, John K.; Bremner, William J.



A recipe for success: ingredients for a successful family planning program.  


The basic elements of a successful family planning (FP) program are variable between countries. Providing better access to modern contraceptives, access to general and reproductive health care, and increasing economic and educational opportunities contribute to reducing fertility rates. Effective distribution is constrained by rural, isolated populations and cultural attitudes. Indonesia has used floating clinics located on boats to reach inaccessible areas; Norplant and hormonal injection availability also contribute to the 53% contraceptive prevalence rate. The Japanese Organization for International Cooperation in Family Planning has shipped bicycles to developing countries. The result has been improved status among peers and greater program success. Contraceptive social marketing programs (CSM) have been successful in some countries to distribute contraceptives through local channels such as shops and stalls; people seem willing to pay also. CSM has been successful in Egypt in increasing condom sales. IUD use increased from 11% to 42% between 1975-88 with CSM. Multimedia promotion that is carefully researched and targeted is another way to increase contraceptive prevalence (CP) rates. A Brazilian multimedia vasectomy campaign led to an 80% monthly increase in Pro-Pater male health clinics. 240,000 women in Turkey were encouraged through multimedia efforts to switch to modern methods. In Zimbabwe, men have been the target of efforts to educate them about the advantages of small families. Women are recruited to implement FP services in INdia and in poor neighborhoods; an increase from 12% to 61% was achieved. Highly motivated workers with a respect for the community's values is essential to any successful FP program as is government support. China's policy has drawn criticism; China has welcomed a UN program which provides financial motivation. Thailand has been successful due to the commitment between public and private sectors; in 17 years CP rose from 10% to 68%. Family life education is prevalent; female literacy is high at 96%. PMID:12317713

Merrill, J



Variation in postpartum contraceptive method use: Results from the Pregnancy Risk Assessment Monitoring System (PRAMS)  

PubMed Central

Objective The National Survey of Family Growth has been a primary data source for trends in US women’s contraceptive use. However, national-level data may mask differences in contraceptive practice resulting from variation in local policies and norms. Study Design We used the Pregnancy Risk Assessment Monitoring System), a survey of women who are 2–4 months postpartum. Information on women’s current method was available for 18 reporting areas from 2000–2009. Using the two most recent years of data, we computed the weighted proportion of women using specific contraceptive methods according to payment for delivery (Medicaid or private insurance) and examined differences across states. We used log binomial regression to assess trends in method use in 8 areas with consecutive years of data. Results Across states, there was a wide range of use of female sterilization (7.0–22.6%) and long-acting reversible contraception (LARC; 1.9–25.5%). Other methods, like vasectomy and the patch/ring, had a narrower range of use. Women with Medicaid-paid deliveries were more likely to report female sterilization, LARC and injectables as their method compared to women with private insurance. LARC use increased ?18% per year, while use of injectables and oral contraceptives declined by 2.5%–10.6% annually. Conclusions The correlation in method-specific prevalence within states suggests shared social and medical norms, while the larger variation across states may reflect both differences in norms and access to contraception for low-income women. Surveys of postpartum women, who are beginning a new segment of contraceptive use, may better capture emerging trends in US contraceptive method mix. Implications There is considerable variation in contraceptive method use across states, which may result from differences in state policies and funding for family planning services, local medical norms surrounding contraceptive practice, and women’s and couples’ demand or preference for different methods. PMID:24237967

White, Kari; Potter, Joseph E.; Hopkins, Kristine; Grossman, Daniel



The enter-educate approach.  


This article describes how the Population Communication Services (PCS) has seized on the "enter-educate" approach, the blending of popular entertainment with social messages, to change reproductive health behavior. The enter-educate approach spreads its message through songs, soap operas, variety shows, and other types of popular entertainment mediums. Because they entertain, enter-educate projects can capture the attention of an audience -- such as young people -- who would otherwise scorn social messages. And the use of population mediums makes it possible to reach a variety of audiences. Funded by USAID, PCS began its first enter-educate project in response to the increasing number of teenage pregnancies in Latin America. PCS developed 2 songs and videos, which featured popular teenage singers to serve as role models, to urge abstinence. The songs became instant hits. Since then, PCS has mounted more then 80 major projects in some 40 countries. Highlights of programs range from a successful multi-media family planning campaign in Turkey to humorous television ads in Brazil promoting vasectomy. Recently, PCS initiated projects to teach AIDS awareness. At the core of the enter-educate approach is the social learning theory which holds that much behavior is learned through the observation of role-models. Health professionals work alongside entertainers to produce works that have audience appeal and factual social messages. The enter-educate approach works because it is popular, pervasive, personal, persuasive, and profitable. PCS has found that enter-educate programs pay for themselves through cost sharing and cost recovery. PMID:12284960

Piotrow, P T; Coleman, P L



As it is in heaven? John Paul II listened to God and misunderstood the message.  


This articles focuses on John Paul II's 1993 Veritatis Splendor, an 1798 page encyclical letter to the Church's bishops on the crisis in the Catholic Church of family limitation and the implications for the laity and society. The communication states that a flexible interpretation of theology must be abandoned. Paul VI's 19963 Humanae Vitae is reportedly affirmed. John XXIII's spiritualism and concern with conscience is ignored. This encyclical is identified as not spoken "ex cathedra" or from the throne, which would have made the pronouncement true, unarguable forever, and subject to excommunication for those disobeying. Pope John Paul II is said to be preparing another encyclical on life issues and sexuality. Reference is made in this encyclical to devices that are acceptable to use to gauge a safe period for copulation without impregnation. The devices include the rectal thermometer and the calculator for determining the infertile days in the natural cycle. Veritatis Splendor's position on fertility is viewed as an issue of loyalty to the Church and not as an honest evaluation of the moral implications of artificial birth control. This encyclical comes closer to "ex cathedra" than the Humanae Vitae, which banned the birth control pill, IUD, spermicides, hormonal implants, vasectomies, and tubal ligation. Liberal Catholic theologians are reported to have interpreted Paul VI's statement that "God illuminates from within the hearts of the faithful and invites their assent," as a validation of dissent. Pope John Paul II closes the door to dissent in this proclamation. The Church also closes the door to free will for people to decide for themselves. The Jesuits, with different notions of divine will, are described as potentially concluding that the denial of free will and individual reason for the sake of Papal supremacy must be the work of the devil himself. For good Catholics this encyclical is interpreted as potentially forcing even stronger opposition to the Vatican's teachings and continued adherence to the dictates of their own conscience. A God who gave men and women the power of his reason would not allow the Pope, however infallible, to take this away. Among nonreligious thinkers the Catholic posture is viewed as very wrong on birth control. Divisions within the Church are expected to increase. PMID:12345270



Latest developments in contraception.  


The 10th Annual Symposium on Latest Developments in Contraception, organized by the Biological Science Committee of the Australian Federation of Family Planning Associations, was held in February 1983 and provided an update on the current status of contraceptive technology. In a review of steroidal contraception, it was proposed that the Silastic vaginal ring is the most promising of the fertility control devices not requiring continual involvement of the couple. Product development costs, the length of time required for safety trials have hindered development of the perfect contraceptive device. In a discussion of IUD use, it was reported that there are fewer expulsions and a lower incidence of infection when the device is inserted between the 11th and 17th days of the menstrual cycle. Although it is current practice to reinsert copper IUDs every 2 years, no increase in failure rates has been observed after 5 years of continual use. It is recommended that IUD insertion be delayed until 8 weeks postpartum. Another participant asserted that there is no empirical evidence to justify the use of spermicides with diaphragms. Unknown factors of vaginal physiology and its interaction with sperm must be elucidated before a good barrier method can be introduced. Concern was expressed with the numbers of women seeking reanastomosis of the Fallopian tubes after tubal ligation. Success of reanastomosis depends on the type of initial procedure and the time elapsed. 7% of Australian men have had vasectomies, and the request rate for reversal is 2-3/1000/year. In a review of immunological contraception, it was noted that long-lasting, non-pharmacologically active agents are the most promising substances for future research, but their potential hazards are great. Dr. Evelyn Billings reported that the ovulation method of natural family planning is superior to the basal-body-temperature or rhythm methods since it takes stress-induced fluctuations in ovulation into account. The Symposium concluded that the effectiveness of the Billings method must be proven in follow-up research before it is offered as an alternative to other methods. A report that 40% of Australian teenagers surveyed did not use contraception at last intercourse underscores the need for medical personnel to educate younger patients about contraceptive techniques. PMID:6843444

Gold, J



Vaso-vasostomy using microsurgical techniques. A preliminary report.  


To respond to the many men on the waiting list for surgical recanalization at Ramathibodi Hospital in Bangkok, Thailand, a new service was established as part of the overall family planning service. From October 1978 to June 1979, 16 vasovasostomies were performed using microsurgery. A 2-layered anastomosis with 8-0 Dexon on an opthalmic needle was used for both mucosal and muscularis sutures. A 16X magnification on the microscope was found adequate. After mobilization of the vas through separate scrotal incision, the scar tissues or sperm granuloma, if any, were excised. The cut ends of the vas deferens were examined to determine if the lumens were patent. Hemostatis must be meticulous using a bipolar electrode, and care must be taken not to strip the adventitia of the vas too much for fear of endangering the blood supply. The mucosa could be easily seen under the microscope. A microscopic examination of the sperm fluid was routinely performed. 2 stay sutures were placed diametrically opposite to one another. The special clamps were applied. 3 anterior sutures were inserted first. Appropriate muscularis sutures were inserted only to reinforce the 1st mucosal layer. Of the 16 patients, follow-ups were possible in only 8 cases. There were 2 definite failures (12%). The 1st case in the series that was a failure was because of unfamiliarity with the technique. The 2nd failure was due to severe bilaterial intrascrotal infection with abscess formation. The patients ranged in age from 29-42 years. The duration postvasectomy ranged from 2-15 years. The reasons for requesting reversal were divorce (55%), death of the children (18.7%), wanting more children (13.8%), and psychological (12.5%). Only in 8 patients was it possible to perform sperm analysis after the 1st postoperative months. The ejaculates contained spermatozoa in all cases, excluding the 2 failures. The sperm reappearances occurred as early as 2 weeks postoperatively. The count increased to 20 million/ml at 4 weeks in 1 patient. 1 patient, on whom vasectomy was performed 15 years previously, showed negative smears intraoperatively and poor sperm count postoperatively. The volume of the ejaculates was 3-4 ml. The motility ranged from 40-60%. All patients except 1 had positive smears intraoperatively. Thus far there is no information on the pregnancy rate. In sum, initial results were encouraging. PMID:12265372

Gojaseni, P; Visuthikosol, V



Voices of acceptors. How family planning has touched the lives of five Filipino couples.  


Five Filipino couples present their experience with family planning (FP). Tomasina Campuso relates that her first exposure to FP was in a high school health class. She then received advice from a health center on the rhythm method and became pregnant before her first wedding anniversary. Two months postpartum she returned to the clinic for oral pills, which caused side effects; she switched to an IUD, which had to be fitted twice before a proper fit was achieved. After the second child, she returned to IUD use. Both parents are happy to have spaced and planned their children. One is currently in preschool and the spacing will make it possible for them to send their first child to college; the second child can be helped through college by the first. Joel and Evelyn Gatdula married as teenagers. Evelyn feels that use of FP has made her look younger in spite of having produced 3 children. Their marriage became stronger because of mutual interest in using FP. Evelyn volunteered to use an IUD after her husband volunteered to use condoms. Evelyn, being a Catholic, expressed that greater guild would be felt if she had more children than she could provide or care for. She talks to friends and family about the advantages of contraception. Loida Bilaoen had a very difficult first pregnancy, was confined to her bed, and relied on intravenous fluids. She was happy to use rhythm, and condoms until the second child was born; thereafter she had a ligation, even though she had two boys. The boys attend a private school and she has returned to nursing school. Violeta was one of 13 children. Her first was born after 5 years of marriage and the second came 6 years later. Initially condoms and rhythm were used; currently she is taking oral pills, which are delivered every other month by an outreach worker. There were some initial side effects of weight loss and then a return of her original weight. She felt that without FP they could not have afforded the luxury of owning modern appliances. Gerry and Divine Cruz, after the birth of twins, chose first an IUD and then vasectomy. The decision meant following their conscience rather than Church doctrine. They hope that their girls will achieve their dreams. PMID:12286378

Santos, R P



Worldwide trends in funding for contraceptive research and evaluation.  


In the past 5 years funding has declined in constant dollars for reproductive and contraceptive research and for the evaluation of long-term contraceptive safety; there has been a general increase in coordination and planning among publicly supported programs, as well as between these programs and private industry. There has been no substantial relaxation of regulatory requirements, and little has been done to make contraceptive research and development (R and D) more attractive to industry. The threat of liability suits and the difficulty in obtaining product liability insurance have become more salient than 5 years ago. This is increasingly restricting clinical research into new methods by both private industry and publicly supported research groups. Nonetheless some major advances have been recorded over the same period. The NORPLANT system, the Today contraceptive sponge, the TCu 380A (a copper-bearing IUD), and biphasic and triphasic pills have all become available in at least some developed and developing countries. In addition, several methods are in advanced stages of clinical trial (e.g., injectable contraceptives for 1 and 6 months' duration; an improved implant, a progestin releasing vaginal ring and Gossypol for sperm inhibition). Presented here are the results of a worldwide survey conducted by the Alan Guttmacher Institute (AGI) of funding for reproductive research, contraceptive development and evaluation of the long-term safety of existing methods. Requests for data on expenditures for 1980-1983 were sent by the AGI to funding agencies, R and D organizations and pharmaceutical companies in the US, Australia, Europe, India and Japan, reported to be doing contraceptive research. Detailed information was sought about fundamental research in reproductive biology, training of pre- and postdoctoral reproductive scientistis, applied research in contraceptive technology and evaluation of the safety of currently marketed contraceptives. An estimated US$154.8 million was spent in 1979 for all 3 categories of research; this amount declined by 12% in 1980. By 1983, expenditures in constant dollars were 79% of the 1979 figure. Contraceptive R and D accounted for 41% of the total expenditures during 1980-1983, fundamental for 52% and long-term contraceptive safety evaluation for 7%. The principal methods under investigation during this period were improved oral contraceptives, other ovulation inhibitors, post-ovulatory methods and pregnancy vaccines. Expenditures for contraceptive development are also presented by contributing organization (publicly supported, private industry and mission-oriented research projects). 46% of funds for evaluation of long-term safety of existing methods were spent on evaluation of oral contraceptives and 16% on the long-term risks of vasectomy. Investigations of barrier methods hardly played any part in overall research on safety in 1980 and 1981; but by 1983 these expenditures were 2nd only to those for the pill. Over the 4-year period, 63% of the funds spent on all types of research were for projects involving female reporduction, 18% for male reproduction and 19% for both. PMID:3843535

Atkinson, L E; Lincoln, R; Forrest, J D



[Contraceptive methods].  


This brief article provides a review of the most common contraceptive methods. Contraceptive methods may be classified into primitive, traditional, and modern categories. Among primitive methods, coitus interruptus has a failure rate of 10-38%. It is not recommended by sexologists because of its possible physical and psychic secondary effects. Vaginal irrigation or washing immediately after intercourse are not effective because sperm arrive in the uterus seconds after ejaculation into the vagina. Prolonged lactation is not an effective method because of the impossibility of predicting the return of ovulation. Among traditional methods, the condom and diaphragm are relatively effective but not usually well accepted. Condoms are effective if the material is of high quality and they are properly positioned and removed before detumescence. The failure rate varies from 8-28%. Diaphragms are inserted into the vagina 2-4 hours or immediately before coitus and must remain in place for 6 hours after ejaculation. The correct size is determined by a physician. The proportion of failures is 20% for the diaphragm used alone and 10% when a spermicide is added. Local spermicides have the double objectives of mechanically blocking the cervix and chemically destroying sperm. They should be inserted deep into the vagina immediately before coitus and remain in place for 6 hours. They have a failure rate of 30% when used without other contraceptive methods. They are available in the form of creams, jellies, sprays, vaginal suppositories or tablets, and effervescent pills. Periodic continence methods require total sexual abstinence during the fertile periods of the menstrual cycle. The Ogino-Knaus method is based on a calendar estimation of the fertile days which normally occur between 19 and 12 days prior to the next menstrual period. The proportion of failures is over 14%. The method is without secondary effects but its acceptability is limited because of its interfrence with sexual expression and high failure rate. The basal temperature method requires sexual abstinence between the beginning of the cycle and the 3rd day after the periovulatory temperature rise. The method has a failure rate of 1-4% but is less widely used than the Ogino-Knaus calendar method because of its inconvenience, greater sexual restrictions, and difficulty of interpretation. Among modern methods, combined oral contraceptives (OCs) have the lowest failure rate, .1%. They function by interfering with the mechanism of ovulation. OC formulations vary by dose, hormones utilized, and form of administration. The physician must decide the appropriate formulation for each woman. IUDs have a failure rate of 3%. They are contraindicated for women with alterations of the genital organs, infections, abnormal uterine bleeding or pregnancy. Among permanent methods, vasectomy is a simple and quick operation which provides complete sterility for men about 8-10 weeks after operation. Tubal ligation by various surgical techniques is the most common form of contraceptive surgical sterilization for women. No currently used contraceptive method can be considered ideal. PMID:6914729

Creus, M E