[The sociological approach to vasectomized patient trajectories at the Buenos Aires University Clinical Hospital "José de San Martín"].

According to the Argentinian Ministry of Health records the number of patients requesting vasectomy increased twelve times in public hospitals in 2015-2019. The physicians and specialists account for this change in recent years, arguing, among other reasons, cultural change when male assumes active position in contraceptive methods. The article addresses vasectomized patient trajectory at the Buenos Aires University Clinical Hospital "José de San Martín". The purpose of the study was to define from sociological point of view if we are actually witnessing cultural change. While considering last ten years (2012-2022), through diachronic analysis of patient demand at the Male Fertility Laboratory (n=1136) it was found that although main motivation is fertility, minority (6%) consulting to confirm absence of sperm in the ejaculate following vasectomy increased significantly in 2022 (Pearson's chi-squared test p<0.0001). After qualitative/quantitative interviews of former patient group (n=36) two sub-populations were distinguished: childless (42%; Median age: 30 years old; range: 24-35) and those having a family (58%; Median age: 39 years old; range: 35-54). Most of them had University degree (67%) and learned about this anti-contraceptive method by the Internet. It is remarkable that 94% of them were not aware of the the Argentinian Law № 236139 of 2006 that grants their right to vasectomy. Among all patients randomly interviewed in 2022 (n=200) condom anti-contraceptive method was the best known (67%). The conclusion was made that in the meantime developed New Trend that comprises high educational level segment of population of Argentina that in the future can become the germ of Cultural Change encompassing the whole society.

Trends in vasectomy and sexually transmitted diseases in Chile: findings from robust national databases / Tendencias de la vasectomía y las enfermedades de transmisión sexual en Chile: resultados de bases de datos robustas / Tendências em vasectomia e doenças sexualmente transmissíveis no Chile: resultados de bases de dados robustas

Abstract: A controversy about the increase or decline of vasectomy is emerging; however, the evidence is still scarce in Latin America. This ecological study analyzed the vasectomy and sexual transmitted diseases (STD) trends over a period of 10 years in Chile and determined if there is any relationship between them. We conducted a mixed ecological study using secondary and representative data on the number of vasectomies and STD cases from 2008 to 2017. Vasectomy rates were calculated for age-specific groups of men aged 20-59 years, and specific STD (HIV, chlamydia, gonorrhea, trichomoniasis, and syphilis) for the same period. Multivariate negative binomial regression models were fitted to evaluate rate trends and relationships. The mean vasectomy age was 40.3 years, with no significant differences between the years of the study (p = 0.058). The overall vasectomy rate significantly increased from 2008 to 2017 (p < 0.001), with differences between age groups (p < 0.001). The most significant increase was observed in men aged 30-49 (p < 0.001). The STD rates significantly increased (p < 0.05) during the study period. A significant positive correlation was found between vasectomy and gonorrhea incidence rates (p = 0.008) and an inverse correlation was found with hepatitis B incidence rates (p = 0.002). Vasectomy trends and STD rates significantly increased from 2018 to 2017 in Chile. especially among men aged 30-49 years. The relationship between vasectomy and STD increments suggests a new risk factor for reproductive and sexual health policies to aid controlling the HIV and STD epidemic.

Resumen: Se viene surgiendo una controversia sobre el aumento o la disminución de la vasectomía; sin embargo, la evidencia aún es escasa en América Latina. Este estudio ecológico analizó las tendencias de la vasectomía y las enfermedades de transmisión sexual (ETS) durante un período de 10 años en Chile y determinó si existe alguna relación entre ellas. Este es un estudio ecológico mixto que utiliza datos secundarios representativos sobre el número de vasectomías y casos de ETS de 2008 a 2017. Las tasas de vasectomía se calcularon por grupos de edad teniendo en cuenta a hombres entre 20-59 años de edad y ETS específicas (VIH, clamidia, gonorrea, tricomoniasis y sífilis) para el mismo período. Los modelos de regresión binomial negativa multivariante se ajustaron para evaluar las tendencias y las relaciones entre las tasas. La edad media de la vasectomía fue de 40,3 años, sin diferencias significativas entre el período del estudio (p = 0,058). La tasa general de vasectomía tuvo un incremento significativo para el período de 2008 a 2017 (p < 0,001), con diferencias entre los grupos de edad (p < 0,001). El incremento más significativo se observó en hombres de entre 30-49 años (p < 0,001). Las tasas de ETS tuvieron una alza significativa (p < 0,05) durante el período de estudio. Hubo una correlación positiva significativa entre las tasas de vasectomía y las tasas de incidencia de gonorrea (p = 0,008) y una correlación inversa con las tasas de incidencia de hepatitis B (p = 0,002). Se concluye que las tendencias de la vasectomía y las tasas de ETS presentaron un incremento significativo en período de 2008 a 2017 en Chile, especialmente entre los hombres de entre 30-49 años. La relación entre la vasectomía y el incremento de las ETS puede ser un nuevo factor de riesgo para las políticas de salud sexual y reproductiva que puede ayudar a controlar la epidemia del VIH y las ETS.

Resumo: Uma controvérsia sobre o aumento ou declínio da vasectomia está surgindo; no entanto, as evidências ainda são escassas na América Latina. Este estudo ecológico analisou as tendências de vasectomia e doenças sexualmente transmissíveis (DST) em um período de dez anos no Chile e determinou se há alguma relação entre elas. Este é um estudo ecológico misto utilizando dados secundários e representativos sobre o número de vasectomias e casos de DSTs de 2008 a 2017. As taxas de vasectomia foram calculadas por grupos etários, considerando homens de 20-59 anos de idade e DSTs específicas (HIV, clamídia, gonorreia, tricomoníase e sífilis) para o mesmo período. Modelos de regressão binomial negativa multivariada foram ajustados para avaliar tendências e relações entre taxas. A média de idade da vasectomia foi de 40,3 anos, sem diferenças significativas entre os anos do estudo (p = 0,058). A taxa geral de vasectomia aumentou significativamente de 2008 a 2017 (p < 0,001), com diferenças entre grupos etários (p < 0,001). O aumento mais significativo foi observado em homens de 30-49 anos (p < 0,001). As taxas de DST aumentaram significativamente (p < 0,05) durante o período de estudo. Houve correlação positiva significativa entre as taxas de vasectomia e as taxas de incidência de gonorreia (p = 0,008) e uma correlação inversa com as taxas de incidência de hepatite B (p = 0,002). As tendências de vasectomia e as taxas de DST aumentaram significativamente de 2008 para 2017 no Chile, especialmente entre homens de 30-49 anos. A relação entre vasectomia e incrementos de DST sugere um novo fator de risco para políticas de saúde sexual e reprodutiva para auxiliar no controle da epidemia de HIV e DST.

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices

ABSTRACT Objectives: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. Patients and Methods: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. Results: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. Conclusion: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Effect of castration and vasectomy on some oxidative stress parameters and blood hormone levels in rats / Efeito da castração e da vasectomia em alguns parâmetros de estresse oxidativo e níveis de hormônios no sangue

Vasectomy and castration are the most preferred surgical methods to control reproduction in males. While sexual functions are terminated reversibly in vasectomy, they are removed irreversibly in castration. After these processes, changes are observed in hormones and oxidative stress parameters. In this study, we investigated the effects of vasectomy and castration operations on blood follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, nitric oxide (NO) and malondialdehyde (MDA) levels in rats. As a result of the analysis, it was determined that FSH, LH, NO, and MDA levels increased (p<0.05) and testosterone levels decreased (p<0.05) in the castration group compared to the sham and vasectomy groups. Considering the data obtained from the present study, when the two operations (vasectomy and castration) are compared in rats, which are preferred for the control of reproduction, it is thought that vasectomy is a healthier method because it is reversible, does not affect hormone levels, and does not increase oxidative stress.

A vasectomia e a castração são os métodos cirúrgicos preferidos para controlar a reprodução no sexo masculino. Enquanto as funções sexuais terminam reversivelmente na vasectomia, elas são removidas irreversivelmente na castração. Após esses processos, são observadas alterações nos hormônios e nos parâmetros de estresse oxidativo. Neste estudo, foram investigados os efeitos das operações de vasectomia e castração nos níveis sanguíneos de hormônio folículo estimulante (FSH), hormônio luteinizante (LH), testosterona, óxido nítrico (NO) e malondialdeído (MDA) em ratos. Como resultado da análise, foi determinado que os níveis de FSH, LH, NO e MDA aumentaram (P<0,05) e os níveis de testosterona diminuíram (P<0,05) no grupo de castração em comparação com os grupos sham e vasectomia. Considerando os dados obtidos no presente estudo, quando comparadas as duas operações (vasectomia e castração) em ratos, preferidas para o controle da reprodução, acredita-se que a vasectomia é um método mais saudável por ser reversível, não afetar os níveis hormonais e não aumentar o estresse oxidativo.

Risk of post-vasectomy infections in 133,044 vasectomies from four international vasectomy practices.

OBJECTIVES: To estimate the risk of post-vasectomy infections in various settings and across various surgical techniques and sanitization practices. PATIENTS AND METHODS: Retrospective review of the records of 133,044 vasectomized patients from four large practices/network of practices using the no-scalpel vasectomy (NSV) technique in Canada (2011-2021), Colombia (2015-2020), New Zealand (2018-2021), and the United Kingdom (2006-2019). We defined infection as any mention in medical records of any antibiotics prescribed for a genital or urinary condition following vasectomy. RESULTS: Post-vasectomy infection risks were 0.8% (219 infections/26,809 procedures), 2.1% (390/18,490), 1.0% (100/10,506), and 1.3% (1,007/77,239) in Canada, Colombia, New Zealand, and the UK, respectively. Audit period comparison suggests a limited effect on the risk of infection of excising a short vas segment, applying topical antibiotic on scrotal opening, wearing a surgical mask in Canada, type of skin disinfectant, and use of non-sterile gloves in New Zealand. Risk of infection was lower in Colombia when mucosal cautery and fascial interposition [FI] were used for vas occlusion compared to ligation, excision, and FI (0.9% vs. 2.1%, p<0.00001). Low level of infection certainty in 56% to 60% of patients who received antibiotics indicates that the true risk might be overestimated. Lack of information in medical records and patients not consulting their vasectomy providers might have led to underestimation of the risk. CONCLUSION: Risk of infection after vasectomy is low, about 1%, among international high-volume vasectomy practices performing NSV and various occlusion techniques. Apart from vasectomy occlusion technique, no other factor modified the risk of post-vasectomy infection.

Factores asociados al rechazo del método anticonceptivo vasectomía en población masculina de Chile / Factors associated with the rejection of the vasectomy contraceptive method in the male population of Chile

Objetivo: Identificar los factores relevantes asociados al rechazo de la vasectomía, en la población masculina de 30 a 60 años, de Chile. Métodos: La muestra fue encuestada a través de Google Forms, con un cuestionario que medía las creencias sobre la vasectomía, evaluada a través de una escala tipo Likert. Las pruebas estadísticas utilizadas fueron chi-cuadrado y la prueba exacta de Fisher. Resultados: Los factores que más relevancia obtuvieron fueron la pertenencia a un grupo religioso y la región de residencia. El 100 % de los participantes que no se identificaban con ningún grupo religioso presentaron una menor percepción negativa de la vasectomía (p = 0,0435). Conclusión: La vasectomía está prejuiciada por falta de conocimientos y accesibilidad hacia ella. Por tanto, urge una mayor difusión de sus beneficios en el sistema de salud público y privado, así también, implementar programas de accesibilidad para hombres que no pretendan tener hijos a futuro(AU)

Objective: Identify relevant factors associated with vasectomy rejection in the male population of Chile, between 30 and 60 years. Methodology: The sample was surveyed through Google Forms, with a questionnaire that measured beliefs towards vasectomy, through a Likert-type scale. The statistical tests used were chi-square and Fisher's exact test. Results: The most relevant factors were membership of a religious group and region of residence. Participants who did not identify with any religious group had a lower negative perception of vasectom (p = 0,0435). Conclusion: Vasectomy is prejudiced by lack of knowledge and accessibility to it. Therefore, there is an urgent need for greater dissemination of its benefits in the public and private health system, also, implement accessibility programs for men who do not intend to have children in the future(AU)

Vasectomy: knowledge, perception and acceptance by medical students in Latin America / Vasectomia : conocimientos, percepción y aceptación por parte de estudiantes de medicina en América Latina

Abstract Introduction: Medical students play an important role in achieving sexual and reproductive health outcomes, including a greater participation of men in family planning. Objective: To describe the level of knowledge, perception, and acceptance of vasectomy in a sample of Latin American medical students (i.e., whether they would recommend this procedure to their patients, and in the case of male students, whether they would undergo it at some point in their lives) in a sample of Latin American medical students. Materials and methods: Multicenter, cross-sectional, analytical study conducted in November 2020 in 2 676 medical students (1st-7th year) from 8 Latin American countries. Data were collected using a questionnaire validated in each country and completed in Google Forms. The chi-square test of independence was used to determine differences in study variables (knowledge, perception, and acceptance) for each established subgroup, with a significance level of p<0.05. Results: The level of knowledge was high and medium in 55.38% and 36.32% of participants, respectively. The country with the highest ratio of students with a high level of knowledge was Mexico (77.31%) and the one with the lowest ratio was Brazil (3.33%). Regarding perception, 96.97% of the students considered that vasectomy does not affect masculinity and 98.99% that contraception is also the responsibility of men. With respect to acceptance, 94.02% would recommend the procedure, but only 69.82% of men (n=759) would undergo it. Conclusions: Most participants have a good level of knowledge, good perception, and a good level of acceptance of the procedure. However, it is necessary to implement more training strategies that allow them to promote the use of vasectomy as a family planning alternative in their professional life.

Resumen Introducción. Los estudiantes de medicina desempeñan un rol importante en el logro de resultados en salud sexual y reproductiva, incluyendo una mayor participación de los hombres en la planificación familiar. Objetivo. Describir el nivel de conocimientos, la percepción y el nivel de aceptación de la vasectomia (i.e. sí la recomendarían a sus pacientes y, en el caso de los hombres, sí se la realizarían en algún momento de su vida) en una muestra de estudiantes de medicina latinoamericanos. Materiales y métodos. Estudio multicéntrico, transversal analítico realizado en noviembre de 2020 en 2 676 estudiantes de medicina (1er-7mo año) de 8 países latinoamericanos. Los datos se recolectaron mediante un cuestionario validado en cada país y diligenciado mediante Google Forms. Se utilizó la prueba de chi-cuadrado de independencia para determinar las diferencias en las variables de estudio (nivel de conocimientos, percepción y nivel de aceptación) para cada subgrupo establecido, con un nivel de significancia de p<0.05. Resultados. El nivel de conocimientos fue alto y medio en 55.38% y 36.32% de los participantes, respectivamente. El país con mayor proporción de estudiantes con alto nivel de conocimientos fue México (77.31%) y el de menor proporción, Brasil (3.33%). Respecto a la percepción, 96.97% de los estudiantes consideró que la vasectomía no afecta la masculinidad y 98.99% que la anticoncepción también es responsabilidad del hombre. En cuanto a la aceptación, el 94.02% recomendaría el procedimiento, pero solo el 69.82% de los varones (n=759) se la realizaría. Conclusiones. La mayoría de los participantes tiene un buen nivel de conocimientos, buena percepción y un buen nivel de aceptación del procedimiento. No obstante, es necesario implementar más estrategias de capacitación que les permitan promover el uso de la vasectomía como alternativa de planificación familiar en su vida profesional.

Vasectomy re-reversal: effectiveness and parameters associated with its success

ABSTRACT Introduction: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. Purpose: To determine the VRR effectiveness and whether specific parameters can be associated with its success. Materials and Methods: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). Results: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). Conclusions: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.

Vasectomy re-reversal: effectiveness and parameters associated with its success.

INTRODUCTION: When the vasectomy reversal (VR) fails, and the patient desires natural conception with his sperm, vasectomy re-reversal (VRR) is the only alternative. PURPOSE: To determine the VRR effectiveness and whether specific parameters can be associated with its success. MATERIALS AND METHODS: We retrospectively evaluated 18 consecutive vasectomized patients, who had failed their VR through bilateral vasovasostomy, and posteriorly were submitted to VRR. The parameters of the study were: age of the patients, elapsed time between vasectomy and VRR (V-VRRt), elapsed time between VR and VRR (VR-VRRt), presence of spermatozoa in the proximal vas deferens fluid (SptzVDF) in the VRR and results of semen analysis after VRR (SA-VRR). RESULTS: The mean of the age of the patients was 44.11±6.55 years (32.0-57.0), the mean of V-VRRt was 11.76±6.46 years (1.5-25.0) and the mean of VR-VRRt was 2.13±2.27 years (0.5-10.0). SptzVDF in the VRR were found bilaterally in 8 patients, unilaterally in 4 and absent in 6. SA-VRR demonstrated normozoospermia in 9 patients, oligozoospermia in 3 and azoospermia in 6, with patency rate of 66.67%. SA-VRR showed statistically significant dependence only with SptzVDF in the VRR (p <0.01). CONCLUSIONS: VRR was effective in restoring the obstruction in more than half of the patients. Furthermore, the presence of spermatozoa in the vas deferens fluid was the parameter associated with the VRR success.

Surgical treatment for male infertility. / Tratamiento quirúrgico de la infertilidad masculina.

Given the nature of the multiple causes of male infertility, some of them are «reversible¼ and can be managed with a surgical procedure to recover, in some cases, the fertilizing capacity of the male reproductive tract. With appropriate use of diagnostic tools and clinical judgement, the physician can identify the ideal candidates for these procedures. Together with the expertise and experience of the surgeon, these treatments can manage to resolve the barrier, and men may become fertile again. In this chapter, we will review some of the most commonly used surgical procedures for the treatment of male infertility and make a brief description of their technical details.

Successful unilateral vasectomy reversal in a lion (Panthera leo).

Background: In 2016, the veterinarian team of Buin Zoo in Chile decided to try to increase the lion population. At that time, the zoo had three lions; two females and one male. The 9-year-old male had been vasectomized 5 years ago at the same institution for birth control. Considering the fact that in humans, vasectomy reversal has excellent reproductive outcomes, a team of human urologists, highly experienced in vasectomy reversal was contacted to perform the procedure. Case description: Surgery was performed on June 16, 2016 under general anesthesia, with the vasectomy site accessed through the previous scar localized in the lower groin. After opening the skin, dartos and tunica vaginalis, we were able to identify the previous vasectomy site. After liberating both vas ends and checking for permeability, a microsurgical anastomosis (magnification 25×) was performed. The surgery took 80 minutes with minimal bleeding, and no surgical complications were observed. After 2 weeks, the lion joined the lionesses and reproductive follow-up was started. Seven months after surgery, one lioness became pregnant, and 4 months later gave birth to two female lion cubs, with no incidents at the zoo. Both cubs were healthy and are still living at the zoo. Conclusion: Vasectomy reversal constitutes a valid perspective to reassume fertility in previous vasectomized lions.

Is time since vasectomy more important as prognostic factor for pregnancy and live birth than female and laboratory variables when treating vasectomised man using ICSI?

Fatherhood after vasectomy can be done by vasectomy reversal or intracytoplasmic sperm injection (ICSI). Time since vasectomy is the best predictive factor for patency and live birth after a vasectomy reversal but has uncertain importance after ICSI with sperm retrieval. The present study examines the influence of male, female and laboratory variables on pregnancy and live birth. The study is based on 450 ICSI cycles from 332 patients performed on three infertility centres between 1994 and 2012. Interval time since vasectomy was divided in four groups GI-less than 3 years (n = 02); GII-3 to 8 years (n = 74); GIII-9 to 14 years (n = 161) and GIV-15 or more years (n = 213). The variables were tested for pregnancy rate and live birth for first and repeated cycles. Pregnancy and live birth rate were not statistically different among the study interval time groups for first or repeated cycles. Female and laboratory variables were statistically different for couples with pregnancy and live birth for the first cycles. The study suggests that variables coming from female and laboratory were more important than time since vasectomy when treating man with vasectomy using ICSI with sperm retrieval.

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

OBJECTIVE: To evaluate the occlusive failure risk of ligation and excision with fascial interposition vasectomy technique. There are doubts about the effectiveness of this technique largely used in Asia and Latin America. STUDY DESIGN: We conducted a prospective longitudinal observational descriptive study among men who underwent a vasectomy performed under local anesthesia in a clinic specializing in sexual and reproductive health services in Bogotá, Colombia. Three urologists used the Percutaneous No-Scalpel Vasectomy technique to isolate the vas deferens. They then ligated the vas, excised a 1 cm segment between ligations, and ligated the fascia on the prostatic end to cover the testicular end. We requested all patients to submit a semen sample three months after the vasectomy. We defined probable and confirmed vasectomy failure as 1-4.9 million sperm/ml and 5 million sperm/ml or more or any number of motile sperm observed on the last semen sample available, respectively. RESULTS: Among 1149 participants, 581 (51%) had at least one post-vasectomy semen analysis. The overall failure risk was 5.2% (30/581; 95% confidence interval [CI] 3.6%-7.3%) with probable and confirmed failure risk of 1.9% (11/581; 95% CI 1.1%-3.4%) and 3.3% (19/581; 95% CI 2.1%-5.1%), respectively. Older men and one urologist had statistically significant higher risk of overall failure. CONCLUSION: Our study confirmed that the ligation and excision with fascial interposition vasectomy technique is associated with an unacceptable risk of failure. IMPLICATIONS: Surgeons who use the ligation and excision with fascial interposition vasectomy technique and countries with large vasectomy programs in Asia and Latin America that still recommend this technique should consider adopting alternatives to reduce the failure risk to below 1% as recommended by the American Urological Association.

Successful twin pregnancy with intracytoplasmic sperm injection using surgical sperm retrieval after 25 years of vasectomy: a case report.

The couple from this clinical case consisted of a 55 years old male with an obstructive interval of 25 years post vasectomy, and a 38 years old female partner. Both partners had normal results in infertility workup. Five mature oocytes were injected with motile spermatozoa showing morphological alterations, obtained by percutaneous epididymal sperm aspiration. Four oocytes fertilized, and three embryos were transferred with assisted hatching on day three of development, of which one was a high-quality embryo. A clinical pregnancy was confirmed by the detection of two gestational sacs with foetal heartbeats. Pregnancy was ongoing during the submission of this manuscript. The use of ICSI with PESA/TESA should be considered as a feasible alternative when vasectomy reversal fails in vasectomized men wishing to father again. Case reports like this may inspire the counseling of couples that have suffered from a previous vasectomy reversal failure and support the recommendation of ICSI with PESA treatment, which could allow those couples to have their own children, even in the presence of advanced parental age.

Do assisted reproduction outcomes differ according to aetiology of obstructive azoospermia?

Azoospermia is defined as absence of spermatozoa and may be secondary to blocked seminal ducts, known as obstructive azoospermia. Semen quality may be impaired due to factors such as sperm cell DNA fragmentation and presence of antisperm antibodies. The objective of this article was to investigate potential differences in outcomes of in vitro fertilisation and intracytoplasmic sperm injection between groups with different obstruction aetiology, as well as between the use of different techniques and sperm cells of different origins. Retrospective, multi-centre analysis of 621 first cycles was carried out between 2008 and 2015: Group I, congenital obstruction, 45 patients and Group 2, vasectomy, 576 patients. Sperm cell retrieval was achieved in all cases. Results were similar for Group I and II fertilisation rates, 70% versus 66.85% (p = .786); pregnancy rates, 42.5% versus 41.46% (p = .896); and live birth rates, 29.73% versus 17.69% (p = .071). According to sperm cell origin (579 epididymal vs. 42 testicular), pregnancy rates, 41.47% versus 43.9% (p = .760); and live birth rates, 18.3% versus 27.78% (p = .163) had no difference. Fertilisation, pregnancy and live birth rates did not differ according to obstruction aetiology. Outcomes did not differ between groups according to sperm cell origin.

Knowledge and Acceptance towards Vasectomy in a Sample of Medicine Students, Meta 2018 / Conocimientos y aceptación sobre vasectomía en una muestra de estudiantes de medicina, Meta 2018

Introduction The low adherence to vasectomy is associated with the cultural environment, with false beliefs, and with lack of knowledge. In Colombia, the practice of vasectomy increased 3% between 1990 and 2015. Medical education seeks to have an impact on the general population; therefore, medicine students should have knowledge and attitudes toward birth control that include a significant participation of the male gender. Objective To describe the level of knowledge, beliefs, and acceptance of vasectomy in a sample of Colombian medicine students. Methods Cross-sectional descriptive study, nonprobabilistic sample by convenience with a total of 112 medicine students from different universities of the country attending at a university event. A total of 20 dichotomous questions were used. Results A total of 72.3% of the students answered correctly most of the answers; the knowledge level was grouped in high (53.35%), medium (41.07%), and low (5.35%). Up to 95.5% of the students recognized vasectomy as a male birth control method. Regarding beliefs, > 99% considered that family planning is not just a responsibility of women, although only 75% of the men would accept undergo a vasectomy. Conclusions Colombian medicine students have a good level of knowledge about vasectomy, they recommend performing the surgery, and recognize the active participation of males in contraception; nevertheless, a higher willingness to perform a vasectomy would be expected from this population. Training on the subject would break barriers about beliefs and promote proper counseling in birth control consultations.

Introducción La poca adherencia a la vasectomía se asocia al entorno cultural, falsas creencias y bajo conocimiento. En Colombia, su prevalencia incrementó 3% entre los años 1990 y 2015. La educación Médica busca tener impacto sobre la población general, por lo cual el estudiante de medicina debe tener conocimientos y actitudes sobre la planificación familiar, que incluya una participación significativa del sexo masculino. Objetivo Describir el nivel de conocimiento, creencias y aceptación de la vasectomía en una muestra de estudiantes de medicina colombianos. Métodos Estudio descriptivo transversal, muestra no probabilista por conveniencia de 112 estudiantes de medicina, de diferentes universidades del país asistentes a un evento universitario. Se emplea instrumento de 20 preguntas dicotómicas. Resultados El 72,3% de los estudiantes acertó correctamente en la mayoría de las respuestas, se agrupó nivel de conocimiento en alto 53,35%, medio 41,07% y bajo 5,35%. Hasta un 95,5% reconoció la vasectomía como método de planificación masculina. En cuanto a creencias, más del 99% manifiesta que la planificación familiar no es responsabilidad solo de la mujer, aunque sólo el 75% de los hombres aceptó realizarse la vasectomía. Conclusiones Los estudiantes de medicina colombianos tienen un buen nivel de conocimientos sobre vasectomía, recomiendan su realización y reconocen la participación activa masculina dentro de la anticoncepción, sin embargo, se esperaría una mayor disposición, por parte de esta población, a la realización de la vasectomía. La capacitación sobre el tema puede romper las barreras de creencias y promover un adecuado asesoramiento en las consultas de planificación familiar.

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study.

PURPOSE: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. MATERIALS AND METHODS: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. RESULTS: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). CONCLUSION: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.

The effect of counseling and family planning education on Knowledge and attitude of comorbid families

To improve the comorbid families behavior, knowledge, and attitudes about evidencebased options, we undertook an educational intervention. In current study, we evaluated the knowledge and attitude of the comorbid families about family planning option s pre and post informing program. the knowledge and attitudes of the comorbid families about family planning options pre and post educational intervention, from Feb -2015 to April-2016. This is a pre-post intervention survey analysis of seventy-six monogamous married couples. Couples were sequentially enrolled if they met inclusion criteria of harboring comorbidities when seeking family planning services. we evaluated the participants by using a questionnaire based on health belief model prior to and fo llowing the educational intervention. Education sessions incloude an educational video programme and a question and answer parts. For analyzing our data was used c hi-square, paired t-test, Spearma n and Pearson's correlation coefficient. Directed family planning education to couples with comorbidities significantly altered their attitude and knowledge. Counseling led to more informed choice behavior about family planning methods,by prioritizing permanent methods of vasectomy versus tubal ligation, especially after the education intervention (P<0.005). Family planning education and counseling directed to couples with multiple comorbidit ies should be a priority in health centers as because the appropriate contraceptive choice will improve their health literacy and outcomes

Contracepção masculina: a visão de candidatos à vasectomia / Male contraception: the view of vasectomy candidates / Anticoncepción masculina: la visión de candidatos para la vasectomia

Objetivo: analisar a percepção de homens, candidatos à esterilização, sobre a vasectomia e identificar os motivos que os levaram a escolher tal procedimento. Método: pesquisa qualitativa descritiva, realizada com 14 homens em um hospital universitário, do município do Rio Grande/RS, em 2019. Foram realizadas entrevistas semiestruturadas, submetidas à análise de conteúdo. Estudo aprovado pelo Comitê de Ética em Pesquisa. Resultados: a idade média foi de 31,8 anos, e a maioria tinha filhos com a atual e com ex-parceiras. O conhecimento vago sobre vasectomia foi reforçado após encontro com assistente social. A influência de conhecidos foi positiva na tomada de decisão. A proteção da saúde da esposa foi um dos motivos para a realização do procedimento. O histórico de vida cercado por violência na infância também serviu como motivação. Conclusão: é preciso um olhar ampliado, dos profissionais da saúde sobre o tema; considerando o contexto e o projeto de vida do cliente nas situações de planejamento familiar.

Objective: to analyze the perception of men, candidates for sterilization, about vasectomy and to identify the reasons that led them to choose the method. Method: qualitative descriptive research, carried out with 14 men in a university hospital, in the municipality of Rio Grande/RS, in 2019. Semi-structured interviews were carried out, submitted to content analysis. Study approved by the Research Ethics Committee. Results: the average age was 31.8 years, and most had children with the current and former partners. Knowledge about vasectomy was reformed after meeting with a social worker. A known influence was positive in decision making. The protection of the wife's health was one of the reasons for carrying out the procedure. The life history surrounded by childhood violence also serves as an individual motivation. Conclusion: an expanded look is needed by health professionals, taking into account the context and the life project in family planning situations.

Objetivo: analizar la percepción de los hombres, candidatos a la esterilización, sobre la vasectomía e identificar las razones que los llevaron a elegir el método. Método: investigación descriptiva cualitativa, realizada con 14 hombres en un hospital universitario, en el municipio de Rio Grande/RS, en 2019. Se realizaron entrevistas semiestructuradas, sometidas a análisis de contenido. Estudio aprobado por el Comité de Ética en Investigación. Resultados: la edad promedio fue de 31.8 años, y la mayoría tenía hijos con las parejas actuales y anteriores. El conocimiento sobre la vasectomía se reformó después de reunirse con un trabajador social. Una influencia conocida fue positiva en la toma de decisiones. La protección de la salud de la esposa fue una de las razones para llevar a cabo el procedimiento. La historia de la vida rodeada de violencia infantil también sirve como una motivación individual. Conclusión: los profesionales de la salud necesitan una mirada más amplia, teniendo en cuenta el contexto y el proyecto de vida en situaciones de planificación familiar

The association between CHA2DS2-VASc score and erectile dysfunction: a cross-sectional study

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.