Comparative review of vasectomy guidelines and novel vasal occlusion techniques.

Vasectomy is the most commonly performed urologic procedure in the United States and is a highly effective form of male contraception. The introduction of guidelines by urological societies has standardized vasectomy care. Providers should be awadre of the rationale behind these guidelines, as well as key differences among them. While few major changes to vasectomy technique have been adopted over the past 40 years, new, reversible vasal occlusive technologies may affect delivery of male contraceptive care in the future. Here, we perform a comparative review of vasectomy guidelines from six urological societies worldwide. In addition, we report on the status of several experimental vasal occlusion methods that may be available in the next decade.

Comparative study between the excision-ligation and autoligation of vas deferens technique for teaser rams preparation.

AIM: The present study was designed to demonstrate the autoligation (AL) of vas deferens and the excision-ligation (EL) technique to generate vasectomized rams to reduce the complications, operative time, and price of the vasectomy techniques. MATERIALS AND METHODS: A total of 12 healthy and mature Iraqi Awassi rams were used, which divided into two groups, six rams for each one. The former group was performed the EL technique while the latter group, the AL of vas deferens technique was used. RESULTS: The results of the present study found that both techniques were same with the reproductive efficient examinations that mean the two techniques had same ability to close the male genital passage for teaser rams preparation. However, the methods were different with the histopathological changes, operation time, prices, and complications, which were minor in the AL of vas deferens compared with the EL technique. CONCLUSION: The AL technique of vas deferens to prepare teaser animal is recommended over the EL technique due to different aspects such as cost, fewer complications, and active teaser for a long period are the main aspects of AL technique.

Modeling the impact of novel male contraceptive methods on reductions in unintended pregnancies in Nigeria, South Africa, and the United States.

OBJECTIVE: We modeled the potential impact of novel male contraceptive methods on averting unintended pregnancies in the United States, South Africa, and Nigeria. STUDY DESIGN: We used an established methodology for calculating the number of couple-years of protection provided by a given contraceptive method mix. We compared a "current scenario" (reflecting current use of existing methods in each country) against "future scenarios," (reflecting whether a male oral pill or a reversible vas occlusion was introduced) in order to estimate the impact on unintended pregnancies averted. Where possible, we based our assumptions on acceptability data from studies on uptake of novel male contraceptive methods. RESULTS: Assuming that only 10% of interested men would take up a novel male method and that users would comprise both switchers (from existing methods) and brand-new users of contraception, the model estimated that introducing the male pill or reversible vas occlusion would decrease unintended pregnancies by 3.5% to 5.2% in the United States, by 3.2% to 5% in South Africa, and by 30.4% to 38% in Nigeria. Alternative model scenarios are presented assuming uptake as high as 15% and as low as 5% in each location. Model results were sensitive to assumptions regarding novel method uptake and proportion of switchers vs. new users. CONCLUSION: Even under conservative assumptions, the introduction of a male pill or temporary vas occlusion could meaningfully contribute to averting unintended pregnancies in a variety of contexts, especially in settings where current use of contraception is low. IMPLICATIONS: Novel male contraceptives could play a meaningful role in averting unintended pregnancies in a variety of contexts. The potential impact is especially great in settings where current use of contraception is low and if novel methods can attract new contraceptive users.

Long-term vasectomy: effects on the occurrence and extent of atherosclerosis in rhesus monkeys.

We demonstrated previously that atherosclerosis develops more extensively in vasectomized cynomolgus macaques fed an atherogenic diet and speculated that the immunologic response to sperm antigens may have exacerbated the atherosclerosis. We report here that rhesus monkeys vasectomized for 9-14 yr and fed monkey chow (devoid of cholesterol and low in fat) rather than an atherogenic diet also had more extensive and severe atherosclerosis than did control animals of the same age. The extent of atherosclerosis was considered as the percentage of intimal surface with plaques. No control animals were found to have plaques in the thoracic aorta, but 7 of 10 vasectomized monkeys were affected. The plaques in the vasectomized monkeys occupied about 13% of the intimal surface. In 4 of 7 control monkeys and 7 of 10 vasectomized monkeys there were lesions in the abdominal aortas; the lesions were considerably more extensive and severe in the vasectomized animals. Lesions were also more common in iliac arteries of vasectomized animals, and the extent was increased about threefold. Plaques were seen at the carotid bifurcation in all of the animals of both the control and vasectomized groups. The carotid bifurcation plaques of the vasectomized monkeys were larger than those of the control animals on the right but not on the left side. Histologically, the lesions of vasectomized monkeys did not appear to be qualitatively different from those of control animals, even though they were larger and contained more collagen, lipid, and mucopolysaccharides. Grossly, the distribution of the lesions in the vasectomized animals was different from that in the control animals, and that of lesions induced by atherogenic diets, i.e., the lesions were distributed randomly within the artery rather than around bifurcations. More extensive atherosclerosis was noted among vasectomized animals that were found to lack demonstrable circulating free antisperm antibodies. On the basis of the observations made in this study, we suggest that the antisperm antibodies that form after vasectomy may result in circulating immune complexes that exacerbate atherosclerosis.

Autoantibodies against spermatozoal antigens detected by immunoblotting and agglutination. A longitudinal study of vasectomized males.

Sera taken pre- and post-operatively at regular intervals within a year from 16 men undergoing vasectomy were analysed for autoantibodies against spermatozoal proteins by immunoblotting. The reaction patterns were compared with the results of sperm agglutination tests. Immunoblotting revealed the presence of autoantibodies against various spermatozoal polypeptides in all sera taken pre-operatively and post-operatively. On average, seven polypeptides showed reaction. During the post-operative period two patients developed spermatozoal agglutinins in moderate titers (greater than 16) but in immunoblotting no change in band reactivity was observed for these two patients. However, scanning of the immunoblotting results revealed that one of the patients, although without sperm agglutinins, during the post-operative period showed an increasing band colouring of a polypeptide of Mr 31,500, reflecting an increased level of the corresponding antibodies.

PIP: Sera taken at the postoperative intervals of 10-21 days, 1-2 months, 3-5 months, 9-12 months from 16 men undergoing vasectomy were analyzed for autoantibodies against spermatozoal proteins by immunoblotting. After recording the natural pattern of antibody binding, qualitative and quantitative changes were identified and related to the sperm agglutinins. On average, an observation time of 6 months was obtained. All the men had been proven fertile prior to surgery and had azoospermia after surgery. Sera also were taken from 7 normal controls with at least 3 month intervals during 1 year to determine whether changes of the spectrum of the antibody specificities occurred. A figure shows an immunoblotting analysis of IgG autoantibodies to SDS-PAGE separate spermatozoal antigens with 5 serum samples from 1 person taken preoperatively and 1, 2.5, 3, and 8 months after vasectomy. Even prior to the operation at a time when the patient was fertile, an IgG binding was demonstrated. This observation held true for all 16 vasectomized males and the group of 7 controls. The staining pattern of the consecutive serum samples was constant. Only 2 patients reacted after vasectomy with a moderate increase in antibody titre (greater than 16), but neither of these patients, nor the rest of the group, developed new bands in immunoblotting for IgG. The immunoblotting analysis for IgM antibodies in sera from the 2 men with sperm agglutinins did not show variation with time. The 7 control men did not show any qualitative or quantitative changes in their IgG reaction pattern during the observation period nor did they reveal the presence of any autoantibodies in the agglutination tests. Scanning of the immunoblotting results revealed that 1 of the patients, although without sperm agglutinins, showed an increasing band coloring of a polypeptide of Mr, 31,500 during the postoperative period, reflecting an increased level of the corresponding antibodies.

Vasectomy failure and open-ended vasectomy.

PIP: 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.^ieng

Variations in seminal plasma constituents from fertile, subfertile, and vasectomized azoospermic men.

PIP: Freshly ejaculated semen specimens from 20 normal fertile, 11 subfertile, and 20 vasectomized men whose semen analyses had reached complete azoospermia were compared. The mean levels of seminal acid phosphatase were significantly higher in the vasectomized men. The mean values of sialic acid in normal and postvasectomy seminal plasmas were similar, in contrast to the lower values in oligospermic men. No significant differences were observed in seminal plasma proteins, alkaline phosphatase, and fructose levels. No correlation was found between seminal alkaline phosphatase and fructose levels and sperm concentration. Azoospermia occurring after vas ligation was attributed to high phosphatase values.^ieng

Sterility in male animals induced by injection of chemical agents into the vas deferens.

PIP: This study was undertaken to develop a simple non-surgical technic for achieving male sterility. The method induces obstruction in the vas deferens by injecting sclerosing chemical agents through the skin of the scrotum directly into the vas. Previous success in rats using 95% ethanol have been reported. This sutdy used 95% ethanol, 10% silver nitrate, 36% acetic acid, 3.6% formaldehyde, 3% sodium tetradecyl sulfate, 5% sodium morrhuate, 5% potassium permanganate, 3.6% formaldehyde in 90% ethanol, and for controls .9% sodium chloride. 25 or 50 mcl of the agent being tested was injected into each vas deferens of mature Sprague-Dawley rats. 2 weeks after treatment the rats were exposed to continuous mating. All of the rats treated with ethanol, silver nitrate, acetic acid, formaldehyde, and sodium tetradecyl sulfate have remained sterile for 8 months. 33% of those treated with potassium permanganate and 67% of those treated with sodium morrhuate have remained fertile. When the experiment was repeated in dogs using 95% ethanol, 10% silver nitrate, or 3.6% formaldehyde in 90% ethanol (100 or 500 mcl injected through the skin of the scrotum) the same obstructing sclerosis was found and a reduction in size of the vas was visible for approximately 2 cm. No sperm granulomas were found either grossly or microscopically. The method has not be used in humans but injections of methylene blue dye in alcohol have been made in several human autopsy specimens. The dye was contained within the sheath of the vas and penetrated the full thickness of the wall of the vas. The method is believed to be suitable for humans, would avoid post-surgical hemorrhage and infection, would require less equipment, and more rapid accomplishment and lower cost would follow if paramedical personnel could be taught the procudre in less developed countries for mass voluntary sterilizations. The results appear to be permanent. Surgical reversibility has not be determined.^ieng

Human sperm function in the ejaculate following vasectomy.

Semen specimens were obtained for analysis from nine men immediately before vasectomy and 3 days following the vasectomy procedure. After vasectomy there was a significant decrease in seminal sperm concentration, percentage of sperm motility, and mean swimming speed. In seven of nine cases the spermatozoa did not survive overnight incubation in capacitation media, and in no case was penetration of zonafree hamster oocytes observed 3 days after vasectomy.

Open-ended vasectomy: an assessment.

Leaving open the testicular end of vas at vasectomy could reduce symptoms of epididymal congestion and improve the success rate of vasovasostomy but might have the disadvantage of increasing the incidence of painful sperm granulomas and spontaneous recanalization. In 4330 open-ended vasectomies the rate of epididymal congestion was significantly less than in 3867 standard vasectomies. The rate of painful sperm granulomas was not increased: it was significantly reduced. Spontaneous recanalization was rare in both groups. Whether or not open-ended vasectomy improves the success rate of vasovasostomy, it represents an improvement in technique because it reduces the rate of complications after vasectomy. Closure of the sheath over the prostatic end of vas is essential if recanalization is to be prevented.

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.

PIP: The records of 5233 vasectomy patients who had had at least 12 ejaculations and had completed semen tests were reviewed to help address the issue of no accepted standard for the time after vasectomy before infertility is achieved. Patients were requested to start semen tests at 3 months postoperatively, after which monthly tests were requested until at least 2 consecutive azoospermic specimens were obtained. This constituted proof of success. If sperm had persisted for more than 6 months after vasectomy, a 3rd such test was requested. patient records provided for up to 10 tests. 4197 (80% of the study group's initial specimens, performed at a median 98 days after surgery, were azoospermic, but 188 of these (45% revealed sperm in the following specimen. At a median 137 days postoperative, 4640 (88.7%) of tests were azoospermic. Azoospermia was not regarded as synonymous with success, for which the criterion was a minimum of 2 negative and consecutive monthly samples. For the study group as a whole, there was a rapid increase with time in the proportion of successful vasectomies, with, for example, 76% of men achieving success at 137 days, 93.3% at the 215th days, and 97.2% by the 301st day. The records of the 8879 men were screened for manifestations of individual anomalous sperm persistence, disappearance, or reappearance. In 8 men, small numbers of sperm appeared intermittently over prolonged periods. These 8 individuals each had 7 or more sequential specimens reported as either "occasional sperm" or azoospermic, with the last appearances of sperm ranging from 297 to 448 days after vasectomy. 5 cases demonstrated either azoospermia or just an occasional nonmotile sperm at the initial semen test, toe be followed in 2 or 3 by substantial concentrations of sperm and then by 1 or more azoospermic tests. 4 men who had had 2 negative and consecutive semen tests, and therefore "successful" operations, were later found to have pregnant partners and significant sperm in their semen. These 4 failures followed their vasectomies by an average of 5.5 years. While for the study group as a whole, sperm disappearance rates were a function of time, the total group contained instances of considerably individual variability. The cause of these variations is unclear.

Annual variation in semen characteristics and plasma hormone levels in men undergoing vasectomy.

Prevasectomy levels of plasma luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), estradiol (E2), and 20 alpha-dihydroprogesterone (20 alpha-DHP), as well as semen analyses including semen volume, sperm count, and sperm motility from 260 healthy men were evaluated for annual changes. A statistically significant (P less than or equal to 0.015) high-amplitude seasonal variation with the peak in April to May was detected in semen volume, sperm count, and sperm motility. A statistically significant (P less than or equal to 0.04) annual change of moderate T to large FSH amplitude was detected in each of the five plasma endocrine variables as well. Plasma LH, T, and E2 peaked in autumn, while FSH and 20 alpha-DHP peaked in summer. Analysis of postvasectomy LH, FSH, E2, 20 alpha-DHP, and T blood levels for the 3 years following vasectomy revealed loss of seasonal rhythmicity as a group phenomenon in LH, E2, and T. The amplitude of the seasonal variation in FSH was decreased and that in 20 alpha-DHP was unchanged compared with before-vasectomy baselines. For those annual rhythms which persisted following vasectomy, the peak time was unchanged. Compared with the prevasectomy group annual mean, that for each of the endocrine values was unchanged, except for that of LH and T, which was slightly, yet statistically significantly, elevated. The existence of prominent annual variation implicates their consideration in the design of research protocols involving investigation of reproductive phenomena in human beings.

PIP: Prevasectomy levels of plasma luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), estradiol (E2), and 20alpha-dihydroprogesterone (20alpha-DHP), as well as semen analyses including semen volume, sperm count, and sperm motility from 260 healthy men were evaluated for annual changes. A statistically significant (P or= 0.015) high amplitude seasonal variation with the peak in April-May was detected in semen volume, sperm count, and sperm motility. A statistically significant (P or= 0.04) annual change of moderate T to large FSH amplitude was detected in each of the 5 plasma endocrine variables as well. Plasma LH, T, and E2 peaked in autumn, while FSH and 20alpha-DHP peaked in summer. Analysis of postvasectomy LH, FSH, E2, 20alpha-DHP, and T blood levels for the 3 years following vasectomy revealed loss of seasonal rhythmicity as a group phenomenon in LH, E2 and T. The amplitude of the seasonal variation in FSH was decreased and that in 20alpha-DHP was unchanged compared with prevasectomy baselines. For those annual rhythms which persisted following vasectomy, the peak time was unchanged. Compared with the prevasectomy group annual mean, that for each of the endocrine values was unchanged, except for that of LH and T, which was slightly, yet statistically significantly, elevated. The existence of prominent annual variation implicates their consideration in the design of research protocols involving investigation of reproductive phenomena in humans.

Married women's dissatisfaction with tubal sterilization and vasectomy at first-year follow-up: effects of perceived spousal dominance.

Examination of first-year follow-up data obtained from 234 tubal ligation women and 154 vasectomy wives indicated a very low incidence of actual regret in both groups. However, use of a broader measure of satisfaction/dissatisfaction indicated that tubal ligation women had significantly more positive feelings about the sterilization decision than did vasectomy wives. Results of a series of multivariate statistical analyses demonstrated that group differences in satisfaction were related to (1) the disproportionate prevalence of perceived male control (particularly extensive control) over reproductive decisions among vasectomy wives and the negative effect it had upon subjects in both groups and (2) the disproportionate prevalence of female control over reproductive decision-making among tubal ligation women and the positive effect it had among subjects in this group. Study results point to the importance of couple counseling and exercising control over one's own body.

Factors associated with married women's selection of tubal sterilization and vasectomy.

Multivariate analyses of data from 248 married women scheduled for tubal sterilization and 165 wives of men scheduled for vasectomy indicated that male and female sterilization methods were selected for different reasons and under different circumstances. More specifically, the woman who underwent tubal sterilization was more likely to have perceived that she had greater influence than her husband over the sterilization decision, to have had cesarean section or vaginal delivery in association with sterilization, to have chosen tubal ligation because her spouse refused to undergo the alternative procedure or because it was convenient to combine it with delivery or other surgery, and to have had a spouse who was unwilling to be sterilized because of possible side effects associated with vasectomy. The woman whose husband underwent vasectomy was more likely to have been very fearful of surgery in general or especially fearful of reproductive surgery, to have known many men who already had had a vasectomy, to have perceived that her husband was more strongly motivated than herself to terminate childbearing, to have had a spouse who participated in birth control, and to have chosen vasectomy because it was easier or less expensive or because her physician advised against tubal sterilization.

PIP: Multivariate analyses of data from 248 married women scheduled for tubal sterilization and 165 wives of men scheduled for vasectomy indicated that male and female sterilization methods were selected for different reasons and under different circumstances. More specifically, the woman who underwent tubal sterilization was more likely to have perceived that she had greater influence than her husband over the sterilization decision, to have had cesarean section or vaginal delivery in association with sterilization, to have chosen tubal ligation because her spouse refused to undergo the alternative procedure, or because it was convenient to combine it with delivery or other surgery, and to have had a spouse who was unwilling to be sterilized because of the possible side effects associated with vasectomy. The woman whose husband underwent vasectomy was more likely to have been very fearful of surgery in general or especially fearful of reproductive surgery, to have known many men who already had a vasectomy, to have perceived that her husband was more strongly motivated than herself to terminate childbearing, to have had a spouse who participated in birth control, and to have chosen vasectomy because it was easier or less expensive or because her physician advised against tubal sterilization.

Vasectomy.

Vasectomy is an excellent method of permanent contraception for the couple whose family is complete, who are mature and fully informed, and who will accept permanent sterility. It is also valuable in preventing bacterial epididymitis. Vasectomy is customarily performed in the office or clinic setting under local anesthesia. Many techniques may be used, but the cut-fulgurate-and-cover technique has never failed in my experience. Postoperative testing is mandatory, and negative results on two samples, collected one month apart, will ensure that delayed spontaneous recanalization has not occurred. The specific complications of vasectomy are spermatic granulomas of vas or epididymis, congestive epididymitis, and antisperm antibodies. Numerous studies have shown no deleterious effects upon the patient's general health. Manhood, pleasure, and sensation are unchanged, and the woman need no longer fear the possibility of an unwanted pregnancy.

PIP: In this discussion of vasectomy, attention is directed to preoperative counseling, performance of vasectomy as an office or clinic procedure -- anesthesia and surgical techniques, and postoperative care. Vasectomy requires preoperative counseling. Every man is aware of the effects of castration, and it is essential to explain to a man how and why vasectomy differs. He also must understand that sterility is not immediate. The couple's every question must be answered. Although counseling may take the form of movie, booklet, or conversation with a trained counselor or the surgeon, or any combination of these, preoperative contact with the surgeon is very important. Patient confidence is essential. In the US, vasectomy for sterilization is generally legal, but this does not protect the surgeon from malpractice suits. The patient should sign a written consent containing the following points: that the patient requests the operation for the purpose of preventing him from fathering further children; that he realizes that the operation could fail to produce sterility; and that he agrees to submit semen specimens for testing and to use contraception until testing has shown that he is sterile. A number of local anesthetics may be used when performing a vasectomy. Both procaine, which takes effect in 1 minute, and lidocaine, effective in 5 seconds, are safe and given anesthesia for at least 1 hour in 1% strengths. The most common vasectomy technique worldwide is that of dividing the vas, removing a segment, and either ligating the cut ends of the vas or closing them with metal clips. This usually fails in 1-3% of patients, either initially or by subsequent recanalization of the vas. Regarding postoperative care, the patient should apply an icebag over the bandages for the 1st several hours with the scrotum immobilized and abstain from sexual activity for the first 2 days. To ensure that a spontaneous anastomosis has not occurred, this surgeon requests 2 semen specimens, 1 month apart. The complications of the operation are largely preventable. Preoperative counseling has prevented most psychological complications. The specific complications of vasectomy include spermatic granulomas of the vas and epididymis, and antisperm antibodies. Numerous studies have reported no deleterious effects upon the patient's general health.

Recent advances in male infertility research.

PIP: 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.^ieng

Reproductive history and semen analysis in prevasectomy fertile men with and without varicocele.

A group of 598 allegedly fertile men requesting vasectomy were investigated; varicocele was found in 97 (16.2%) of these men. The mean ages and age distributions of men with and without varicocele were not significantly different. Reproductive histories (number of pregnancies, living children and spontaneous abortions, as well as incidence of present pregnancy) were similar in both groups. The average seminal characteristics (semen volume, sperm count, total sperm count, percentage of motile spermatozoa, quality of motility, morphology) were not different for men with and without varicocele, except for a slight, but significantly higher incidence of oval-headed sperm in men without varicocele. However, the incidence of varicocele was significantly higher in men with sperm counts below 40 million/ml. Three important observations may be made from this study: 1) the incidence of varicocele in this prevasectomy population was similar to that reported for the general population, but lower than the incidence reported for male partners of infertile couples; 2) in this population of allegedly fertile men, the presence of a varicocele did not significantly affect reproductive performance; 3) even though the incidence of varicocele was higher in men with sperm counts below 40 million/ml, the average seminal characteristics were not different in men with and without varicocele.

PIP: A group of 598 allegedly fertile men requesting vasectomy were investigated; varicocele was discovered in 97 (16.2%) of these men. The mens ages and age distributions of men with and without varicocele were not significantly different. Reproductive histories (number of pregnancies, living children, and spontaneous abortions, as well as incidence of present pregnancy) were similar in both groups. The average seminal characteristics (semen volume, sperm count, total sperm count, percentage of motile spermatozoa, quality of motility, morphology) were not different for men with and without varicocele, except for a slight, but significantly higher incidence of oval-headed sperm in men without varicocele. However, the incidence of varicocele was significantly higher in men with sperm counts below 40 million/ml. 3 important observations may be drawn from this study. 1) The incidence of varicocele in the prevasectomy population here was similar to that reported for the general population, but lower than that reported for male partners of infertile couples. 2) In this population of allegedly fertile men, the presence of varicocele did not significantly affect reproductive performance. 3) Even though the incidence of varicocele was higher in men with sperm counts below 40 million/ml, the average seminal characteristics were not different in men with and without varicocele.

Antisperm antibodies and circulating immune complexes of vasectomized men with and without coronary events.

We compared antisperm antibody and circulating immune complex (CIC) levels in serum samples from 101 vasectomized and 101 normal age-matched nonvasectomized men; 31 of each group had histories of coronary heart disease (CHD). Vasectomy and CHD status were treated as categorical independent variables in the two-way analysis of variance. Elevations of both systolic and diastolic blood pressures were significantly associated with age and body mass index but not vasectomy. Antisperm antibodies (immobilizing and agglutinating) were significantly associated with vasectomy (P less than or equal to .001); the incidences were similar in men with and without CHD. The CICs were significantly associated with vasectomy in a Staphylococcus aureus (FcSa) CIC assay (P less than or equal to .001) and a Raji cell CIC assay (P less than or equal to .05). A third CIC assay, the Clq binding assay, did not reveal a difference between any subgroups. Generally, CICs occurred more frequently in the CHD group by the FcSa assay and particularly the Raji cell assay (P less than or equal to .001). In summary, vasectomized men had a higher incidence and higher levels of circulating antisperm autoantibodies and CICs than did age-matched controls.

Morphological observations of vas deferens occlusion by the percutaneous injection of medical polyurethane.

Histological observations of 20 occluded vas segments obstructed by the standard procedure of medical polyurethane-vas occlusion in 10 volunteers requesting vasectomy and of 20 vas segments with plugs removed from 10 vas-occluded men requesting vas reversal were carried out in order to elucidate the mechanism of vas occlusion by medical polyurethane (MPU). Twenty vas deferens in vasectomy group were ruptured, only a small amount of MPU elastomer remained within the vas lumen, most having leaked through to encircle the ruptured vas. Histomorphology of the removed vas segments from 10 vas-occluded men, who had undergone MPU-vas occlusion 4 years earlier, showed diffuse proliferation of connective tissue, fibrosis, or hyalinization of fibroplastic tissue and local infiltration of lymphocytes and macrophages. The vas lumen both proximal and distal to the plugs was completely blocked. Sperm granuloma, foreign body granuloma, proliferation of nerve fibers and local infiltration of lymphocytes were found in four vas-occluded men with painful nodules. These results suggest that the contraceptive mechanism of MPU-vas occlusion could be the result of secondary obstruction due to tissue proliferation by MPU irritation after the rupture of the vas deferens.

PIP: Findings are reported from a study of the mechanism of vas occlusion by medical polyurethane (MPU). Histological observations were made of 20 occluded vas segments obstructed by the standard procedure of medical polyurethane vas occlusion in 10 volunteers requesting vasectomy and of 20 vas segments with plugs removed from 10 vas-occluded men requesting vas reversal. 20 vas deferens in the vasectomy group were ruptured, with only a small amount of MPU elastomer remaining within the vas lumen, most having leaked through to encircle the ruptured vas. Histomorphology of the removed vas segments from the 10 vas-occluded men who had undergone vas-occlusion four years earlier showed diffuse proliferation of connective tissue, fibrosis, or hyalinization of fibroplastic tissue and local infiltration of lymphocytes and macrophages. The vas lumen both proximal and distal to the plugs was completely blocked. Sperm granuloma, foreign body granuloma, proliferation of nerve fibers, and local infiltration of lymphocytes were found in four vas-occluded men with painful nodules. These findings suggest that the contraceptive mechanism of MPU-vas occlusion could be the result of secondary obstruction due to tissue proliferation by MPU irritation after the rupture of the vas deferens.

Serum lipid levels before and after vasectomy in men.

The blood lipid profile was determined in sixty-two men, 24 to 62 years old, before and two, six and twelve months after surgical occlusion of the vas deferens. No statistically significant differences were found in mean body weight, blood pressure, serum levels of non-esterified fatty acids, total lipids, triglycerides, total cholesterol and alpha, beta and prebeta fractions of the lipoproteins, which were measured before and after surgery. When the serum levels of the alpha and beta fractions were considered in the same subject, it was observed that 12 months after vasectomy a similar percentage of cases showed a predominance of either one of them. Hence, no modifications on the lipid profile of these subjects were found that could indicate an increased risk of arteriosclerotic disease.