General Overview

Vasectomy is a birth control method in which part of the vas deferens is surgically removed to prevent sperm from entering the ejaculate. Vasectomy does not affect the testicles nor the production of testosterone. Sexual desire and the ability to have an erection and an orgasm are not affected. Because the sperm itself makes up a very small proportion of the ejaculate, a vasectomy does not affect the volume or appearance of the ejaculate. If the vasectomy is successful, sperm can no longer be included in the ejaculate. They are broken down and absorbed by the body (more details).

Vasectomy Effectiveness

Some sperm remain in semen for several ejaculations after a vasectomy. Therefore, it is critically important to examine semen specimens to ensure sterility. A British society of semen experts recommends using alternate methods of birth control for 16 weeks to avoid a post vasectomy pregnancy (assessment of post vasectomy PDF). They recommend the first vasectomy test at 16 weeks post vasectomy, a second vasectomy test at 18 weeks post vasectomy, and a third vasectomy test at one year post vasectomy.

Once semen specimens are free of sperm, most vasectomies are effective for life. The following studies outline the importance of post-vasectomy testing:

The Risk of Pregnancy After a Vasectomy

Denise J. Jamieson, MD, MPH, Caroline Costello, MPH, James Trussell, PhD, Susan D. Hillis, PhD, Polly A. Marchbanks, PhD, and Herbert B. Peterson, MD, for the U.S. Collaborative Review of Sterilization Working Group*

A 2004 study by the CDC estimated a probability of 11 pregnancies per 1,000 vasectomies, principally due to non-compliance with follow-up semen analyses.

More Details…

Sperm are produced in tubes (seminiferous tubules) within the testis. Most men produce billions of sperm every day. Once the sperm are mature enough to swim, they enter the epididymis, a small organ attached to the testicle. The epididymis connects to the vas deferens, the tube that carries sperm into the body to connect to the urethra for ejaculation. The seminal vesicles and the prostate contribute the fluid portion of ejaculated semen.

As noted in the diagram, it is the vas deferens that is cut during a vasectomy. This blocks sperm from entering the urethra, but does not interfere with the fluids produced by the seminal vesicles and prostate.

IT IS IMPORTANT TO NOTE THAT A SPERM STORAGE POUCH, THE AMPULLA, IS NOT BLOCKED BY THE VASECTOMY. SPERM STORED IN THE AMPULLA REMAIN VIABLE AND MOTILE FOR AN EXTENDED PERIOD OF TIME. THESE SPERM CAN PRODUCE A PREGNANCY UP TO SEVERAL MONTHS AFTER VASECTOMY.

Doctors performing vasectomies around the world report pregnancy rates varying from one to eleven pregnancies per every thousand vasectomies. ALMOST ALL “POST VASECTOMY” PREGNANCIES RESULT FROM UNPROTECTED SEX WITHIN THE FIRST FEW MONTHS AFTER VASECTOMY.

Rarely, the vas deferens can grow back together, usually within the first year, leading to viable sperm in semen. A repeat vasectomy can restore contraception. It is commonly agreed that a follow up semen analysis is the only way to confirm that a vasectomy was successful. But doctors do not always agree on when and how many semen specimens should be analyzed.

A British society of semen experts (the British Andrology Society) reviewed the vasectomy literature and in 2002 published their recommended guidelines:

1. Patients should use alternate methods of birth control for at least 16 weeks post vasectomy.
2. Men should ejaculate at least 24 times in that 16 week period, then submit a semen specimen for sperm detection.
3. They should submit a second specimen two weeks later.

IF NO SPERM ARE DETECTED IN BOTH SPECIMENS, THE VASECTOMY WAS SUCCESSFUL

1. If sperm are detected, repeat semen analyses should be performed until no sperm are present. If semen specimens contain 100,000 sperm/ml, either moving or not moving, a repeat vasectomy may be indicated.
2. A follow-up semen analysis at one year post vasectomy will guarantee re-growth of the vas deferens did not occur.

References

Vasectomy in the United States, 2002 – “Poor compliance with follow up recommendations continues to be a problem…”

Mark A. Barone,* Paul L. Hutchinson, Christopher H. Johnson, Jason Hsia and Jennifer Wheeler, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CHJ, JH), Atlanta, Georgia

The CDC surveyed vasectomy practices for the years 1991, 1995 and 2002. In 2002, 526,501 vasectomies were performed in the U.S., approximately the same rate (10 per 1,000 men) as in 1991 and 1995. Urologists, Family Practitioners and General Surgeons performed 79%, 13%, and 8% of vasectomies, respectively. There was wide variation in the timing and number of follow-up semen analyses and only 36% of physicians reported that most men completed follow-up.

Pregnancy rates after vasectomy: a survey of US urologists
Catherine Deneux-Tharaux, Erum Kahn, Hanif Nazerali, David C. Sokal

A survey of 500 urologists to determine the incidence of pregnancy after vasectomy for the years 1993-1998 revealed 177 pregnancies, 51% due to unprotected sex during the immediate post-vasectomy period.

British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002) P Hancock and E McLaughlin

The British Andrology Society has developed guidelines for post-vasectomy semen analyses. They recommend the first semen analysis at 16 weeks and after at least 24 ejaculations post procedure, and a second specimen 2 to 4 weeks later. The absence of sperm in both ejaculates represents a successful procedure, but does not preclude the appearance of sperm later on due to recanalization. The persistence of sperm, motile or nonmotile, requires continued follow-up.

Vasectomy Follow-up: Clinical Significance of Rare Nonmotile Sperm in Postoperative Semen Analysis\

Ashis Chawla, Ben Bowles, and Armand Zini

The presence of sperm, motile or non-motile, necessitates repeat follow-ups. Six hundred and ninety men undergoing no-scalpel vasectomy in Toronto, Canada, were instructed to produce follow-up semen specimens at 3 and 4 months post procedure. Forty-six percent of the men failed to submit specimens. Of the remaining 295 men, 60% were azoospermic in both specimens, 37% had rare non-motile sperm (RNMS) and 3% had rare motile sperm. In follow-up specimens, 20 (7%) of the men had persistent RNMS. One man with persistent RNMS subsequently developed motile sperm and underwent repeat vasectomy, as did one man with rare motile sperm.

EVIDENCE-BASED CLINICAL PRACTICE

Postvasectomy Semen Analysis: Are Men Following Up? (pdf)

Ronald E. Christensen, MD, and Dalton C. Maples Jr., PA-C

Review of the records of a Family Practice performing 551 vasectomies revealed 58% of men returned for a 6-week follow-up semen analysis; 25% returned for a 3-month follow-up, and only 8% of men returned for a one year follow-up.