Vasectomy remains the safest method of birth control and there is much to commend it in the setting of a stable family relationship. However, some aspects of this operation have been wrongly presented in an attempt to widen its popularity and increase public acceptance. A simple procedure it may be but it is not totally free of complications; sometimes the operation has to be repeated and rarely it may reverse spontaneously even after the most stringent precautions. The family planning officer who counsels a prospective candidate and the surgeon who undertakes the procedure must ensure that these facts are understood by the patient with crystal clarity and that this fact is duly recorded on a signed and witnessed permission slip. Any organization which includes vasectomy in its programme of family planning should include advice and referral for vasectomy reversal in exactly the same way that the pill may be stopped or a coil can be removed. Fertility can be successfully restored by vasovasostomy in 50% of men who wish to have their vasectomies reversed, which often is due to a change in circumstances beyond their direct control.
PIP: Vasectomy is the most reliable method of birth control. More than 33 million couples now rely on it in the United States, the United Kingdom, India, China, Thailand, South Korea, Canada, the Netherlands, and New Zealand. Many of the problems associated with vasectomy can be prevented by discussion about the procedure beforehand with the couple concerned, with clear warning that complications can sometimes occur. Recently, a no-scalpel technique has been introduced by Dr Li Shunqiang in China with good results. During 10 and 12 weeks follow-up, semen should be examined. The detailed study of 1000 vasectomies performed under local anesthetic at the Margaret Pyke Centre in London defined the expected complication rate. Two patients suffered vasovagal attacks during the operation and required resuscitation. Minor hematomas occurred in 3.5%. 12 developed minor sepsis but only one abscess occurred. Three cases of epididymo-orchitis were seen. Altogether, 5.6% of patients complained of minor local symptoms including bruising. In the large Oxford Series, 7.7% sought medical advice for local pain and 3.6% for bleeding. Scrotal hematoma developed in 0.9%. 80% returned to work in 3 days and 96% within 1 week. Spermatozoa have been found in a para-aortic lymph node one year after vasectomy in a man undergoing laparotomy, and circulating antisperm antibodies can be detected by sperm-agglutination tests in the serum of 60-80% of men following vasectomy. Technical difficulties with vas anastomosis and secondary changes in the epididymis make the chances of successful restoration of fertility only a little better than 50%. There are four causes of failure of vasectomy reversal: 1) in about half of patients there is stenosis or blockage of the previous vaso-vasostomy, 2) the second most common cause is epididymal blockage, 3) development of a very high antisperm antibody response to the vasectomy, and 4) cessation of spermatogenesis.