Vasectomy as a method of contraception. A review

Various aspects of vasectomy are discussed. The operation is ineffective in 0-5% of the operations (depending on the method used) caused by the resection of an incorrect structure or by spontaneous recanalization. Azoospermia after vasectomy is unpredictable but occurs before the 29th ejaculation in 75% of the cases. 2 negative sperm counts with a month between them taken 3 months after the operation is considered sufficient to determine azoospermia. Single spermatozoa in the ejaculate have an uncertain significance; theoretically only 1 spermatozoon is necessary for fertilization. Persisting spermatozoa in the ejaculate point to failure of the operation or infrequent ejaculation. Sperm counts should be taken regularly to determine when azoospermia begins or if spontaneous recanalization takes place. The most frequent complications of vasectomy are sperm granuloma (8%) and epididymal congestion (5%). A table of various operation techniques is presented. Less than 1% of vasectomy patients request refertilization. 80-90% of these patients show spermatozoa in the ejaculate and 25-50% lead to pregnancy. Sperm autoantibodies occur in 30-50% of patients undergoing vasectomy. Sperm immobilizing antibodies can cause sterility. Men with marital sexual or psychosexual problems should not undergo vasectomy.