Vasectomy Effectiveness -- December 4, 2003

WASHINGTON, DC -- Global vasectomy experts agreed Wednesday that modifying a simple ligation and excision technique commonly used in developing countries to perform male sterilization can increase its effectiveness.

The experts reviewed a growing body of both published and unpublished vasectomy research during the first day of a three-day expert consultation on vasectomy cosponsored December 3 to 5, 2003, by the Research Triangle Park, NC-based Family Health International (FHI) and the New York City-based EngenderHealth. Working together, the organizations have recently completed a series of studies addressing the effectiveness of different vasectomy methods. Because post-vasectomy pregnancies are rare and difficult to study, these recent research findings are based on semen analysis rather than pregnancy data.

Simple ligation and excision vasectomy involves cutting and removing a short piece of the vas deferens (each of two tubes that carry sperm from the testicles to the penis), then tying the remaining two ends. This procedure is safe and highly effective. However, participants at the experts' meeting agreed that modifying ligation and excision by adding a technique called fascial interposition reduces the likelihood of vasectomy failure, as defined by semen analysis. Fascial interposition involves pulling the sheath that covers the vas over one severed end, then sewing it shut to create a natural tissue barrier.

Available data also suggest that use of cautery (burning the inside of the ends of the vas) is more effective than ligation and excision, the experts agreed. Still unknown, however, is whether cautery is more effective than ligation and excision with fascial interposition.

A preliminary evaluation of a battery-powered, hand-held cautery device suggests that disposable thermal cautery devices may be effectively processed and safely reused. The experts recommended further study of the programmatic feasibility of using cautery devices in a cost-effective way in low resource settings.

The vasectomy experts also recommended that:

• Training of vasectomy providers emphasize the potential increased effectiveness of vasectomy when fascial interposition is added to the standard technique of ligation and excision.

• Providers now using simple ligation and excision consider adopting fascial interposition, with appropriate training as needed.

• Where resources, training, and logistical support are available, cautery can be considered as an effective and safe way to block the vas.

Finally, the experts strongly recommended use of a no-scalpel approach – rather than the standard incisional approach – to the vas since it is well established that the former approach has significantly fewer side effects and complications.

More information about vasectomy is available here and at:
http://www.engenderhealth.org/wh/fp/cvas2.html.

Published Sources:

Chen-Mok M, Bangdiwala SI, Dominik R, et al. Termination of a randomized controlled trial of two vasectomy techniques. Controlled Clinical Trials; 2003;24(1):78-84.

LaBrecque M, Nazerali H, Mondor M, et al. Effectiveness and complications associated with two vasectomy occlusion techniques. J Urol 2002;168(6):2495-98.

Sokal DC, Irsula B, Chen-Mok M, et al. A comparison of vas occlusion techniques: cautery vs. ligation and excision with fascial interposition. Contraception 2003;68:143 [abstract #14].

Family Health International is dedicated to improving lives, knowledge, and understanding worldwide through a highly diversified program of research, education, and services in family health and HIV/AIDS prevention and care. Since its inception in 1971, FHI has formed partnerships with national governments and local communities in countries throughout the developing world to support lasting improvements in the health of individuals and the effectiveness of entire health systems.

Founded in 1943, EngenderHealth is a nonprofit organization that has been working internationally for more than 30 years to support and strengthen reproductive health services for women and men worldwide. Since its inception, its work has improved the health and lives of more than 100 million individuals in 90 countries.