Vasectomy

Family Health International (FHI) believes that the following research and programmatic findings, if more widely incorporated into policies and programs, could improve family planning and reproductive health services. FHI is committed to promoting more extensive use of these and related research findings. If you would like more information, or if you are interested in technical assistance on using these results, contact the Research to Practice team. This page is part of a larger guide on family planning research. To read other sections of the guide, click here.

• The skill and training of a surgeon, and techniques used during a vasectomy, can affect the success rate, degree of pain, and number of complications experienced by the client.

  • Studies continue to show that vasectomy is an extremely safe and effective form of contraception. However, success rates can vary depending on the skill of the surgeon and technique used. The vasectomy procedure entails two major steps: (1) isolation of the vas, using the standard incision or no-scalpel technique; and (2) occlusion of the vas, for which a variety of techniques may be used. One study also suggests that the type of suture material used for ligation of the vas might affect the rate of vasectomy success.
    • Kotwal S, Sundaram SK, Rangaiah CS, et al. Does the type of suture material used for ligation of the vas deferens affect vasectomy success? Eur J Contracept Reprod Health Care 2008 Mar;13(1):25-30. (abstract)
    • Schwingl P, Guess H. Safety and effectiveness of vasectomy. Fertil Steril 2000;73(5):923-36. (abstract)

  • Comparison of the no-scalpel and standard incision methods reveals that while the efficacy of the two approaches is virtually identical, the no-scalpel technique requires a shorter operating time and leads to fewer complications, less pain, and a more rapid resumption of sexual activity.
    • Cook LA, Pun A, van Vliet H, et al. Scalpel versus no-scalpel incision for vasectomy. Cochrane Database Syst Rev 2006(4):CD004112, 20. (full text)
    • Sokal D, McMullen S, Gates D, et al. A comparative study of the no scalpel method and standard incision approaches to vasectomy in 5 countries. J Urol 1999;162(5):1621-25. (abstract)

  • Ligation and excision is currently the most common method used for vas occlusion worldwide. Adding fascial interposition to ligation and excision reduces failure rates by about half. Providers currently using only ligation and excision should consider adopting fascial interposition, with appropriate training as needed.
    • Aradhya KW, Best K, Sokal DC. Recent developments in vasectomy. BMJ 2005;330(7486):296-9. (abstract)
    • Chen-Mok M, Bangdiwala S, Dominik R, et al. Termination of a randomized controlled trial of two vasectomy techniques. Control Clin Trials 2003;24(1):78-84. (abstract)
    • Labrecque M, Hays M, Chen-Mok M, et al. Frequency and patterns of early recanalization after vasectomy. BMC Urol 2006 Sep 19.6(Article No. 25):9. (abstract)
    • Sokal D, Irsula B, Hays M, et al. Vasectomy by ligation and excision, with or without fascial interposition: a randomized controlled trial. BMC Medicine 2004;2:6. (full text)

  • Some research and expert opinion suggest that intraluminal thermal cautery with fascial interposition is a more effective method of vas occlusion than ligation and excision with fascial interposition; however, they have not been compared in a randomized controlled trial. Hand-held thermal cautery devices, powered by standard AA alkaline batteries, are inexpensive and practical for use in low-resource settings. More study of a specific cautery technique in low-resource settings should be done before cautery is recommended for routine use. However, a recent study showed that the costs of training and of adding new techniques such as fascial interposition, thermal cautery, or thermal cautery combined with fascial interposition, are cost-effective compared to the continued use of ligation and excision alone.
    • Aradhya KW, Best K, Sokal DC. Recent developments in vasectomy. BMJ 2005;330(7486):296-9. (abstract)
    • Labrecque M, Dufresne C, Barone M.A, et al. Vasectomy surgical techniques: a systematic review. BMC Med 2004;2(1):21. (full text)
    • Labrecque M, Pile J, Sokal D, et al. Vasectomy surgical techniques in South and South East Asia. BMC Urol 2005;25.5(Article No. 10):6. (full text [PDF, 312 KB])
    • Seamans Y, Harner-Jay CM. Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and Mexico. Cost Eff Resour Alloc 2007 Jul 13;5:8. (abstract)
    • Sokal D, Irsula B, Chen-Mok M, et al. A comparison of vas occlusion techniques: cautery vs. ligation and excision with fascial interposition. BMC Urol 2004;4:12 (full text).

• Successful promotion of vasectomy as a permanent contraceptive method relies on detailed, accurate, and culturally relevant counseling.
  • Bunce A, Guest G, Searing H. et al. Factors affecting vasectomy acceptability in Tanzania. Int Fam Plann Perspect 2007;33(1):13-21. (full text[PDF, 213 KB])

• Patients should be counseled on the procedure's effectiveness, follow-up visits, pain, and use of a backup contraceptive method.
  • Although vasectomy failure rates are generally low, they can vary depending on vasectomy method, the surgeon's experience, and the age of the patient's female partner. Since vasectomy is not 100 percent effective, it is essential that counseling emphasize the small possibility of vasectomy failure. Since a post-vasectomy pregnancy could potentially lead to marital conflict, couples should be counseled to assume that the pregnancy is due to method failure, rather than infidelity.

  • Nazerali H, Thapa S, Hays M, et al. Vasectomy effectiveness in Nepal: A retrospective study. Contraception 2003;67(5):397-401. (abstract)

  • Irrespective of occlusion technique, it takes several months after the procedure is performed for vasectomy to become effective. While older guidelines suggested a waiting period of 20 ejaculations or three months (whichever comes first), new WHO guidelines, based on data from studies by FHI and EngenderHealth, suggest that a three-month waiting period is significantly more reliable than 20 ejaculations.

    • WHO. Selected Practice Recommendations, 2nd Ed. Geneva, 2004. (full text [PDF, 1.2 MB])

  • When possible, the success of vasectomy should be confirmed by semen analysis. However, in developed countries, between one-third and one-half of vasectomy clients do not return for their follow-up semen analyses. A number of studies report that 15 percent to 97 percent of clients do not comply with the follow-up protocol recommended by their provider. If counseling messages on follow-up semen analyses are failing, it is likely that some men also ignore the counseling on using a backup contraceptive method for the proper amount of time after their vasectomy. Men or their partners should use another method of contraception during the first 12 weeks after vasectomy to avoid an unplanned pregnancy. The USFDA recently approved SpermCheck Vasectomy, an immunologic semen analysis test that men can do at home, similar to a home pregnancy test. This test deserves study to determine whether (1) it can improve men's compliance with instructions for postvasectomy semen analysis, and (2) it will be practical or cost-effective for use in low-resource settings.
    • Barone M, Nazerali H, Cortes M, et al. A prospective study of time and number of ejaculations to azoospermia after vasectomy by ligation and excision. J Urol 2003;170(3):892-96. (abstract)
    • Pollack A. Prevalence of occlusion techniques, vasectomy follow-up protocols and compliance with follow-up. Presentation at Expert Consultation on Vasectomy Effectiveness (sponsored by FHI and EngenderHealth), Durham, NC, April 18-19, 2001. (summary report)

  • Research indicates that some men may experience postvasectomy scrotal or testicular pain for months or years after the vasectomy. Usually, the pain is mild and does not lead men to say that they regretted having a vasectomy, but men should be informed of this possibility.
    • Male and Female Sterilisation, Evidence-based Clinical Guideline No. 4. London, UK: Royal College of Obstetricians & Gynaecologists Press, 2004. (summary)

Additional Resources

Topical page: Male Sterilization

Brief: Improving Provision of Vasectomy (PDF, 157 KB)