Vasectomy

Vasectomy

Vasectomy is a surgical procedure for male sterilization or permanent contraception.

It is a minor surgery to block sperm from reaching the semen that is ejaculated from the penis. Semen still exists, but it has no sperm in it.

Once done, a future request for reversal of the procedure is not definite and easy, hence one should consider this as a permanent and possible irreversible procedure. There are various centers which may offer to do reversal of vasectomy, but they are not an easy procedure to do.

Hence it is always advisable to inform your wife or spouse of your intention to proceed with vasectomy.

One should also understand that there are rare cases that recanalization may occur, with sperm continuity reestablished again.

During the procedure, the male vasa deferentia (sperm tubes) are cut and tied or sealed on BOTH SIDES so as to prevent sperm from entering into the urethra and thereby prevent fertilization of a female through sexual intercourse.

Vasectomy procedure where the vas deferens of both sides is cut and a small piece may be removed, leaving a short gap between the 2 ends. Pic from Wikipedia.

Procedure

Local anesthesia will be injected to numb the area. You may need some sedation occasionally. If you feel pain during the procedure, you can let your urologist know so you can get more anesthesia.

1 or 2 small cuts are made in the skin of the scrotum to reach the vas deferens (sperm tube). The vas deferens is cut and a small piece may be removed, leaving a short gap between the 2 ends. Next, the urologist may sear the ends of the vas, and then tie the cut ends with a suture.

These steps are then repeated on the other vas, either through the same cut or through a new one. The scrotal cuts may be closed with dissolvable stitches or allowed to close on their own.

Your urologist will give you instructions for care after a vasectomy.

  • Swelling and pain can be treated with an ice pack on the scrotum and wearing a supportive undergarment, such as a jockstrap. Most men heal fully in less than a week. Many men are able to return to their job as early as the next day.
  • You should avoid any unprotected sexual intercourse until the urologist says it is safe to do so. Use contraception until your urologist says it is safe enough not to use it. This is because the vasectomy does not work right away. After the vasectomy, new sperm will not be able to get into the semen, but there will still be lots of sperm in the left-over vas deferens (sperm tube) that takes time to clear. You will have to follow up with your urologist for regular repeated semen analysis to check for sperm in your ejaculate. During this time, you should use other forms of birth control.
  • You should avoid sex or activities that take a lot of strength.

The time it takes for your ejaculate to be free of sperm can differ. Most urologists suggest waiting to check the semen for at least 3 months or 20 ejaculates, whichever comes first. One in 5 men will still have sperm in their ejaculate at that time, and will need to wait longer for the sperm to clear.

You should not assume that your vasectomy is effective until a semen analysis proves it is, and your urologist has given the green light to proceed with unprotected sexual intercourse.

Post-vasectomy semen analysis (very important that this is done as instructed by your doctor):

Post Vasectomy Semen Analysis (PVSA)

Semen testing to confirm the absence of sperm in your semen (azoospermia) following vasectomy is an absolutely essential part of the process. This is why you have been asked to produce a semen sample for testing following your vasectomy procedure.

This process enables your doctor to confirm that the vasectomy procedure has been successful. You will need to produce more than one sample over a period of time to ensure that sperm do not start to appear again in your semen sample.

Semen analysis is the examination of your semen using a microscope to determine in your case whether or not sperm are present to allow us to confirm if your vasectomy procedure has been successful.

It is recommended that you have at least 20 ejaculations within the 12-week period after your vasectomy. Depending on the results of your initial sample, you may be asked by your physician to provide another sample.

You must utilize an alternate method of contraception until cleared by your physician. You are considered fertile following vasectomy until, as per the American Urological Association recommendations, at least one semen analysis shows no fertile sperm.

On rare occasions, the vasectomy can fail and the vas deferens tubes can rejoin.

What do I have to do?

Firstly, you need to ensure at least the minimum two completed semen analysis for a post vasectomy semen analysis at 12 weeks and 20 weeks after your vasectomy.

You can either produce your samples at the center or, if you live within 30 minutes travel time of the center you have the option to produce the sample at home.

You will be provided with a suitable sterile container on both occasions when you arrive or you can collect your containers from the center prior to your appointment if you wish to produce at home. We will only accept samples produced into our own containers as we know these are fit for purpose and will not compromise the quality of the sample.

Secondly, your sample should be produced no sooner than 12 weeks post vasectomy and that your second samples is produced no earlier than 20 weeks post vasectomy.

Before you produce the first sample you must ensure that you have ejaculated at least no less than 20 times following your vasectomy. These measures are in place to ensure that we are as likely as possible to be able to give you clearance post vasectomy with as little inconvenience to you as possible.

In order to get the best sample from you we require you to abstain from any sexual activity (including masturbation) for between two and five days (but in no case more than seven days) prior to your appointment date.

How do I collect the sample?

Samples are either produced on site in the dedicated sample rooms or at home in certain cases.

  • Ensure that you have been provided with a completed semen analysis request form from your doctor and they have indicated the test required is a post vasectomy semen analysis. Abstain from any sexual activity for two to five days but for no more than seven days.
  • Always provide the sample during office hours as it needs to be interpreted and reported immediately. Preferably give the semen sample on the morning of the working day. If not, the report may falsely show dead sperms and give an impression that there are no viable sperms in your semen.
  • Thoroughly wash, rinse and dry your penis, testicles and hands before you produce the sample
  • If producing the sample at home; masturbate and collect the sample into the container making sure you tightly cap it and place it in the self-sealing bag provided. Immediately transport the sample to the center keeping it close to the body for example in a jacket pocket during transportation. Avoid temperature extremes during transportation.
  • If producing at the center, masturbate and collect the sample into the container making sure you tightly cap it and give it to the laboratory.
  • Inform us if any of the sample is missed during production. Most of the sperm in the ejaculate are contained in the first part. If you do miss some of the sample we may ask you to repeat the test to ensure an accurate result can be provided.

Your semen specimen obtained at home can be brought by yourself to the hospital only if:

  • It can be in the laboratory within half hour of collection, and
  • It is kept at room temperature during that time.

It is still the best that you produce your semen specimen while you are at the hospital itself.

Please note that masturbation is the only recommended method for collecting the sample ‘cleanly’ for analysis. The withdrawal method (vaginal, oral or anal) is not recommended as it is likely that some of the sample will be lost and may in any case be contaminated. The first part of the ejaculate contains most of the sperm so this is particularly important.

Ordinary condoms cannot be used for collection during masturbation as these contain a spermicide which will kill any sperm in the ejaculate.

Please note the following important instructions and guidelines for semen collection:

  • The sample should be collected after a minimum of 2 days, and a maximum of 7 days, of sexual abstinence.
  • If you choose to collect the specimen at home, it must be collected in a clean specimen container with a secure lid, such as one with a screw-on cap. If you do not have the proper container, please contact the Urology clinic to obtain a sterile container for collection. Do not bring the specimen in a bag, or a condom, etc.
  • The specimen must be collected by masturbation directly into the container. Avoid use of lubricants as they are toxic to sperm. It is important to collect an entire specimen and it is critical that you notify the lab if any of the semen was lost.
  • Because sperm are very sensitive to temperature changes that might be encountered during transport, the best place to collect the specimen is here in the hospital.
  • If you perform the semen collection at home, please make certain that you bring it to the lab within 30 minutes and kept at body temperature.

How will my sample be tested?

We examine the sample under the microscope to determine if any sperm are present in the sample and carry out the following tests:

  • Sperm volume.
    We record the actual volume in millilitres of the semen sample you provided. We do not expect you to fill the container; an average ejaculate will be around 2.5 ml but some men will produce more or less semen.
  • Sperm concentration (sperm count).
    Reported as millions per millilitre of semen. We use a microscope to identify if sperm are present in a droplet of your sample and if any are, we count the number of sperm in the sample using a special counting chamber and report this finding to your doctor.
  • Sperm motility
    If sperm are present in the sample, the sperm are grouped into four groups with the strongest swimmers (grade ‘a’) being the most fertile. If there are motile sperm in your sample we cannot grant you clearance as just a single motile sperm could fertilize an egg.
  • Sample centrifugation
    If no sperm are seen from the droplet of sperm examined we load the whole sample into a test tube and spin it in a machine called a centrifuge which causes any cells in the sample (including sperm) to form a concentrated ‘pellet’ in the bottom of the tube. This can then be harvested and examined under the microsope to confirm whether or not there are sperm present in your sample.

How do I know when my sample is clear?

Clearance post-vasectomy is defined as follows:

  • One sample where there are no sperm in the ejaculate (azoospermia) as long as acceptance criteria have been met (samples with no sperm in the ejaculate)
  • One sample with <100,000 immotile sperm cells, followed by an azoospermic sample

If your samples fall into these criteria following analysis you will be granted clearance to stop using other forms of contraception.

There are still sperm in my sample(s), what does this mean?

Persistent non-moving (immotile) sperm can remain in men for several reasons and your doctor will explain what they believe is the reason for this to you. ‘Special clearance’ can be granted by your doctor in such cases where a concentration of less than 10,000 immotile sperm remains 28 weeks following vasectomy. The doctor need to be consulted for interpretation on such case scenarios.

Azoospermia and <0.1×106 non-motile sperm per mL (or <100,000 non-motile sperm per mL) are reliable indicators of vasectomy success. The doctor need to be consulted for interpretation on such case scenarios.

Incomplete ejaculation and/or incomplete collection of total ejaculate may cause false oligospermia (low sperm count) or false azoospermia.

If >0.1×106 non-motile sperm per mL (or >100,000 non-motile sperm/mL) persist beyond six months after vasectomy, then trends of serial post-vasectomy semen analyses and clinical judgment should be used to decide whether the vasectomy is a failure and whether repeat vasectomy should be considered. The doctor need to be consulted for interpretation on such case scenarios like this.

If there is a persistence of non-motile sperms, fewer than 100,000 per ml non-motile sperms in the second specimen, and after a repeat specimen again, you will be given a “special clearance”. This means it is extremely unlikely that you can produce a pregnancy. The doctor need to be consulted for interpretation on such case scenarios like this.

The institution or doctor cannot be held accountable where clearance on such case scenarios like this has been granted in such circumstances and a patient then goes on to form a pregnancy.

Key Points

  • Vasectomy is the most effective method of male sterilization
  • It should always be regarded as “irreversible”
  • You will not be sterile immediately, but will need to continue alternative contraception until you have been given the “all-clear” from at least 2 post-operative semen tests after at least 12 weeks and 20 ejaculations, and a second sample after 20 weeks
  • Late failure (recanalization), due to the ends joining themselves back together, occurs in 1 in 2000 men
  • There is no evidence that vasectomy causes any long-term health risks (e.g. testicular cancer, prostate cancer)
  • Troublesome chronic testicular pain is reported in up to 15% of patients and can be severe enough to affect day-to-day activities in up to 5%

Informative link to post-vasectomy semen analysis from Cambridge IVF, and FAQs on this:

https://www.cambridge-ivf.org.uk/patients/andrology-services/post-vasectomy-semen-analysis-pvsa

Another informative link from University of Virginia School of Medicine:

https://med.virginia.edu/urology/wp-content/uploads/sites/248/2015/11/PatInstructionsPostVasecSemen.pdf

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