Vasectomy

Vasectomy

Vasectomy is a permanent male contraceptive procedure involving surgical disruption of the vas deferens to prevent sperm from entering the ejaculate, thereby preventing pregnancies. It is considered a safe, effective, and outpatient-based method of male contraception.

Indication

1. Couples with completed family - most common indication.

2. If female partner has contraindications to tubectomy or pregnancy due to underlying health issues like severe cardiac disease, clotting disorders, severe hypertension or any condition where anesthesia and surgery is dangerous or life-threatening.

3. Medical, genetic, or social reasons to avoid future pregnancies.

4. Men seeking personal reproductive control.

Types of vasectomy

CONVENTIONAL VASECTOMY

1. Involves a small incision on each side of the scrotum to access the vas deferens, through which the vas is then cut and a small segment removed. Ends are then sealed with clips, ties or cautery (heat).

NO-SCALPEL VASECTOMY (NSV)

1. Uses a sharp-tipped forceps to puncture the skin instead of a scalpel through which the vas is then handled. This is a preferred technique in India under the National Family Planning Mission.

2. Less bleeding, fewer complications, quicker recovery.

PROCEDURE

1. Pre-procedure: Informed consent, genital shaving, antiseptic prep of the area is done (scrotum and perineum).

2. Anesthesia - local anesthesia - 1% lignocaine is used General anesthesia is rarely required (eg - anxious patients or when combined with other procedures).

Steps:

1. Local anesthesia injected into scrotal skin and around vas deferens.

2. Vas is accessed via small incision or puncture.

3. Vas deferens is cut and a segment removed (3–4 cm).

4. Ends are ligated or cauterized and often separated to reduce recanalization.

5. Skin closed or left to heal naturally in NSV.

Cost

1. Public sector - The procedure is free under the National Family Planning initiatives. Also men receive monetary compensation up to 1500 Rs for undergoing the procedure.

2. Private Sector - 5000-15,000 Rs depending on the hospital, state, procedure and additional anesthesia if required. Follow up - to confirm azoospermia (complete absence of sperms )- semen analysis needs to be done which can cost around 200-1500 Rs.

Efficacy: 99.85 %

1. Failure rate : 1 in 2000 procedures after azoospermia is confirmed not effective immediately.

Advantages

1. Simple, quick outpatient procedure (10–15 minutes).

2. Minimum downtime- it is a daycare procedure with local anesthesia, hence no extended hospitalization or medication is required.

3. Minimal complications- relatively small operating field and time, results in almost no blood loss or chances of infection.

4. Permanent and highly effective once azoospermia is confirmed with semen analysis (after 3 months or 20 ejaculations).

5. No effect on sexual drive, erection, ejaculation, or hormones- as the procedure only blocks the vas deferens and doesn't impact the production of semen and testosterone (which influences drive).

Disadvantages

1. Not reversible in most cases.

2. Offers no protection against STIs.

3. Minor post-op complications (pain, bleeding leading to hematoma, infection, (sperm granuloma)- these complications are rare.

4. Psychological discomfort for some men about loss of fertility.

Reversal

Vasovasostomy (reattaching both the ends of the vas deferens) or Vasoepididymostomy (reattaching the distal end of the vas deferens directly to the epididymis) can be attempted micro surgically.

Success of reversal depends on:

1. Time since vasectomy- shorter the interval between vasectomy and recanulation better chances of success (<10 years = better outcome).

2. Surgeon expertise- microsurgeries have a steep learning curve, hence surgeon experience and expertise affect the success rate.

3. Presence of anti-sperm antibodies-antisperm antibodies develop in the vas deferens due to vasectomy which can be harmful to the vitality and reproductive function of the sperms.

4. Pregnancy rates post-reversal: 30% The procedure is cost intensive and there is no way to guarantee a positive outcome.

Vasectomy is a safe, effective, and underutilized method of male sterilization, especially in India where female sterilization is more prevalent. Promoting vasectomy can help balance the gender disparity in contraceptive responsibility.

References

1. FSRH Service Standards for Vasectomy (April 2024). (n.d.). https://www.fsrh.org/Public/Documents/fsrh-service-standards-for-vasectomy-april-2024.aspx

2. Research Studies & Standards Division, Ministry of Health and Family Welfare, & Government of India. (2006). Standards for female and male sterilization services. https://nhm.gov.in/images/pdf/guidelines/nrhm-guidelines/family-planning/std-for-sterilization-services.pdf