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  • Title: Male sterilization.
    Author: Davis JE.
    Journal: Curr Opin Obstet Gynecol; 1990 Aug; 2(4):535-40. PubMed ID: 2130950.
    Abstract:
    Reflective of increasing attention to male sterilization are the development in China of the so-called "no scalpel" vasectomy technique, experiments with predicting reversibility through measurement of the cytometry of testicular aspirates, and research on issues such as the effects of vasectomy on spermatogenesis, the immunological consequences of the procedures, and regeneration of the vas deferens proximal to the vas occlusion. Studies have shown that if the vasectomy technique does not allow for permanent vas occlusion (i.e., interpose connective tissue between the proximal and distal ends of the vas), spontaneous recanalization may occur to prevent too much pressure on the testicle. The major histologic findings in such cases are the sprouting of tubules and extravasation of sperm. Even with excellent surgical technique, anatomic and immunologic changes associated with vasectomy imply a return to fertility in little over 50% of cases. Successful reversal can be enhanced, however, by vas sectioning in the straight portion and away from the convoluted portion, minimal resection, closure of the proximal end by fulguration of the mucosal surface, and fascial interposition. Immune factors appear to play a less significant factor in vasovasectomy failure than was previously believed; damage to the testis and epididymis is more likely implicated. A byproduct of the proliferation of research on vasectomy and its sequelae has been greater understanding of the mechanism of sperm transport during ejaculation. There is a constant rate of sperm disappearance after vasectomy, but the number of ejaculations rather than the duration of time after the procedure is the crucial factor to achievement of aspermia.
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