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  • Title: A comprehensive review of the sequelae of male sterilization.
    Author: Frances M, Kovacs GT.
    Journal: Contraception; 1983 Nov; 28(5):455-73. PubMed ID: 6370585.
    Abstract:
    This study of the sequelae of vasectomy considers morphological and immunological changes, epidemiological studies, reversibility, and psychological aspects. The data on morphological changes after vasectomy are diverse and contradictory, as a wide range of experimental animals have been studied. The number of studies on men has been limited, but they suggest little histologic change in testicular morphology or spermatogenesis. Hormonal changes after vasectomy are difficult to assess because of the large fluctuations in semen levels of testosterone and gonadotropins. Most of the studies on this topic have been small and have lacked controls, with comparisons consisting of pre-post differences in the same subject group. The only prospective controlled study found no differences between vasectomized and control subjects on any of the hormones investigated. 2 large-scale studies have also produced conflicting results; 1 found no changes in hormone levels, and the other found that only follicle stimulating hormone levels did not change. It is apparent from the studies that any hormonal fluctuations after vasectomy remain within the normal range, and it has not been demonstrated that testicular endocrine function or the relationship of the pituitary to the testis are in any way adversely affected by vasectomy. It has been shown that after vasectomy 50-60% of men develop sperm agglutizating antibodies while 20-30% develop sperm immobilizing antibodies. The implications are 1) that if some of the antibodies are nonspecific or cross-reacting, the incidence of autoimmune disease may be increased in vasectomized men; and 2) the persistence of sperm antibodies may cause failure of reversal attempts despite anatomical patency. Studies of the incidence of atherosclerosis in vasectomized monkeys showed that they developed antisperm antibodies and much more extensive atherosclerosis than controls, causing concern because of the phylogenic closeness of monkeys to man. Epidemiologic studies as yet furnish insufficient evidence to extrapolate findings on postvasectomy atherosclerotic lesions in monkeys to man. There is no clinical evidence after several large studies to show that vasectomy is harmful to the circulatory system in man, but surveillance of men who have undergone vasectomy is indicated. Pregnancy rates after reversal attempts are not as high as success rates in terms of canalization and sperm appearance in the ejaculate, but it is not yet known what causes the difference. No adverse psychological effects of vasectomy have been demonstrated in developed countries, and the high incidence of regret and other psychological effects in developing countries may be due to a lack of truly voluntary consent.
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