Do we really know that vasectomy is a highly effective contraceptive method? There are many reasons to believe that the generally quoted vasectomy failure rate of ‘1% or less’ is probably biased towards the low side. Reporting of pregnancy in a spouse or sexual partner after vasectomy is less likely because of potential issues surrounding paternity and possible infidelity. In many settings semen testing is not routinely provided after vasectomy and follow-up rates are low. Generally, data are not systematically collected. Vasectomy case series are more likely to be published by experienced surgeons, after rates have been improved by application of multiple vas occlusion techniques. Rates are often erroneously calculated using all cases, not just those who return for follow-up semen testing, in the denominator.
We conducted a cross-sectional study in approximately 1000 vasectomy acceptors, randomly selected from more than 30,000 men who received vasectomy during a 3-year period (1996-1999), typically provided through mobile services in the hill districts of Nepal. Vasectomy effectiveness was evaluated 1-4 years post-vasectomy, by semen testing as well as reports of pregnancy in partners. Fifteen of 16 surgeons who performed the vasectomies completed a questionnaire on vasectomy techniques and experience level.
Point estimates and 95% confidence bounds for prevalence of sperm in semen will be presented for this population. Secondary analyses will estimate the prevalence and timing of contraceptive failures after vasectomy, and will explore the association of surgeon characteristics with persistence of sperm (recanalization of the vas or surgical failure).
Learning Objectives: At the conclusion of this session, the participant (learner) in this session will be able to: 1. Recognize three sources of bias that may result in an underestimate of the generally quoted rate for vasectomy failure. 2. Define the measures of vasectomy effectiveness. 3. Quote the observed rate of failure in one national vasectomy program (Nepal). 4. Discuss the program-, provider-, and individual-level factors affecting vasectomy success or failure. 5. Articulate the programmatic implications of new evidence on vasectomy effectiveness.
Keywords: Contraception, Family Planning
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Ministry of Health, Nepal
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.