The 130th Annual Meeting of APHA

Abstract #44604

David C. Sokal, MD¹, Belinda Irsula, AS¹, Melissa Hays, MPH², Mario Chen-Mok, PhD², and Mark Barone, DVM, MS³. (1) Clinical Research Department, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, 919-405-1466, dsokal@fhi.org, (2) Biostatistics Division, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, (3) EngenderHealth, 440 Ninth Ave, New York, NY 10001

Background: The benefit of imposing a layer of the vas sheath between the cut ends of the vas during vasectomy is unclear. We designed a multicenter RCT to evaluate this technique. Methods: The study was to include 1200 men at 8 centers. Men were randomized to have a vasectomy with or without fascial interposition (FI). All vasectomies were performed by excision of 1 cm of vas and ligation of each cut end. The FI technique was performed using sutures to contain the testicular end of the vas inside the fascial sheath with the prostatic end outside. Semen testing was done every 4 weeks for a maximum of 34 weeks or until azoospermia was confirmed. Results: Following the planned interim analysis, we halted recruitment. Among a total of 517 men, FI improved vasectomy success, with a significant interaction between age and treatment group. Among men < 35 years, 91% of men in the FI group reached azoospermia by 34 weeks compared to 76% of men in the non-FI group, but FI in older men showed no benefit. Using an alternate definition of success, less than 100,000 sperm/ml rather than azoospermia, 92-93% of men in the FI group reached success, while in the non-FI group, 77% of men < 35 years and 86% of men ³ 35 years reached success. Discussion: FI is a valuable part of the vasectomy procedure. A limitation of this study is that the correlation between post-vasectomy sperm counts and the risk of pregnancy is not well understood.

Learning Objectives:

• Understand why the risk of pregnancy after vasectomy may depend on a surgeon's vasectomy technique
• Identify key aspects of vasectomy techniques
• Recognize the program implications of different vasectomy techniques

Keywords: Male Reproductive Health, Family Planning

Related Web page: www.fhi.org/en/fp/fpother/conferences/vascet/vasectomymtg.html

Presenting author's disclosure statement:
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.