Vasovasostomy results in 66 patients related to obstructive intervals and serum agglutinin titres

In this series we present the results of a retrospective analysis of 66 vasovasostomy procedures performed between 1983 and 1991. Obstructive intervals and serum antisperm antibodies were correlated with pregnancy and patency rates. With obstructive intervals of less than 5 years a patency rate of 100% (31/31) was obtained. Even more than 10 years after reversal, pregnancy occurred in 25% (2/8) of the patients. Preoperative serum antisperm antibodies were correlated with pregnancy rates. Patients with a high agglutinin titre of 1/64 obtained a pregnancy rate of 23% (3/13). Those men who had no circulating antisperm antibodies in their blood had a significantly better chance in obtaining pregnancy (pregnancy rate 80%). In this study we accounted for an overall pregnancy rate of 51.5% (34/66) versus an overall patency rate of 84.8% (56/66). Neither long obstructive intervals nor high antisperm antibody titres should dissuade a surgeon from performing a vasovasostomy procedure.

The safety of vasectomy: recent concerns

Vasectomy has been accepted for family planning by approximately 42 million couples worldwide, the majority of whom live in developing countries. It is a highly reliable and safe contraceptive method, which has been extensively studied. Recently, however, renewed concerns have been raised about a possible effect between vasectomy and cancer of the prostate many years after the procedure has been performed. These concerns are based on research conducted in the USA, where there is a high and rising incidence of prostate cancer. This review discusses the evidence for this association and its potential impact in developing countries. The factors influencing the development and growth of prostate cancer are poorly understood and complicate any research into risk factors for the disease. Overall incidences of prostate cancer in some developed countries, such as the USA, are fifty times higher than in some developing countries, such as China. The majority of epidemiological studies on the relationship between vasectomy and prostate cancer have been based in the USA, but the findings are inconsistent and the reported associations weak. On the basis of currently available data, no changes in family planning policies with regard to vasectomy are warranted, but the concerns raised by these studies require that research into any possible association be undertaken in developing countries where vasectomy is widely practised.

Vasectomy, serum assays, and coronary heart disease symptoms and risk factors

We compared three serum assays (two antisperm antibody assays and one assay for circulating immune complexes) and a number of CHD-related variables in 69 vasectomized (V) and 126 non-vasectomized (NV) participants in the Portland Center for the Multiple Risk Factor Intervention Trial. Significant differences between the V and NV men were found in sperm agglutination (SA) and sperm immobilization (SI) titers, as well as in several CHD risk factors, symptoms, and treatments; men in the V group had higher titers for SA and SI, smoked more, and had lower diastolic and systolic blood pressure than men in the NV group. Differences between V and NV in SA and SI activity remained even after we controlled for any effects that CHD risk factors, symptoms, and treatments may have had on the serum assays. Antibody development tended to decrease with age-at-vasectomy and increase with time-post-vasectomy. In the case of SA the antibodies clearly increased with time-post-vasectomy.

Anti-sperm antibodies and semen profiles in re-anastomosed men

A group of 29 re-anastomosed men were examined with respect to semen quality, anti-sperm antibody titres in serum and seminal plasma, presence of anti-sperm antibodies on sperm, and success rate in inducing pregnancy. Results indicated no association between pre-reversal serum anti-sperm antibody titres and post-reversal semen quality, but a pregnancy induction rate of zero was associated with serum anti-sperm antibody titres greater than 160. It is recommended that men considering reversal, with anti-sperm antibody titres of this level, should receive counselling about the possibility of post-reversal infertility.

The WHO Task Force on Vaccines for Fertility Regulation. Its formation, objectives and research activities

Over the past 18 years, the WHO Task Force on Vaccines for Fertility Regulation has been supporting basic and clinical research on the development of birth control vaccines directed against the gametes or the preimplantation embryo. These studies have involved the use of advanced procedures in peptide chemistry, hybridoma technology and molecular genetics as well as the evaluation of a number of novel approaches in general vaccinology. As a result of this international, collaborative effort, a prototype anti-HCG vaccine is now undergoing clinical testing, raising the prospect that a totally new family planning method may be available before the end of the current decade.

Reproductive failure and antisperm-antibody production among prostitutes

Reproductive failure and anti-sperm antibody (ASA) production among prostitutes were investigated. A questionnaire including the subject's age, years of prostitution, date of most recent birth, number of children and contraceptive method used at the beginning of prostitution were asked of 109 prostitutes, but only 53 agreed to complete the questionnaire. ASA was detected by ELISA in the prostitutes (n = 109) and in the control group (n = 40) sera. The tests revealed a high ASA rate (43.1%) among the prostitutes. The difference in the incidence of ASA between controls (5%) and the prostitutes (43.1%) was highly significant (p less than 0.01). It was found that ASA positivity incidence in 27 prostitutes who had never use any contraception method and who became infertile within 9.3 years (average) was 61.3%. These results may be explained by repeatedly inoculations with multiple sperm antigens and/or microorganisms.

Vasectomy reversal

A small personal series of vasovasostomies and a review of the literature on this subject are presented. The importance is stressed of good counselling before vasectomy is undertaken in the first place.

Post-vasectomy antisperm immune reaction after testosterone-induced azoospermia

We describe preliminary experiments on the effects of testosterone-induced azoospermia on post-vasectomy antisperm antibody reaction in two subjects. Progressive resumption of spermatogenesis following gradual suspension of testosterone therapy was still associated with antisperm antibody formation. Post-vasectomy antisperm antibody production does not seem to be triggered exclusively by acute, sudden and massive reabsorption of spermatoza after vasectomy but also by slow, gradual and late sperm antigen reabsorption.

Antisperm antibodies and circulating immune complexes of vasectomized men with and without coronary events

We compared antisperm antibody and circulating immune complex (CIC) levels in serum samples from 101 vasectomized and 101 normal age-matched nonvasectomized men; 31 of each group had histories of coronary heart disease (CHD). Vasectomy and CHD status were treated as categorical independent variables in the two-way analysis of variance. Elevations of both systolic and diastolic blood pressures were significantly associated with age and body mass index but not vasectomy. Antisperm antibodies (immobilizing and agglutinating) were significantly associated with vasectomy (P less than or equal to .001); the incidences were similar in men with and without CHD. The CICs were significantly associated with vasectomy in a Staphylococcus aureus (FcSa) CIC assay (P less than or equal to .001) and a Raji cell CIC assay (P less than or equal to .05). A third CIC assay, the Clq binding assay, did not reveal a difference between any subgroups. Generally, CICs occurred more frequently in the CHD group by the FcSa assay and particularly the Raji cell assay (P less than or equal to .001). In summary, vasectomized men had a higher incidence and higher levels of circulating antisperm autoantibodies and CICs than did age-matched controls.