Vasectomy is a permanent, sometimes reversible male contraceptive method. It consists of cutting the two vas deferens which allow sperm to escape from each of the testicles and reach the prostate before being expelled during ejaculation.
Fast and safe, the minimally invasive “no scalpel” technique
This rapid intervention, without major contraindications, was authorized in France in 2001. Since then, the number of vasectomies has increased, and even exponentially since 2017: there were 1,908 interventions per year at the start of the 2010s and in 2022, this figure reached 30,292, or 15 times more in just 12 years!
Today, the minimally invasive “no scalpel” technique is the most used. Carried out on an outpatient basis and under local anesthesia, it causes very few complications and in particular very few hematomas.
The procedure consists, in around ten minutes, of making a small perforation in the scrotum (the bag of skin and fibromuscular tissue located at the root of the penis), then exteriorizing the vas deferens using forceps. ring. Once out, the channels are cut.
Although this method is deemed safe, sometimes sperm are still detected when a control spermogram is carried out 3 months later.
Nothing abnormal in this, except that it generally reflects a failure to respect the protocol by the person concerned himself. Because for the vasectomy to be effective, it is essential to observe certain rules.
This was recalled in the 1era recommendations on the subject by the Committee of Andrology and Sexual Medicine of the French Association of Urology (AFU) published last year.
Rules to follow for an effective vasectomy
The persistence of spermatozoa in the control spermogram often worries patients. Doctors sometimes have difficulty managing these situations, as recognized by Dr. Boris Delaunay, urologist at Toulouse University Hospital, during the 118th congress of the French Association of Urology (November 20-23, 2024, Paris): “ it is neither exceptional nor worrying,” he reassures.
“Perhaps the patient did not follow the recommendations of performing 20 to 30 ejaculations within three months after the vasectomy to clean the genital tract. Indeed, once the vas deferens have been cut, they must be properly “drained”. »
The urologist adds: “vasectomy often represents a transition phase for the couple. The woman removes her IUD or stops taking the pill, and during this period, they sometimes use condoms. This can cause some men to fear that their partner will become pregnant, reducing the frequency of sexual intercourse and, therefore, the number of ejaculations needed to empty the genital tract. »
If, three months after the vasectomy, the spermogram confirms the total absence of spermatozoa in the ejaculate (azoospermia) or only shows rare immobile spermatozoa (less than 100,000 spermatozoa/mL), no additional control is necessary. ; the man is considered sterile. The spermogram must be carried out at three months, and not earlier, otherwise the results will be distorted.
Another reason why a man is not considered sterile three months after a vasectomy may simply be carrying out the control spermogram too early. According to the urologist, many patients perform this examination too early, often at two or two and a half months.
Furthermore, in some men, motile sperm may persist or a larger quantity of immotile sperm is detected (>100,000 sperm/mL). During this transitional period, an alternative method of contraception must be used.
If sperm persist at three months, a new spermogram is recommended at six months. If there are motile spermatozoa or more than 100,000 immotile spermatozoa per milliliter at six months, a new intervention should be considered.
Rarer factors
Other factors can explain a sterilization failure such as an ineffective surgical procedure due to technical difficulties (inconspicuous, buried vas deferens, etc.). The doctor may wrongly believe he has cut the vas deferens.
Another possible cause is “late recanalization” of the vas deferens. This phenomenon is very rare (0.04% of cases). To limit this “reconnection” of the two ends of the severed vas deferens, the AFU has drawn up good practices to follow for urologists during the vasectomy procedure.
Finally, some men have 3 vas deferens, 2 of which are on the same side. The urologist can therefore cut two without imagining that there is a third. This anatomical anomaly is extremely rare and a study published in 2018 identified 29 cases worldwide.
