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Clinical Research on NSV

Clinical Research on NSV. Recent Findings and Programmatic Implications. Programmatic Implications of Clinical Research Findings. New evidence on: pregnancy rates following vasectomy effectiveness of different occlusion methods when can men rely on their vasectomy for contraception

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Clinical Research on NSV

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  1. Clinical Research on NSV Recent Findings and Programmatic Implications

  2. Programmatic Implications of Clinical Research Findings New evidence on: • pregnancy rates following vasectomy • effectiveness of different occlusion methods • when can men rely on their vasectomy for contraception • cautery device reuse EngenderHealth

  3. Location Failure rate Time after vasectomy US 1.9% 3 years China 4.2% 1 years 9.5% 5 years Nepal 4.2% 3 years Pregnancy Rates After Vasectomy Sources: Costello et al, Centers for Disease Control & Prevention, unpublished; Wang, Contraception; 2002 and Nazerali et al. Contraception, 2003 EngenderHealth

  4. What is the Best Vas Occlusion Technique? Recent results based on semen analysis: • Retrospective review • Clips - 7.1% (103/1453) • Cautery - 0.09% (1/1165) • Prospective, non-comparative study • Ligation & excision alone - 11.5% (25/217) Sources: Labrecque et al. J Urol 2002; Barone et al. J Urol in press, 2003 EngenderHealth

  5. Vasectomy Failure and Recanalization Rates Recanalization based on qualitative assessment by 3 masked reviewers Failure defined as > 10 million sperm/mL at 12 weeks or later EngenderHealth

  6. When Can Men Rely on Their Vasectomy for Contraception? • Ideal is semen analysis to confirm azoospermia (or severe oligospermia) • Semen analysis unavailable or inaccessible in many low resource settings • A common recommendation is after 12 weeks or 20 ejaculations EngenderHealth

  7. 20 ejaculations 12 weeks 100 90 80 70 60 50 40 30 20 10 0 When Can Men Rely on Their Vasectomy for Contraception? azoospermia < 3 million / mL 3-20 million/ml. 20 million + / mL EngenderHealth Source: Barone et al, in press, 2003

  8. Severe Oligospermia at 12-14 Weeks and 20 Ejaculation After Vasectomy EngenderHealth

  9. Conclusions… • Vasectomy failures may be more common than generally thought, none the less vasectomy is an excellent method • Ligation & excision without fascial interposition is an inferior occlusion method • Cautery appears to be better than ligation & excision with fascial interposition • 12 weeks is a better endpoint than 20 ejaculations for when men can rely on their vasectomy in setting where semen analysis is not practical EngenderHealth

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