Male sterilisation

THE famous Scottish philosopher, satirical writer and historian, Thomas Carlyle is considered one of the most important social commentators in the 19th century.

He famously said: “Permanence, perseverance and persistence in spite of all obstacles, discouragements, and impossibilities: It is this, that in all things distinguishes the strong from the weak.”

This must the principle of the “survival of the fittest” proposed by Darwin. “In the long history of humankind and animal kind, those who learnt to collaborate and improvise most effectively have prevailed”. Of course, only the strong and persistent survive all challenges in life.

In medicine, we often observe how the perseverance and tenacity of the robust, works in a mysterious manner. With that consideration, lets deal with one reader’s conundrum when it comes to persistent sperms.

Dear Dr G,

I wonder if you can help me with my problem.

I am a 36-year-old father of three and soon to be a dad again before year-end.

Needless to say my wife and I were very excited about welcoming our new baby but worried about future unplanned pregnancies.

I had built up the courage to get my vasectomy done three months ago. I must confess, it was not as terrible as I expected.

The procedure was carried out under local anesthesia and the doctor managed to distract me with pleasant conversation.

I anticipated experiencing traumatic weeks, but it turned out to be OK.

My doctor told me to return to the clinic to check for the sperm tests.

I am somewhat surprised to learn there were still sperms in the ejaculations on two separate occasions.

My doctor told me to wait for another month until all the “hangers on” are flushed out of the “system”.

Is it normal to have sperms in ejaculations, three months after vasectomy?

Do you think something had gone wrong? If so, how do I find out?

I am rather worried that my wife may get pregnant again.

Please advice,
LOST

Although vasectomy is an effective perfect method of sterilisation, it is not flawless. One of the reasons for vasectomy failures is recanalisation of the ligated vasa.

Recanalisation occurs when the blocked sperm tubes somehow find its way and reconnect on one or both sides after the procedure.

I guess it does not take a genius to work out that sperms are resilient “creatures” which are designed to overcome the hostility and obstacles of the female cervix.

When faced with artificially induced obstruction such as vasectomy ligations, the sperms with their head and tails can potentially burrow through the occlusion and create a “swiss cheese” appearance of the vasectomy gap. This can make the operation completely pointless.

Before men start using recanalisation failure as an excuse to avoid the snip, I must point out that such failure in vasectomy is rare.

The vast majority of catastrophes occurred within the first four months of the intervention, and the incidence can be as rare as one in 2,000 operations.

Vasectomy as a mode of contraception can also be unsuccessful when intimacy occurs too soon after the ligation.

This is because there are live sperms remaining downstream from the vasectomy site, after the occlusions.

As a result, the “flushing” of the excess sperms are crucial, and other mode of contraception is essential to ensure no unplanned pregnancies.

Men, who just had the vasectomy, are usually advised to ejaculate at least 15 to 20 times or wait for the natural demise of the “old sperm” after the snip.

Men would also be told to perform semen analysis before given the “green light”.

However, the 15 to 20 times ejaculations or the three months’ interval is not supported by robust scientific evidence.

A recent study conducted on more than 200 participants of vasectomy highlighted such interval or frequency of ejaculations in order to eradicate the remaining “hangers-on” may be longer than expected.

In this study, men were asked to return to the clinic after the vasectomies, on a fortnightly basis, up to six months, to provide the samples (poor men, I guess this is in the name of research).

The study involved men with mean age of 32 (ranging from 21 to 58 years).

At the end of the third month, nearly 80% of the participants were successfully steriled and 17% still had persistent live sperms, which had a significant risk for pregnancy.

Five percent of the subjects had dropped out of the study (I wonder why?).

On other parameters observed, the mean frequency to sperm clearance was noted to be 32 ejaculations.

Former US secretary of state Colin Powell once said: “Success is the result of perfection, hard work, learning from failure, loyalty and persistence.”

So, Dr G’s advice to LOST is when faced with obstacles against all odds, keep calm and carry on!