Seldom does one meet a vasectomy surgeon who will claim to have to have any significant number of failures or complications.  The medical literature (peer-reviewed published studies that appear in respected medical journals) tell a different story.  Published studies suggest that the success rate with vasectomy can vary widely (71% to 99.98%) depending on the technique used.  Obviously anyone choosing a vasectomy surgeon wants to find the one who uses the technique that delivers the great results not the poor results.  Unfortuantely finding this information out is not as easy as it might seem. 

One also wonders why there is such a wide range of approaches used in the performance of vasectomy when it has been clearly shown that some approaches do not deliver acceptable results.  The answer lies in part with the fact that the American Urological Association (the entity that the urology profession in the USA relies upon for guidance as to "best practices") has not issued any guidelines on vasectomy yet (although such guidelines are expected in 2011).

A recent report from the Western Section meeting of the American Urological Association in late October 2010 described a study involving over eight hundred vasectomy patients treated over a four-year period, roughly half the patients were treated by one doctor and the other half treated by the other doctor; each using his favorite vasectomy techique.  The one doctor had very good results >99% successful where as the other doctor had generally poor success rates that ranged from about 74% to 99% averaging approximately 3%.  Few (if any) surgeons would admit to a 97% success rate.  Even this paper mentioned no names and instead referred to "doctor A and doctor B" This paper, once again illustrates the discrepancy that can be found in vasectomy results from one surgeon to the next. 

The solution to this problem will come from greater standardization of technique on those practices that have been shown to deliver the best results and also on the movement towards techniques that reduce the dependance on surgical skill and experience in the delivery of good results.

Most surgeons also believe that their complication rates are very low, yet the medical literature suggests that complication rates; notibly chronic testicular pain syndrome can be higher than most doctors realize.  Why is this?  One reason could be that patients with such problems don't return to the doctor who created the problem in order to have the problem fixed.  Another reason could be due to doctors' reluctance to characterize a particular patient's condition as "chronic".  

What ever the reasons, prospective vasectomy patients would be well served to perform some reseach and proceed with caution.  A good place to research the published literature is www.pubmed.gov

Vasectomy is one of the only procedures available to men which provide them with a permanent contraceptive solution. A vasectomy leads to sterility meaning that there is no sperm contained in the semen rendering a man unable to father children. Although there is no sperm in the semen, apparently there are no noticable changes in the semen in terms of appearance or volume.

Vasectomy is extremely effective meaning that in only rare cases does it fail leading to pregnancy. There are several ways in which vasectomized men might father children. The most common way is for a man to ignore the instructions of his physician and fail to use alternative forms of birth control until after a semen analysis shows that the semen contains no viable sperm cells. Even if the sperm ducts are cut and blocked to sperm flow, it can take months for all the sperm to be purged from the system. Another failure mode is called recanalization where sperm leaks out and finds its way back into the downstream end sometimes through microtubules that form.

Vasectomy's very low failure rate (generally <2% over the man's life) means that men can have a fairly high level of confidence that their sexual relations are not likely to lead to fatherhood. This comfort makes sex more fun for both the man and the woman. For those who would have otherwise used inconvenient forms of contraception like condoms or other female barrier methods; contraception by vasectomy will seem like a very freeing experience.

Approximately 4 million vasectomies are perform each year worldwide.  Obviously the procedure must be pretty good if that many men are willing to have it – and that many doctors are willing to perform it.  Most doctors claim success rates north of 99% and complication rates perhaps below a percent.  Results of this quality have been reported in the literature and therefore the possibility of achieving them has been established.  However, a review of the peer reviewed published data suggests that on average, vasectomy results are not that good.  Failure rates vary in the literature from 0.02% to 29%.  Perhaps an average is around 1-2%.  Rates of bleeding and infection are reported in the literature to be between <1% to 18% and rates of chronic pain sufficient to lower quality of life ranges from 2.2% to 15%.   Why the big variance?  The answer can be summed up in; 1. Surgical Skill/Experience and 2. Technique.   Most men would pass on a vasectomy of they thought their results would be anywhere near the high end of those ranges.  How do you know if you are picking a surgeon that can deliver the results you want?… its challenging.  One solution is to consider alternatives that are less technique/skill dependent such as vasectomy by Pro-Vas occlusion.

"Vasectomy" is a term that describes a surgical procedure that is intended to create permanent sterility in men.  Vasectomies involve blocking the flow of sperm through the vas deferens (sperm duct) so that it cannot mix with the other fluids that form the ejaculate.  When the semen carries no sperm it is sterile and cannot cause pregnancy.  The first step in a vasectomy involves accessing the vas deferens and bringing a small loop out of the scrotum where it can be manipulated.  The preferred approach for accessing the vas deferens is called: "No-Scalpel-Vasectomy".  Once a loop of bare vas deferens has been delivered to the surface it must be occluded.  It is the method of occlusion that is going to determine the effectiveness of the procedure.  There are many approaches to the occlusion of the vas deferens, some being better than others.  In fact the reported rates of success with vasectomy as published in the peer-reviewed literature ranges from 71% to 99.98%.  Obviously if you choose to have a vasectomy you are hoping to fall into the 99%+ category rather than the 7 out of 10 success-category.  But how do you know which group you will fall into?  You can research the literature - there are some useful publications that can be found here: http://www.no-scalpel-vasectomies.com/clinicaldetails.php .  Most occlusion strategies involve one or more of the following techniques; excision of a vas segment, cauterization (searing of the vas ends or lumens), ligation (with suture of metal crush-clip) sometimes after folding the vas back on itself, fascial interposition (separating the two severed ends using the fascial sheath as an added barrier), application of a titanium spring ligation clip (www.Pro-Vas.com).   Confusion can arise from the fact that the broad word; "vasectomy" is often used in combination  with specific information such as; efficacy rates, complication rates or other points.  When in fact the rates of success or failure and the complication rates can vary widely from one technique to the next.  Always do your home work and ask your surgeon informed questions before making your decisions.