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Immunologic Effects of Vasectomy

Jul 27, 2008 - 11 comments

Vasectomy can be performed in a doctor's office in around twenty minutes. In fact, you will see a lot of references like this on the Internet, “Most significantly, an estimated 20 to 30 women die in the United States each year from complications from tubal ligation surgery. Dr. Kennon, an urologist at Tripler Army Medical Center in Honolulu observes, "We [men] are subjecting our wives to a life-threatening procedure when we should be stepping up to the plate ourselves."

The idea that men should “step up” to the plate and have a vasectomy may contribute to the estimated 500,000 vasectomies performed each year in the United States. Even with the vasectomy “push”, tubal ligations still outnumber vasectomies by about two to one. But this article is not about which procedure is best. I am not a fan of surgical treatment for infertility, but accept that each person must choose for themselves what to do about these matters.

The post-operative pain and swelling associated with vasectomy are fairly easy to mange with Tylenol, ice packs, and a few days rest. The acute complications of excess bleeding and infection are not common and usually respond to available treatments. This is the story you are meant to see. Little is said about the long-term effects of vasectomy.

When a man has a vasectomy, his body continues to produce sperm. There is nowhere for this sperm to go and while some of it is reabsorbed, the amount produced can present some problems. In many men, this sperm builds up in the tail of the epididymus (a mushy sperm maturation organ connected to the testes). This leads to leaks in the epididymal lining. Sperm can then leak into areas they were never meant to be, and stimulate a different and stronger antibody response than is normal and seen during puberty.

You see, sperm is highly antigenic, meaning it stimulates a strong immune response. It is recognized by the man's body as foreign. During puberty, some anti-sperm antibodies develop when the body is first exposed to sperm. Prior to this, the man's immune system has never “seen” sperm. After puberty, the sperm are protected by a “blood-testes barrier”. When this barrier is broken by vasectomy and sperm are “presented” to the immune system, new anti-sperm antibodies are formed and the previous “normal” immune response becomes abnormal in strength, specific antibody types, and perseverance of response.

The fact that humans form some anti-sperm antibodies during puberty is known. Some people “poo poo” the anti-sperm issue based on this. However, it seems that the immune response to sperm after vasectomy is more robust, new antibody species appear that are not found in intact men. The response correlates with pre-vasectomy sperm count and continues to increase after vasectomy due to chronic sperm antigen presentation to the immune system.

See this reference: “In 1970, 50% of vasectomized men were found to have circulating spermatozoal antibodies. A more recent survey provides confirmation for this finding and presents an incidence of only 2% of agglutinating antibodies and 0% of immobilizing antibodies in a fertile control population. Some recent and convincing studies have shown sperm agglutinating and immobilizing antibodies to remain either at the same titer level or actually to increase 5-12 years postoperatively. Titers range from 2 to 2048 among different patients. The highest incidence of titers is 1 year after vasectomy, but titers can be found as early as 6 months or as late as 20 years postoperatively.

The wide range in titers can be explained in terms of technical problems in immune assays, since only immunoglobulins and not those antibodies part of immune complex systems can be measured. Since sperm antigens are in abundant supply in vasectomized men because of the continuous resorption of spermatozoa after vasectomy, possibly undetectable antibody titers actually reflect high levels of anti-sperm antibodies circulating in the form of immune complexes. Also it may be possible that the variety in measured titers of auto-antibodies, as well as the non-universal (70%) antibody response in a vasectomized population, is a variable dependent on genetic content and, therefore, an individual characteristic.”

And this reference: “High antibody titer was also seen in 5 of 7 subjects who developed swelling at the ligation site. The results in this study yielded and 11% incidence of sperm agglutinating antibodies in nonvasectomized fertile males. 62% of those who had vasectomies developed these antibodies within the 1st few years. This indicates that the majority of vasectomized men are early responders to sperm antigens. This study also revealed that sperm immobilizing antibodies rise as the post-vasectomy period lengthens, even beyond 20 years.

Another study: “A comparative study of 69 vasectomized and 126 nonvasectomized men enrolled in the Portland (Oregon, US) Center for the Multiple Risk Factor Intervention Trial evaluated vasectomy as a risk factor for cardiovascular disease. In animal studies, atherosclerosis development has been linked to circulating anti-sperm antibodies and immune complexes formed in response to sperm breakdown products released in the body after vasectomy. Vasectomized men smoked more and had lower diastolic and systolic blood pressure than men in the control group.

As expected, both sperm immobilization and sperm agglutination assays were significantly higher among vasectomized men than controls; 29.4% of vasectomized men compared with only 2.5% of nonvasectomized men had sperm immobilization values of 0.3 or less, while 54.1% of vasectomized men compared with 12.5% of nonvasectomized men had sperm agglutination values of 20.0 or above. These significant differences persisted even when a variety of coronary heart disease risk factors and treatments were controlled. Multivariate analysis showed that antibody development tended to decrease with age at vasectomy and increase with time since vasectomy. In the case of sperm agglutination, the antibodies clearly increased with time since vasectomy.”

Why should you care?

In primate studies, there is an increase in atherosclerotic plaque formation after vasectomy even after controlling for dietary factors:

“We demonstrated previously that atherosclerosis develops more extensively in vasectomized cynomolgus macaques fed an atherogenic diet and speculated that the immunologic response to sperm antigens may have exacerbated the atherosclerosis. We report here that rhesus monkeys vasectomized for 9-14 yr and fed monkey chow (devoid of cholesterol and low in fat) rather than an atherogenic diet also had more extensive and severe atherosclerosis than did control animals of the same age. The extent of atherosclerosis was considered as the percentage of intimal surface with plaques. No control animals were found to have plaques in the thoracic aorta, but 7 of 10 vasectomized monkeys were affected. The plaques in the vasectomized monkeys occupied about 13% of the intimal surface. In 4 of 7 control monkeys and 7 of 10 vasectomized monkeys there were lesions in the abdominal aortas; the lesions were considerably more extensive and severe in the vasectomized animals.

This research finding has not been conclusively demonstrated in humans. It is concerning that a simple procedure could have unintended consequences on areas of the body far from the site of the surgery. The long-term effects of this immunologic experiment have yet to be fully discovered.

“In response to enquiries received by the World Health Organization (WHO) from several countries, the WHO Special Program of Research, Development and Research Training in Human Reproduction convened a meeting of experts in Geneva during August 1981 to review the available animal, clinical, and epidemiological data on vasectomy, with particular emphasis on clinical implications of long-term sequelae of vasectomy in cardiovascular disease. The occurrence of circulating antibodies to sperm antigens has been demonstrated after vasectomy in all animal species studied thus far by various techniques. Prospective clinical studies of vasectomized and nonvasectomized men have been conducted at 4 centers in the U.S. involving clinical and laboratory evaluation of subjects before surgery and at intervals thereafter. A total of 412 vasectomized men were enrolled in these studies; most were followed for 2, 3, or 4 years. The only significant finding was the development of antibody to sperm antigens. Alexander and Clarkson first reported that vasectomy increases the extent and severity of diet-induced atherosclerosis in cynomolgus monkeys. In a 2nd study, Clarkson and Alexander extended their previous findings to evaluate the effects of vasectomy on naturally occurring atherosclerosis in rhesus monkeys. The mechanism by which vasectomy exacerbates atherosclerosis in monkeys has not been defined. At present epidemiological data which have been published come from observations in the U.S. and United Kingdom and in particular from 2 studies involving 4830 and 1764 vasectomized men studied at about 5-6 years after surgery. No health risks of vasectomy were detected in these early years.”

Another area of concern after vasectomy is “Vasectomy Induced Testicular damage. Most people think of vasectomy as benign and safe. You are told that it will have no effect on you other than to stop sperm from getting in the ejaculate. What happens to all that sperm?

"When a patient elects to have a vasectomy, he must understand that pressure build-up proximal to the vasectomy site, congestion of the epididymus, and, indeed, epididymal blowouts are inevitable consequences of this surgical procedure. In more than 800 vasovasostomy (vasectomy reversal) patients whom we have seen, there is always some degree of epididymal engorgement and congestion. Indeed, after one explores these post-vasectomy patients microsurgically, it becomes difficult to understand why the vast majority of such patients have no pain or discomfort." EI Shapiro and SJ Silber, Open-ended vasectomy, sperm granuloma, and post-vasectomy orchialgia., Fertility and Sterility, 32: 5, 546-550, November, 1979.

“The local effects of vasectomy on the reproductive tract are not fully determined. Distention of the epididymal duct occurs in most patients and granuloma formation is common. Vasectomy may also induce autoimmune orchitis. While many men develop structural changes in the reproductive tract after vasectomy, only a minority report discomfort.”  (Autoimmune orchitis is a chronic inflammatory condition that can lead to pain, low testosterone levels, and testicular shrinkage.)

And this: Germ cell differentiation, DNA synthesis, and apoptosis can be evaluated quantitatively. On the other hand, an interstitial (testicular) lesion is difficult to examine. We have focused on the quantitative analysis of testicular interstitial fibrosis after vasectomy. MATERIALS AND METHODS: Forty testicular biopsy specimens from twenty consecutive men were obtained at vasovasostomy. (Vasectomy reversal) Johnsen's mean score was calculated from testicular biopsy specimens. Percent of interstitial fibrosis was determined quantitatively by the NIH-Image after Masson-trichrome staining. RESULTS: A significant increase in interstitial fibrosis was observed along with the obstructive interval (p < 0.001). Johnsen's mean score count did not associate with the obstructive interval. CONCLUSION: Interstitial lesions of testicular physiology and pathophysiology can be evaluated using the NIH-Image. Interstitial fibrosis (permanent scarring), but not the intraseminiferous status, reflects the irreversible damage of vasectomized testes.

Clearly, the “party line” that vasectomy is safe is not justified for all cases. There are other consequences as listed on my website. The post-vasectomy incidence of chronic testicular pain in as many as 15% of patients is also of great concern. It does not seem to be of concern to the men that do fine after the procedure, but perhaps the known and unknown long-term immunologic issues will be of more interest to prospective vasectomy candidates.

I believe the testicular damage is related to back-pressure form closing off the system with vasectomy and also auto-immune (in some patients more than others).

This may be person specific based on:

   1. The degree of epididymal obstruction which may depend on the vigor of the auto-immune response
   2. The length of the testicular segment of vas left after vasectomy for sperm reabsorption and the effect of this on sperm granuloma formation.
   3. Individual variation in pre-vasectomy sperm count and thus post-vasectomy immune response which is genetically pre-determined
   4. The continuing presence of soluble antigen presented to the immune system in sperm granulomas (the bodies response to immune cell contact with sperm and sperm components.)

It is easy to make a case for the back pressure effects on the testes based on the human studies and other mammalian studies I have read. The immune component is much more difficult to prove. Nonetheless, the issues presented here are cause for caution.

I believe that more research needs to be done on the effects of auto-immune phenomenon after vasectomy. Perhaps patients that develop problems are different in their response to chronic sperm antigen presentation. The immunologic experiment continues with the 500,000 men per year that choose vasectomy.

Comments
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by tennisbum, Nov 03, 2008
Your article is one of the first I agree with on the safety of vasectomies.  I am a 47 year old male and  have never been happy about doing the procedure.

The  vasectomy was botched.   I suffered a massive hematoma from my naval to my back which was quite painful.  It was my belief from reading several articles on the procedure that the urologist had mistakenly cut a blood vessel, which the article quoted as being a common mistake.  

He did perform the vasectomy correctly at the one time visit.  However, I felt my erection after the surgery and general sex drive was never the same to this day.  I have always had pain in the general area which comes and goes.  I am compelled to having it reversed just so the system is back to normal - opened - if possible.  What is your opinion on this and would it help me to have this procedure.  I would appreciate your input on how to best proceed with reversing this proceedure.  

I seem to get colds now regularly within 24 hours of ejaculating which gives me some concern.  I never got many colds in the past and I am curious if there is a connection.

Eric F. Iker  818 / 889-3175  <http://***@****




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by Brain DoctorBlank, Nov 05, 2008
Tennisbum,

You can reach me via my website.

www.VasectomyPain.org

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by kiransunil, Jun 15, 2009
Gooood. I Can see how your article effects men out there. Good. Comment is from Tubal Reversal website http://www.mybabydoc.com. Contact tivseoteam@gmail.com if any question or query

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by latestarter2006, Aug 29, 2010
I find this article very interesting. As with most Vasectomy candidates I was told it was a safe procedure. This was about twenty six years ago. Contrary to what I was told I did find a difference in ejaculation which always was a lesser experience after the procedure. I had no other ill effects until recent years.

My current problems are in the immune system (I am now 61) and two years ago I started to lose weight and so my doctor did extensive tests to rule out cancer. My white cell count remained abnormal during several months of tests including bone marrow analysis. Eventually after six months or more the blood count began toapproach normal but was never confirmed as such completely.

I have recently (6 weeks) had hip replacement surgery and the blood cell count is abnormal again with no other signs of infection. I have prior to this had symptoms like BPH and tests were done in this area but it was found that my prostate was only moderately enlarged. Symptoms like a urine infection were experienced with no evidence that ther was any infection at all. This has cleared up before the operation on my hip.

Also I have had testosterone replacement for ten to twelve years as prior to this intervention I had difficulty finding strength to complete a working day. Apart from these anomalies I am a very healthy man and have had very few illnesses (colds and flu) in my life.

This are just my non medical observations. Thank you for the article. Barry Roberts

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by texasreb, Nov 29, 2010
Don't do it ! I had a vasectomy done circa 1975. Whack em and tie in knots. I hurt for days. Then got over it. Or so I thought.

My problems started about 3 years ago. I am now 61. I first noticed it seemed that one testicle started shrinking. Then soon after symptoms of low T. So I go to GP Doc. Does a T test and I am borderline for therapy. So nothing is done. Within 6 months I now have a pain in the scrotum. First time for such since having the Vx done.

So I go back to GP. He puts me on Cipro for the infection. Two weeks later after it not working, the GP schedules me for the urologist. I see the urologist. He wants an ultra-sound, and puts me on Cipro again. We do an ultra-sound, and the round of Cipro. There is a lump either in, or touching the right testicle.

He wants to remove both testicles. His office colleagues concur. I said I want another opinion. So a week or two later I go out of town to another urologist. He says don't operate. It is an infection of the epididymitis. He puts me on the other drug, Levaquin ?

Long story shortened is infection was cleared up. I inquired about a reversal. Decided that the damage may have already been done, so don't do it. My right testicle is now almost gone. I take T shots sometimes. They cost a bunch. The GP has retired, and the urologist has moved out of town. Fixing to go see a new GP in a few weeks.

I don't have diabetes, high blood pressure, and I am generally healthy for my age. Never been in hospital for anything. I don't take any meds, nor ever have except for infections.

Just too much research from foreign sources against doing a vasectomy. It will sooner or later mess up your immune system. Cause it to attack the source of the foreign invaders called sperm. Cause atrophy or fibrosis of your testicles.

A real bummer modern medicine has left me with.

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by sprevrha, Jan 11, 2011
Interesting. Re atherosclerosis, certainly a big turn-off if indeed correlated, a 2002 study on almost 4,000 men did not find association: http://cat.inist.fr/?aModele=afficheN&cpsidt=13382957

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by denhamphery, Mar 04, 2011
Yeah this is great..Thanks for sharing such a nice info
now in this modern world nothing is impossible..
Tubal Ligation Reversal is now become very secure..
but remember successions  of this operation depends upon the doctor's moves.so be sure that Doctor is experienced in this field.

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by teagueron, Apr 25, 2012
I am also 61 years old, in good health otherwise.
I had a vesectomy in 1978. I am taking 150 milligrams testosterone injection weekly. My LH level is less than 1.0 and my testicles are shrinking slightly as well. I am being treated for
E D with trimix injections, works great! If my description is you, ask urologist about trimix injections. Sperm or no sperm erections are really fantastic 4-1 to 2 hours duration.
I have always felt that I was damaged by my Vasectomy, and tri mix changed my life. Hope someone can use this information.

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by teagueron, Apr 25, 2012
VASECTOMY: DON'T DO IT! It can put you well on your way to early e d and other problems.

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by JoeFromTheSouth, Apr 11, 2014
I had mine 23 years ago.  It was pretty painful for me and it took me about 2 weeks to recover.  I had the vasectomy about a month after my son was born.  I was 30 years old.  I never had a weight problem or a cholesterol problem and it was after the vasectomy that I started to struggle to keep weight off.  It has been a constant struggle.  Around the age of 47 I started to develop problems with being tired all the time.  I also noticed that I no longer got nocturnal erections.  My penis actually seemed to shrink and go inside my body, which it had never done before.  My T levels were almost non-existent.  I went through a long odyssey  to get proper treatment and am now taking Testosterone injections, HCG injections and anastrozole to control estrogen levels.  My thyroid is messed up.  I had a brain MRI done and there is a 2mm micro adenoma on my pituitary that I thought was the problem.  I moved south and recently went to a new endocrinologist who believes this is an autoimmune response.  This is the first I am even hearing of this.  This was never discuss when I got the vasectomy and of course we didn't have the Internet (Al Gore hadn't invented it yet) to research this stuff.  I am very concerned about long term effects.  I am now taking blood pressure medications because the T made my blood thicken and I had a very tiny stroke as a result.  No lasting affects.  Not sure what this all means now.  I doubt getting the procedure reversed will do anything at this point and I am not sure they could even do it if I wanted it.  Hopefully my new endo can help figure out a way forward.

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by dt400eman, Apr 15, 2014
Can getting a vasectomy reversed cure these problems. I too was led to believe by close friends that it was a great procedure. I know my testes are shrinking. I remember that doctor now lying to make a buck about the procedure. I got my vasectomy 20 years ago. He was in it to support himself and family. It is a very unhealthy act to perform on ones body. Can a vasectomy be reversed and will kiesar cover it.

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