Various Medical Abstracts About Vasectomy

Abstract: OBJECTIVE. To determine whether or not there is an association between testicular histologic changes and antisperm antibodies in vasectomized men. METHODS. Morphometry was performed on testicular biopsy specimens obtained from 19 vasectomized men and 21 fertile control subjects. Antisperm antibody status was determined on the serum of each patient and control subject using the indirect immunobead assay. RESULTS. Significant increases in seminiferous tubule wall thickness (p < 0.001), focal interstitial fibrosis (p < 0.001), and percent composition of interstitium (p < 0.01) were observed in vasectomized men as compared with control subjects. Serum antisperm activity was present in 74 percent of the vasectomized men but none in the control subjects (p < 0.001). There was no association between testicular histologic changes and immune status. CONCLUSIONS. Vasectomized men exhibit significant testicular histologic changes and increased autoimmune activity as compared with fertile control subjects. These histologic changes are not directly associated with antisperm antibody status, suggesting that some other pathophysiologic process must be responsible. Jarow JP, Goluboff ET, Chang TS, Marshall FF. Relationship between antisperm antibodies and testicular histologic changes in humans after vasectomy. Urology 1994;43:521-4.

My Comment: Because of the low titers of the sperm autoantibodies and the polyclonal nature of the serum, it has been extremely difficult to determine the nature and the number of sperm autoantigens involved in vasectomy-induced autoimmunity.

"When a patient elects to have a vasectomy, he must understand that pressure build-up proximal to the vasectomy site, congestion of the epididymis, and, indeed, epididymal blowouts are inevitable consequences of this surgical procedure. In more than 800 vasovasostomy patients whom we have seen, there is always some degree of epididymal engorgement and congestion. Indeed, after one explores these postvasectomy 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 postvasectomy orchialgia., Fertility and Sterility, 32: 5, 546-550, November

"In more than 50% of men (closer to75%), vasectomy leads to auto-immune pathology. The auto-immune response to sperms following vasectomy is triggered by the phagocytosis of sperm in the epididymis. In the humoral immune response, sperm agglutinating, sperm immobilizing, and antibodies to sperm nuclear protamines occur, as early as 3-4 days after vasectomy. The incidence reaches 60-70% within 1 year and remains almost the same even after 20 years. Shahani SK, Hattikudur NS, Immunological consequences of vasectomy., Archives of Andrology, 7: 2, 193-9, September, 1981.

My comment: The epididymal blowouts may be more common in men with intense auto-immune reactions to sperm after vasectomy compromises the blood/testes barrier via back pressure and antibody related inflammation. Men with higher pre-vasectomy sperm counts have been reported to have this sort of reaction, but pre-vasectomy sperm counts are not routinely done and no studies exist testing this potential risk factor for PVPS.

The process of spermatogenesis commences after the acquisition of a fully functional immune system. Therefore, all the sperm antigens could become potential autoantigens. Under physiological conditions, both blood-testis and blood-epididymis barriers prevent this undesirable autoimmunity by sequestering these sperm autoantigens from immune cells. Although vasectomy has been used as an effective means of birth control in men, immune response to the sperm antigen is the major consequence of obstruction following vasectomy. There are several reports in the literature illustrating the fact that this alteration in the patency of the vas deferens leads to the generation of ASA, which may result in irreversible auto-immune infertility (Flickinger et al, 1994). A similar phenomenon is also observed in virtually all the laboratory animals studied (Handley et al, 1990). These observations led to the use of the vasectomized mouse model to identify these sperm-associated autoantigens. Journal of Andrology, Vol. 26, No. 6, November/December 2005

Following vasectomy, spermatogenesis continues, the human epididymis and ductus deferens may distend and leak, and the extravasated spermatozoa stimulate formation of a sperm granuloma. Granulomas may occur at 60% of vasectomy sites and are usually asymptomatic and relieve intraluminal pressure. About 3-5% of patients experience pain. Intraluminal phagocytosis may explain why some reproductive tracts become depleted of spermatozoa. Distension of the epididymis is common after vasectomy and may lead to granuloma formation there. Up to 6% of patients have symptoms, but many with epididymal changes have no discomfort. Most episodes of painful epididymitis and granulomas resolve with conservative treatment, but < 1% require vasectomy reversal or, if this is ineffective, excision of the epididymis and obstructed ductus deferens.

My comment: Maybe men should be told this information before vasectomy...