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Contraception - Management
What advice and information should I give a man who is considering vasectomy?

  • Provide advice and written information about:
    • The advantages, disadvantages, and risks of both tubal occlusion and vasectomy:
      • Vasectomy has a 10-year failure rate of about 1 pregnancy per 2000 men. Tubal occlusion has a lifetime failure rate of about 10 in 2000 women.
      • Vasectomy has less risk related to the procedure than does tubal occlusion.
    • Alternative long-term reversible methods of contraception, including information on the advantages, disadvantages, and relative failure rates of each method.
    • The success rates associated with reversal, should this procedure be necessary:
      • Reported success rates vary from 52% to over 82%. This variation in success rates may reflect variations in time since vasectomy, type of vasectomy (e.g. open-ended, sealed with suture, sealed with heat), type of reversal (vasovasostomy or vasoepididymostomy, unilateral or bilateral), technique used (macrosurgical or microsurgical, one-layer or two-layer anastomosis), skill and experience of the surgeon, presence or absence of other abnormality (e.g. varicocele), and presence or absence of anti-sperm antibodies.
      • Men should be informed that the NHS rarely provides reversal operations.
    • The need to use effective contraception until azoospermia has been confirmed:
      • The way in which azoospermia is confirmed depends on local protocols.
      • In a small minority of men, non-motile sperm persist after vasectomy. In such cases, 'special clearance' to stop contraception may be given when less than 10,000 non-motile sperm/mL are found in a fresh specimen examined at least 7 months after vasectomy.
Clarification / Additional information
  • The information given to the man should be recorded in the notes, and the provision of a supporting leaflet or tape to the man should be documented.
Basis for recommendation
  • These recommendations are based on guidelines published by the Royal College of Obstetricians and Gynaecologists [RCOG, 2004].

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