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Erschienen in: Journal of Medical Case Reports 1/2020

Open Access 01.12.2020 | Case report

Paternity seven years after a negative post-vasectomy semen analysis: a case report

verfasst von: Athena Michaelides, Mehrban Ghani

Erschienen in: Journal of Medical Case Reports | Ausgabe 1/2020

Abstract

Background

Vasectomy is one of the permanent methods of contraception; however, the risk of conception still exists. Early failure, defined as a postoperative semen analysis showing persistent motile sperm, occurs in 1 in every 250 patients. Late failure, defined as the rejoining of the severed ends of the vas deferens, occurs in 1 in every 2000 patients.

Case presentation

A healthy 37-year-old British male presented to our clinic because his wife had conceived seven years after he had undergone a vasectomy. The result of his semen analysis after the vasectomy was negative, and the histopathological report confirmed that the sample contained tissue from both the left and right vas deferens. His wife conceived seven years after the procedure, and semen analysis at that time confirmed a total of 0.5 million sperm per milliliter of semen in a total semen sample of 6.3 ml. The total number of motile sperm recorded was 2.5 million.

Conclusion

This case shows that late recanalization can occur up to seven years after a vasectomy. Patients should be informed prior to the procedure that late recanalization, although rare, may still occur. Post-vasectomy paternity necessitates further counseling to ensure that the patient and the patient’s partner fully understand the implications and options available to them.
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Abkürzungen
WHO
World Health Organization

Background

Vasectomy is recognized as one of the permanent methods of contraception; however, the risk of conception after vasectomy still exists [13]. Vasectomy failure can be due to technical error during the procedure, early recanalization, late recanalization, or patients’ failing to use alternative contraceptive methods immediately after the procedure when sperm could still be present in the ejaculate [4].
There is a general consensus that men are considered sterile if < 100,000 non-motile spermatozoa per milliliter are present in the ejaculate sample taken three months after the vasectomy [4, 5]. Early failure, defined as a postoperative semen analysis showing persistent motile sperm, occurs in 1 in every 250 patients. Late failure, defined as the rejoining of the severed ends of the vas deferens, occurs in 1 in every 2000 patients [6]. This report aims to describe the case of a young man who became a father after a negative post-vasectomy semen analysis.

Case presentation

A healthy 37-year-old British male came to our clinic because his wife had conceived seven years after he had undergone a vasectomy. The decision to have a vasectomy was motivated by him already having two children. The result of his semen analysis post-vasectomy was negative: no sperm were detected in a 5 ml sample of his semen. The histopathological report confirmed that the vasectomy sample contained a strip of tissue 1.5 cm in length from both the left and right vas deferens. This confirmed that the procedure was carried out successfully, and paternity seven years later could not be attributed to technical failure.
Seven years after the procedure, the patient’s wife conceived. Semen analysis at this time confirmed that sperm were present within the sample. A total of 0.5 million sperm per milliliter of semen (World Health Organization [WHO] normal reference range, > 15 million/ml) was recorded in a total semen volume of 6.3 ml. The total number of progressive motile sperm recorded was 2.5 million (WHO normal reference range, > 7.2 million). This case shows that late recanalization can occur up to seven years after a vasectomy and despite oligospermia, conception is still possible.

Discussion and conclusions

Vasectomy is one of the safest methods of male contraception. Voluntary vasectomy is available to men of any age and family size as part of advanced family planning [7]. A preoperative discussion between the physician and the patient includes the consideration of the patient’s age, his current partnership status, and his irrevocable decision to undergo a procedure with a permanent outcome of sterility. The risks and complications are also discussed [7].
The procedure is usually carried out in an outpatient setting with the patient under local anesthesia, but general anesthesia may be used in some instances. Different vasectomy techiques may be employed. The standard ligation technique consists of identification and resection of 2–4 cm of the vas deferens. The fulguration technique employs a diathermic needle to create thermal damage to the mucosa of the vas by inducing an inflammatory reaction that results in occlusion. The “no-scalpel” vasectomy employs a clamp to perforate and separate the skin covering the vas. The vas is then grasped with forceps to produce a result similar to that of the fulguration technique [7].
The more common complications of a vasectomy include mild scrotal swelling and bruising, bleeding and postoperative hematoma formation, blood in the semen of the first few postprocedural ejaculations, chronic testicular pain that may affect day-to-day activities, and epididymo-orchitis or testicular infection and inflammation [6, 8]. The less common complications are early and late failure, which occur in 1 in 250 patients and 1 in 2000 patients, respectively [6].
Studies have shown that early recanalization usually occurs between 2 and 6 weeks post-vasectomy [9, 10]. Our present case report describes failure due to late recanalization that occurred seven years post-vasectomy. Recanalization occurs when epithelial microtubules proliferate through the granulomatous tissue between the severed ends of the vas deferens producing a fistula that allows sperm to pass through [10]. Recanalization is more likely to occur if less than 1 cm of the vas is removed during the surgery or if an abscess forms after the procedure [3]. Because our patient’s histopathological report confirmed 1.5 cm of vas removed from each testis, our patient does not fall into the group at high risk of recanalization.
Vasectomy, although mostly successful, still has a degree of failure. Patients should be counseled prior to the procedure that late recanalization may occur in 1 in every 2000 cases. Post-vasectomy paternity necessitates further counseling to ensure that the patient and the patient’s partner fully understand the implications and options available to them.

Acknowledgements

The authors thank the patient for agreeing to have his case published.
This study did not include experiments on animals or humans. The patient consented to the use of his personal data for the purpose of this case report.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in- Chief of this journal.

Competing interests

The authors declare that they have no competing interests. The authors have no association with commercial entities that could provide support for the work reported in this report, nor with entities that could be viewed as having a general interest in the area of the submitted manuscript. The authors have no association with financial or nonfinancial organizations.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Literatur
1.
Zurück zum Zitat Jamieson DJ, Costello C, Trussell J, Hillis S, Marchbanks PA, Peterson HB. The risk of pregnancy after vasectomy. Obstet Gynecol. 2004;103(5):848–50. A published erratum appears in Obstet Gynecol. 2004;104(1):200.CrossRef Jamieson DJ, Costello C, Trussell J, Hillis S, Marchbanks PA, Peterson HB. The risk of pregnancy after vasectomy. Obstet Gynecol. 2004;103(5):848–50. A published erratum appears in Obstet Gynecol. 2004;104(1):200.CrossRef
2.
Zurück zum Zitat Lucon M, Kucon AM, Pasqualoto FF, Srougi M. Paternity after vasectomy with two previous semen analyses without spermatozoa. Sao Paulo Med J. 2007;125(2):122–3.CrossRef Lucon M, Kucon AM, Pasqualoto FF, Srougi M. Paternity after vasectomy with two previous semen analyses without spermatozoa. Sao Paulo Med J. 2007;125(2):122–3.CrossRef
3.
Zurück zum Zitat Philip T, Guillebaud J, Budd D. Late failure of vasectomy after two documented analyses showing azoospermic semen. Br Med J (Clin Res Ed). 1984;289:77–9.CrossRef Philip T, Guillebaud J, Budd D. Late failure of vasectomy after two documented analyses showing azoospermic semen. Br Med J (Clin Res Ed). 1984;289:77–9.CrossRef
4.
Zurück zum Zitat Lowe G. Optimizing outcomes in vasectomy: how to ensure sterility and prevent complications. Transl Androl Urol. 2016;5(2):176–80.CrossRef Lowe G. Optimizing outcomes in vasectomy: how to ensure sterility and prevent complications. Transl Androl Urol. 2016;5(2):176–80.CrossRef
5.
Zurück zum Zitat Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. European Association of Urology guidelines [in Spanish]Actas Urol Esp. 2012;36(5):276–81.CrossRef Dohle GR, Diemer T, Kopa Z, Krausz C, Giwercman A, Jungwirth A. European Association of Urology guidelines [in Spanish]Actas Urol Esp. 2012;36(5):276–81.CrossRef
6.
Zurück zum Zitat British Association of Urological Surgeons (BAUS). Vasectomy: information about your procedure from the British Association of Urological Surgeons. London: Author; 2017. British Association of Urological Surgeons (BAUS). Vasectomy: information about your procedure from the British Association of Urological Surgeons. London: Author; 2017.
8.
Zurück zum Zitat Raspa RF. Complications of vasectomy. Am Fam Physician. 1993;48(7):1264–8.PubMed Raspa RF. Complications of vasectomy. Am Fam Physician. 1993;48(7):1264–8.PubMed
9.
Zurück zum Zitat Lucon AM, Pasqualotto FF, Schneider-Monteiro ED, Saldanha LB, Danilovic A. Spontaneous recanalization after vasectomy. ScientificWorldJournal. 2006;6:2366–9.CrossRef Lucon AM, Pasqualotto FF, Schneider-Monteiro ED, Saldanha LB, Danilovic A. Spontaneous recanalization after vasectomy. ScientificWorldJournal. 2006;6:2366–9.CrossRef
10.
Zurück zum Zitat Labrecque M, Hays M, Chen-Mok M, Barone MA, Sokal D. Frequency and patterns of early recanalization after vasectomy. BMC Urol. 2006;6:25.CrossRef Labrecque M, Hays M, Chen-Mok M, Barone MA, Sokal D. Frequency and patterns of early recanalization after vasectomy. BMC Urol. 2006;6:25.CrossRef
Metadaten
Titel
Paternity seven years after a negative post-vasectomy semen analysis: a case report
verfasst von
Athena Michaelides
Mehrban Ghani
Publikationsdatum
01.12.2020
Verlag
BioMed Central
Erschienen in
Journal of Medical Case Reports / Ausgabe 1/2020
Elektronische ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-020-02374-0

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