VASECTOMY

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Vasectomy has become an extremely popular method of contraception. In the US alone, more than 10 percent of men with wives of childbearing age have undergone vasectomy. In India, Japan, and South Korea, more than 13 million vasectomies were performed by 1977; since that time the procedure has increased worldwide. This method has special appeal to population control programs in Third World countries because of its simplicity, effectiveness, low cost, and permanence. To promote its use in India, awards and prizes were offered to village health workers who performed large numbers of vasectomies. They, in turn, hired agents paid on commission for supplying candidates. In several villages, virtually the entire male population was sterilized, including prepubertal boys.

There is recent evidence that vasectomy may have health effects beyond sterilization. Animal studies show a definite association between vasectomy and premature atherosclerosis (hardening of the arteries). Early studies in cynomolgus monkeys on high fat diets showed that vasectomy caused a significant increase in arterial disease which was out of proportion to that expected from the high fat die alone. This year, it was reported that after 9 to 14 years of observation, vasectomized rhesus monkeys fed on low fat, no cholesterol diets had significantly more severe and extensive atherosclerosis than nonvasectomized controls.

Several factors could explain this association. Most likely, the problem stems from antibodies formed against one's own sperm. These antibodies arise in one-half to two-thirds of vasectomized men, probably from a leakage of sperm fragments into the bloodstream after vasectomy. Since sperm products are not normally found in the blood, they are perceived as foreign, and the body responds by producing antibodies to bind and eliminate them. When the antibodies and sperm fragments combine, they are deposited in the blood vessel wall. This injures blood vessels, thereby initiating the development of atherosclerosis. Even with successful reversal of vasectomy, which is not always possible, these anti-sperm antibodies persist.

It is to yet known whether the finding of premature atherosclerosis in monkeys can be extrapolated to humans. Data in humans is limited. One study reports a significant narrowing of the retinal artery in the eyes of vasectomized men. There is no evidence to date, however, of excess heart disease. The three reports which address this issue are limited by the very small number of men who have been followed for ten years or more after their operation. Thus the implications for millions of vasectomized men are still unknown. If the findings from tests in monkeys are borne out in humans, there may be a worldwide cardiovascular disease epidemic on the horizon. The next two decades will tell.

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