The following was typed up from Chapter 4 of 'Male and Female Sterilisation: Guideline Summary' (January 2004) from the Royal College of Obstetricians and Gynaecologists. Errors may have been introduced.
[A]: Requires at least one randomised controlled trial as part of a body of literature of overall good quality and consistency addressing the specific recommendation.
[B]: Requires the availability of well-conducted clinical studies but no randomised clinical trials on the topic of recommendation.
[C]: Requires evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities. Indicates an absence of directly applicable clinical studies of good quality.
[+]: Recommended good practice based on the clinical experience of the Guideline Development Group.
Recommendation 1: [C] If there is any question of a person not having the mental capacity to consent to a procedure that will permanently remove their fertility, the case should be referred to the courts for judgement.
Recommendation 2: [C] Additional care must be taken when counselling people under 30 years of age or people without children who request sterilisation.
Recommendation 3: [C] All verbal counselling advice must be supported by accurate, impartial printed or recorded information (in translation, where appropriate and possible), which the person requesting sterilisation may take away and read before the operation.
Recommendation 4: [C] Counselling and advice on sterilisation procedures should be provided to women and men within the context of a service providing a full range of information about access to other long-term reversible methods of contraception. This should include information on the advantages, disadvantages and relative failure rates of each method.
Recommendation 5: [C] Both vasectomy and tubal occlusion should be discussed with all men and women requesting sterilisation.
Recommendation 6: [B] Women in particular should be informed that vasectomy carries a lower failure rate in terms of post-procedure pregnancies and that there is less risk related to the procedure.
Recommendation 7: [C] A history should be taken and an examination should be performed on all men and women requesting vasectomy or tubal occlusion.
Recommendation 8: [C] The operating doctor will need to ensure that the counselling, information exchange, history and examination have been completed and be satisfied that the patient does not suffer from concurrent conditions which may require an additional or alternative procedure or precaution.
Recommendation 37: [A] Except when technical considerations dictate otherwise, a no-scalpel approach should be used to identify the vas, as this results in a lower rate of early complications.
Recommendation 38: [A] Division of the vas on its own is not an acceptable technique because of its failure rate. It should be accompanied by fascial interposition or diathermy.
Recommendation 39: [B] Clips should not be used for occluding the vas, as failure rates are unacceptably high.
Recommendation 40: [C] Vasectomy should be performed under local anaesthetic wherever possible.
Recommendation 41: [C] Excised portions of vas should only be sent for histological examination if there is any doubt about their identity.
Recommendation 42: [C] Men should be advised to use effective contraception until azoospermia has been confirmed. The way in which azoospermia is confirmed will depend upon local protocols.
Recommendation 43: [A] Irrigation of the vas during vasectomy does not reduce failure rates or time to clearance.
Recommendation 44: [C] 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 seven months after vasectomy, as no pregnancies have yet been reported under these circumstances.
Recommendation 45: [B] Men should be informed that vasectomy has an associated failure rate and that pregnancies can occur several years after vasectomy. This rate should be quoted as approximately one in 2000 after clearance has been given.
Recommendation 46: [B] Although men requesting vasectomy should understand that the procedure is intended to be permanent, they should be given information on the success rates associated with reversal, should this procedure be necessary.
Recommendation 47: [+] Men should be informed that reversal operations or intracytoplasmic sperm injections are rarely provided within the National Health Service.
Recommendation 48: [B] Men requesting vasectomy can be reassured that there is no increase in testicular cancer or heart disease associated with vasectomy. The association, in some reports, of an increased risk of being diagnosed with prostate cancer is at present considered likely to be non-causative.
Recommendation 49: [B] Men should be informed about the possibility of chronic testicular pain after vasectomy.
Recommendation 50: [C] Practitioners who are being trained to perform vasectomies should ensure that their training conforms to that advocated by the Faculty of Family Planning and Reproductive Health Care. Doctors with no prior experience should be supervised for ten operating sessions or 40 procedures, while doctors with relevant prior surgical experience should perform eight supervised procedures.
Recommendation 51: [C] A national register and audit of failed sterilisations is needed. Hospital-based registers of sterilisation procedure failures would assist this.