From John:-
According to one, and only one, report, there is some controversy over the effect that anti-sperm antibodies could possibly have on the brain. A fairly anecdotal report came out of Northwestern Medical Center in Feb. 2007 that showed a very small group of men may be at risk for developing primary progressive aphasia. Considering the millions of men who get vasectomies and vas. reversals, do you see any cause for concern?In May of 2007, I had my vasectomy reversed and all was fine. But lately I have trouble sleeping, ringing in my ears, tingling in my calfs that comes and goes, although my energy level is fine as is my coordination and I am able to carry on my duties of teaching and educational development. The reason I had my reversal was two painful granulomas had developed and to prevent further pain, swelling and more granulomas, medical literature indicated a reversal and I readily concurred. The urologist suggested first removing the granulomas but I had had so much discomfort from the vasectomy in Dec 2003, that I simply wanted it gone.
A second semen analysis, about three months after the reversal, showed very healthy sperm, high count, motility and excellent morphology – ‘much better than most of our patients at any age’ said my urologist. (I am a very active 63).
Considering the lack of research on the possibility of ASA’s causing this rare form of dementia do you any cause for concern? Naturally, a lack of research doesn’t mean that it couldn’t cause this very serious problem but it’s just that nothing else seems to suggest it.
Unfortunately, I also have lumbar spinal stenosis, arthritis in the cervical vertebrae (5 & 6) and experienced a several fall (on the tennis court) last August, 2007 where I blacked out for a second. This was followed by two more head injuries later – perhaps due to poor equilibrium resulting from the fall? – didn’t help. Twice since then, I have had a pattern of mild headaches seeming to be around the head and neck but this pattern lasts about a month and they disappear.
Sorry this seems to be so convoluted but you can understand my concern about over any possibility of life-altering effects of the reversal. Do you have any more recent information on this?
Like all physicians (my father was an ophthalmologist), I am sure you are swamped but if you can offer any ideas on this, I would appreciate it.
There has been only one paper to date addressing the association between vasectomy and this rare type of dementia called primary progressive aphasia (PPA). This is not your “garden variety” dementia that commonly occurs in people as they get older. This type of dementia has been reported in less than 300 patients in this country. This study from Northwestern University looked at 47 men with PPA and 19 of them (40%) had a vasectomy performed by patient report. This rate of vasectomy was higher than that in a population of normal controls (16%) and this was the entire basis of the conclusion that the authors came to after analyzing their data. Whether or not these patients actually had vasectomies was never confirmed by the investigators and only relied on the patient self reporting. The authors went on to speculate that this is a real relationship because we know that virtually all men after a vasectomy will develop anti-sperm antibodies (ASA) and previous animal research in vitro has shown that these ASA’s bind to certain brain epitopes.
The problem with such a conclusion is that several logical steps are missing in this equation and have yet to be proven. First of all, do ASA’s cross the blood-brain barrier in the first place. If they don’t then it is irrelevant that they bind to brain epitopes when we place them directly onto brain matter in the laboratory. The second big assumption is that even if these ASA’s bind to brain epitopes, do they they cause any effect to the affected area of the brain. Our body produces millions of different antibodies that bind to different tissues in the body sometimes without any effect on the end organ. Neither one of these two important points have been shown to be true and we are making big assumptions about how this relationship between vasectomy and PPA exists.
Until we have better controlled studies evaluating the relationship between vasectomy and this rare type of dementia, we should be cautious as to telling patients that any relationship exists. This recent controversy brings to mind previous associations between vasectomy and certain medical diseases. Vasectomy has previously been implicated in the development of prostate and testicular cancer. Both of these association have been refuted by the medical literature in the subsequent years after initial reports stating some type of association. Vasectomy is performed in over 500,000 men annually in this country and there is inevitably going to be some overlap with other medical conditions in these patients. Prior to assuming causation, we should investigate thoroughly any associations that we find in our clinical practices.
