The subject of sterilization for the control of overpopulation is receiving increasing attention from all quarters. A few years ago when the family planning program was undertaken by the Government of India, sterilization was not selected as a method for the family planning. It was thought that as sterilization was a permanent measure for control of conception, it couldn’t be included in the family planning program. The failure of the rhythm method of birth control and the insignificant success of the chemical and mechanical contraceptives, have now drawn our attention of sterilization. The Governments of Madras and Kerala, in this country, and that of Japan have already undertaken a mass program of voluntary sterilization. It is bold step in checking the rapidly growing population in this country. The 350 million population of India has increased by fifty million in the last ten years.
Sterilization for the control of conception can be done for man or woman. The subject of vasectomy will be discussed in this paper. This operation is not a new subject to the medical profession. Enough experimental and clinical work has been done on the subject (Cooper, 1830). It was accidental vasectomy during a hernia operation in 1907, that made it necessary to make an attempt at repair of the cut vas (Vasorraphy). Since 1907 many workers (Twyman and Nelson, 1941, Cameron, 1945; O’Connor, 1948; Handley, 1951; Phadke, 1953, Dorsey, 1957) have successfully carried out vasorraphy. Although the clinical data for vasorraphy was available from amongst the ‘sterilized’ persons, or when the vas was accidentally cut during surgical operation, not enough clinical material was available from any surgeon performing a long series of such operation. Yet the operation of vasorraphy is established.
Can sterilization in men be used for spacing childbirth? This question occurred to the writer, while he was performing sterilization operations during the last ten years. During vasectomy a short segment of the vas deferens is excised. It has been reported that mere division of the vas deferens was followed by a natural reunion with canalization in human beings as well as in animal experiments. No mention has been made as to how long after the division of vas deferens the natural reunion took place, and whether the ends of the vas deferens were ligatured after division, and if so ligatured, with what material?
The author has been carrying on studies on sterilization in men. His technique has been a single incision scrotal operation, excision of a short segment of the vas deferens, and ligature of the cut ends of the vas deferens with chromic catgut No: 1(now changed to cotton thread). In July-October 1956, the chromic catgut’ was not available, and so plain catgut No. 0 was employed. In a follow up study later, four operated persons reported conception in their wives after 8 to 16 months of the operation. The problem was discussed and a study made of conception taking place even after vasectomy. It was found that all these cases were operated during July-October 1956 when plain catgut ligature was used. Examination of the semen of these persons showed presence of motile spermatozoa. At the second operation it was found that the site of the breach in vas deferens was now occupied by a fusiform swelling, which was continuous on either side with the vas deferens. The vas deferens with this fusiform swelling was then excised. Fluid injected one end of the vas deferens was seen first filling this fusiform swelling and then coming out at the other end. Further, pathological sections were made which also suggested that natural reunion and canalization had followed the operation.
Natural reunion and canalization follows mere division of the vas deferens. Re-canalization occurred after vasectomy in our cases (Ohri and Jhaver, 1958, Jhaver and Ohri, 1959). If the vas deferens is only tied with absorbable ligature it is quite likely that in course of time it will recanalyze. The time at which recanalization will take place, will depend upon the ligature material used. If natural reunion and canalization of the cut vas deferens and canalization after ligature of the vas deferens can be planned and timed, sterilization for spacing childbirth can be achieved.
The subject is being studied for the last few years, and it is hoped that vasoligation with different materials, will follow recanalization after specific period of time. Vasectomy, vasorraphy and vasoligation for spacing childbirth are subjects, which will play a big role in the solution of the population problem.
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