Sterilization is the most effective contraception to achieve NRR =1 Male sterilization Male sterilization or vasectomy being a comparatively* simple operation can be performed even in primary health centres by trained doctors under local anaesthesia. When carried out under strict aseptic technique, it should have no risk of moality. In vasectomy, it is customary to remove a piece of vas at least 1 cm after clamping. The ends are ligated and then folded back on themselves and sutured into position, so that the cut ends face away from each other. This will reduce the risk of recanalization at a later date. It is impoant to stress that the acceptor is not immediately sterile after the operation, usually until approximately 30 ejaculations have taken place. During this intermediate period, another method of contraception must be used. If properly performed, vasectomies are almost 100 per cent effective. Following vasectomy, sperm production and hormone output are not affected. The sperm produced are destroyed intraluminally by phagocytosis. This is a normal process in the male genital tract, but the rate of destruction is greatly increased after vasectomy. Vasectomy is a simpler, faster and less expensive operation than tubectomy in terms of instruments, hospitalization and doctor's training. Cost-wise, the ratio is about 5 vasectomies to one tubal ligation. Ref: Park 25th edition Pgno : 543