Vasectomy

What is a "vasectomy"?
A vasectomy is a minor procedure performed on men desiring permanent sterilization, permanent contraception. They have made the decision that they no longer want to father a child. A small incision used to be made, but nowadays, it is done without an incision. It's done with a tiny little hole made in the skin of the scrotum right above the vas. The vas is grabbed in a little clamp and it's pulled up, a couple of titanium clips are placed on the ends of the vas and a small cut is made between them, the two ends are dumped back in, and the hole is so small that it seals up on its own. Men don't even need a stitch any more. It's all done under local anesthesia. It's just like going to the dentist and getting a tiny little shot in the skin with some Novocain. It's a very affective technique of permanent male contraception.

When should a man consider having a vasectomy?
A man should consider having a vasectomy as part of family planning discussing with his wife that they do not desire children and he doesn't want to wear condoms and she, for whatever reason, doesn't want to take the birth control pill or for health reasons can't take the birth control pill. A vasectomy is a much easier procedure than a tubal ligation, which is the female counterpart of vasectomy, blocking the woman's fallopian tubes. That's an interabdominal procedure that has to be done under general anesthesia, whereas a vasectomy is a quick office procedure. So when a man is sure that he no longer wants to have children, then a vasectomy is an appropriate procedure for him.

Are there any risks associated with vasectomies?
The risks to a vasectomy--any time you make a cut, poke anywhere on the body you can have pain, you can have bleeding, you can get an infection. Specifically, the risks to a vasectomy are it can fail. They are not 100% fool-proof. The ends of the Vas can grow back together. We've developed some techniques to prevent that from happening. It's possible that years and years and years down the line the vasectomy site grows back together. That happens maybe 1 in 200 times, so it's very, very low.

Why would a couple choose vasectomy over tubal ligation?
The reasons to choose vasectomy over tubal ligation are numerous. Number one, a vasectomy is a safer procedure for a man to undergo than a tubal ligation is for a woman to undergo. The vas is sitting in the scrotum outside of the body. It's just sitting right under the skin. So to perform a vasectomy the doctor just needs to make a tiny little poke hole in the skin to access the vas, which can be done under local procedure. It takes roughly about 10 to 15 minutes to perform a vasectomy and the man walks out of the office, rests for a few days and then goes back to life as usual. For a woman to have a tubal ligation, it is a procedure that is done with her asleep. So she has have general anesthesia and the risks of anesthesia. One has to enter the abdomen. It's usually done through laproscope these days. So several tiny holes are cut in the abdominal wall and through belly button surgery and video camera the fallopian tubes are accessed and they are blocked. This is usually more costly than a vasectomy because it is more intense.

Can a vasectomy be reversed?
Vasectomies can be very effectively reversed. In the hands of a trained micro-surgeon who has lots of experience, vasectomy reversal for men who still have sperm in the vas at the time of the reversal will have probably upwards of 90-95% -- and close to 98% in the top specialists – chance of having sperm come through the tubes again through a reversal. For men who have other blockages after they've had a vasectomy, and a little bypass procedure needs to be performed, it's about 60-70% chance that they'll have sperm coming through again.The overall chances of conceiving after having a vasectomy are upwards of 50%. So that's very good and it's really up from years ago, as the techniques and the skills of the surgeons have gotten better.

Do vasectomies sometimes fail to prevent pregnancy?
Vasectomies can fail to prevent pregnancy. It is very important for men, after they've had a vasectomy, to provide sperm samples until the sperm are absent from the ejaculation; Until they become asospermic. It can take awhile. Sperm live upstream in the vas from where the doctor makes the cut, and it can take six weeks to three months, sometimes longer, for all that sperm to get flushed out or die. If you were to do a vasectomy on someone and do a sperm count the next day, the sperm count would be completely normal. So it is important for men to realize that until they have gone back and done the appropriate follow up testing, they need to use contraception, otherwise the vasectomy will fail to prevent pregnancy.