Like any family planning or contraceptive method, a vasectomy is a personal decision. It's also one that more than 500,000 men annually choose to have for a multitude of reasons.
"Vasectomy is the most effective form of contraception for men," says Dr. Akhil Muthigi, a urologist and male infertility specialist at Houston Methodist. "It's safe, can be performed in the clinic and is typically covered by insurance."
Not only that, but compared to female sterilization (getting your tubes tied), vasectomies are generally safer, less expensive and have a shorter recovery time.
They can also be reversed in select patients, still allowing couples the option to conceive naturally. Or like many, couples may consult a fertility specialist to explore assisted reproductive technologies, such as in vitro fertilization (IVF).
Ultimately, when it comes to vasectomies, fertility is still an option, but what should men and couples consider when it comes to choosing the contraceptive method that's right for them? In this article, Dr. Muthigi answers your questions about one of the least talked about types of family planning: vasectomy.
What is a vasectomy and how does it work?
A form of male birth control, a vasectomy is a small surgical procedure that involves cutting and removing a segment of the vas deferens, two thin tubes used to transport sperm from each testicle into the seminal fluid. The hallmark of a successful vasectomy procedure is azoospermia, a medical term meaning there is no sperm in the ejaculate (semen), or very few non-motile (dead) sperm.
But not all vasectomy procedures are the same. In fact, the way the surgery is performed can significantly affect a person's future fertility, including the ability for it to be reversed and the rate at which it fails, according to Dr. Muthigi, whose minimally invasive procedure involves no sutures, no large incisions and no scalpels. It can be done in office with local anesthesia or in a procedure room with light sedation and takes about 20 to 30 minutes, he says.
"In the vasectomy procedure, I remove a segment from each of the vas deferens, cauterize the cut edges and place a small clip on both cut segments, which prevents the two ends from fusing back together," Dr. Muthigi says. "This is one of the most effective ways for performing a vasectomy, according to the guidelines set by the American Urological Association."
What's the recovery like with a vasectomy?
March is unofficially coined as "vasectomy season" since many men elect to have vasectomies that align with March Madness, the NCAA's men's basketball tournament that takes place over the course of about three weeks. But vasectomies, per Dr. Muthigi, really only take about seven days to heal before men can begin resuming their daily activities, including sexual intercourse and ejaculation.
"Patients should avoid heavy activity, such as the gym, biking, sexual intercourse and ejaculation for at least one week following a vasectomy," he says. "Side effects will include mild pain and swelling in the scrotum for a few days that can be controlled with OTC pain medication and ice packs, but very rarely will pain persist more than one or two weeks."
In those extremely rare cases, Dr. Muthigi says patients may be prescribed a stronger anti-inflammatory medication.
How long are men fertile after a vasectomy?
"Men can still be fertile from anywhere from eight to 16 weeks after a vasectomy," says Dr. Muthigi. "The patient has to clear out the sperm that remains in their reproductive tract through frequent ejaculations beginning after their seven-day period of no sexual activity."
Three months after a vasectomy, Dr. Muthigi will order a semen analysis, which determines if there are any remaining sperm in the ejaculate. Once a patient shows no sperm in their ejaculate or very few non-motile sperm — meaning less than 100,000 per milliliter — they may stop using other methods of contraception such as condoms or birth control pills if they so choose, says Dr. Muthigi. However, it should be noted that vasectomies do not protect against STDs.
Luckily, it's rare to see sperm in a follow-up semen analysis, in which case those patients may be asked to repeat another analysis in a month or two to ensure sterility.
Can a vasectomy fail?
"Vasectomy is considered a failure if any motile [or moving] sperm is seen on a post-vasectomy semen analysis six months after the procedure, in which a repeat vasectomy should be considered," says Dr. Muthigi.
Seeing viable sperm at this point is rare, he says, but the body — in an attempt to heal itself — can sometimes fuse the cut ends of the vas deferens back together even after a proper vasectomy has been performed. This accidental "reversal" is referred to as recanalization and occurs in less than 1 percent of all vasectomies. Even so, recanalization does not necessarily indicate that full fertility has been restored.
Can a vasectomy be reversed?
While vasectomies are often seen as a permanent form of contraception, vasectomies can be and are frequently reversed, says Dr. Muthigi, who also specializes in this type of microsurgery.
"A vasectomy reversal entails bringing the ends of the vas deferens back together on both sides with very fine sutures under the magnification of a microscope," he says. "I perform the most effective method for bringing the vas deferens back together, using very fine sutures to connect both the inner tube and outer layer of the vas deferens."
In select patients, Dr. Muthigi says success rates for a vasectomy reversal — defined as the return of sperm back into the ejaculate — can be as high as 80% to 95% but vary on a patient-by-patient basis.
What are my fertility options after a vasectomy?
Per Dr. Muthigi, there are two main options for fertility following a vasectomy: a vasectomy reversal; and assisted reproductive technology (ART), an umbrella term for fertility treatments that involve manipulating sperm, eggs or embryos beyond natural conception. Both options have their pros and cons, he says.
For couples who are interested in having children through natural conception, a vasectomy reversal is the only option. ART allows many options for alternative conception, including IVF, in which a women's egg is fertilized with sperm outside of the uterus and later implanted for potential conception. Another popular ART method is intrauterine insemination, in which healthy sperm are placed directly onto the uterus around the natural time of ovulation.
With ART, rather than retrieving sperm through ejaculate, doctors can aspirate or collect sperm directly from the testicles or reproductive tract from patients who have undergone a vasectomy. Couples who utilize certain ART methods may also choose to freeze their sperm, eggs or embryos for later use, allowing for even more freedom when it comes to family planning.
Both vasectomy reversals and ART are effective fertility options following a vasectomy, Dr. Muthigi says, but the appropriate one depends on the couple's goals and situation, such as the number of future children desired, openness to ART, financial considerations and time.