Vasectomy: To Do or Not To Do?

By Hans Stricker, MD

Enjoying sex without fear of pregnancy; Limiting your family size; Protecting your partner from a dangerous pregnancy. These are all common reasons why men choose to have a vasectomy. And, with the minimally invasive techniques available today on an outpatient basis, the procedure is quick, easy and virtually painless. It’s also a fairly inexpensive procedure, especially compared to female sterilization. As with any procedure, you need to consider the long-term ramifications.

Despite the fact that vasectomy can be reversed in some cases, men should always consider it to be a permanent form of birth control. If there is any reason to believe that a man may wish to have children in the future, he definitely must consider other forms of birth control instead.

During a vasectomy, the surgeon makes one or two small openings in the scrotum, then cuts both the left and right vas deferens, which are the muscular tubes that carry sperm out of the testicles. Both ends of the tube are then tied off or sealed. Alternately, the surgeon can use the “no-scalpel” vasectomy method, which is performed through tiny puncture holes that don’t require stitches. There’s very little blood loss with this technique, as well as less pain and a lower risk of complications.

Overall, vasectomy is a highly effective, relatively simple procedure that takes as little as 10-20 minutes – which is why more than 500,000 American men choose this type of sterilization every year. But because it is permanent, the decision to have a vasectomy must not be made lightly. So here is a checklist of the do’s and don’ts you should consider both before committing to a vasectomy and after the surgery is complete:

Do make sure both you and your spouse or significant other is in absolute agreement that your family is complete and you won’t want more children in the future. If either of you is unsure, don’t go through with the procedure.

Do consider all other forms of birth control first. Female contraceptive methods are more than 97 percent effective, and many of them, like diaphragms and cervical caps, have no serious complications or side effects.

Do remember that personal circumstances can change over time. Death and divorce are a fact of life, and there’s always the possibility that one day you may want to have children with a new spouse or partner.

Do make sure you’re mentally ready. Although a vasectomy does not affect testosterone levels, sexual performance or the amount of ejaculate, some men or their spouses still have a hard time accepting the fact that they’ll be sterile permanently. If there may be doubts in your mind about going through with the procedure, postpone it for a while – or even indefinitely.

Don’t allow yourself to be pressured into having the procedure. Only you can make the final decision with the loving support of your partner.

Don’t bank sperm just in case you change your mind later. Sperm does not always survive the freezing process, and can begin to lose its ability to fertilize an egg in as little as six months. It’s also expensive to store sperm. So if you can’t make a firm decision about whether you’ll want children in the future, you probably should forego the vasectomy.

Don’t rush into having the surgery after the birth of your last child. Regrettably, some couples lose their child to Sudden Infant Death Syndrome (SIDS), and the heartbreak of knowing they can’t have another child can make the loss even harder to bear.

Don’t try to return to regular activities too soon after the procedure. Although the procedure is considered minor, you still need time to recuperate. You must avoid lifting anything heavier than 15 pounds – including babies and children – as well as doing any strenuous activities or sports, having sex, getting into and out of cars, and going up and down stairs for up to seven days so you have time to heal properly. You’ll also need to avoid doing heavy work of any kind for up to two weeks after the procedure.

Don’t forget to have your post-vasectomy sperm count tests. Vasectomy is extremely effective, but it can take several months after surgery for sperm to be flushed completely out of the vas deferens. Only a semen test can tell you whether it’s safe to have unprotected sex. You’ll usually need two consecutive tests to be sure, and until you’re given the all-clear, you’ll need to continue to use your previous birth control method.

Sidebar: Second Chance

An estimated 2-6 percent of the half million American men who undergo vasectomy later decide to have a vasectomy reversal. However, even though vasectomy is a fairly simple procedure, the microsurgical reversal procedure is not and a subsequent pregnancy is not guaranteed. The surgery also is usually not covered by insurance so the out-of-pocket costs can be high — $10,000 on average, but as much as $20,000.

The microsurgical reversal usually consists of sewing the vas deferens back together or reattaching it directly to the testicles, which allows sperm to reach the semen again. But while an experienced reversal specialist can reestablish sperm flow 99 percent of the time, a natural pregnancy will result only about two-thirds of the time, and it takes an average of 12 months for the woman to conceive. But for the man who wants to father a child again, the discomfort and cost of a reversal may be a small price to pay.

Hans Stricker, MD, is board certified by the American Board of Urology. He completed medical school at the University of Michigan Medical School followed by his general surgery and urology training, also at U of M. His clinical and special medical interests are in the areas of prostate, bladder and kidney cancer.

Ask the Doctor: February 2008

Question: I am 36 and have been trying to get pregnant for about 6 months, and we have not yet been successful. I haven’t decided if I want to go through fertility treatments yet. Do you have any suggestions? -L.D., Troy

Answer: There are a few things you can do on your own before consulting with your gynecologist. You can start by determining when you ovulate. First of all you need to know your cycle length. This is the number of days between the first day of one period and the first day of the next. If your periods are not regular and you can never predict them, there is a good chance that you are not ovulating and you should talk to your gynecologist about the reasons why you might not be ovulating.

Most women have cycles ranging from 26-31 days. It doesn’t matter if your cycle is long or short, if you are regular; you are most likely ovulating on schedule. Most women average about 28 days, so I will use that as my example. If the first day of your period is day 1, you are most likely to ovulate on day 14.

There are commercially available ovulation monitors that can help you predict when you are going to ovulate, but there is also a technique you can do yourself called basal body temperature. Your normal body temperature will go up around the time of ovulation and back down after ovulation. If you plot your temperature every day you should be able to tell when you will ovulate.

For an accurate basal body temperature, you must take your temperature at the same time every day – first thing in the morning. You should use a digital thermometer to be accurate to the decimal point, because the rise in temperature that you are looking for is very subtle. You should keep the thermometer right next to your bed and take your temperature as soon as you wake up, BEFORE you get out of bed or have any water or coffee.

Like I said, the difference in temperatures is small and different for everybody, but if you are ovulating you will begin to notice a pattern, and then can try to get pregnant around your time of ovulation. The last patient I explained this too got pregnant within a few months!

Question: My New Years Resolution is to lose weight, as it is every year. THIS year however I don’t want to give up! I already think I eat healthy but I am not losing weight! Can you help? – R.A., Utica

Answer: It’s great that you are already eating healthy, but unfortunately, healthy is not always enough to lose weight. It is really about calories. Healthy food will give you all the vitamins and minerals that you need but can have the same amount of calories as junk food if you are not careful. To lose weight successfully you really need to understand the math of calories.

There are 3500 calories in a pound. This means to gain a pound you have to eat an extra 3500 calories and to lose a pound you must burn off that same amount. I have 2 examples for you. One banana is about 100 calories and two Oreo cookies are 100 calories. The banana is much healthier and provides the nutrients that we need. But, if you give up your snack of two Oreos in the afternoon for a banana and think that will help you lose weight, it will not since the calories are the same.

My other example is those “Big Grab” bags of potato chips you can find in the convenience stores. You think that they are one serving size and that they are a good value since they are usually 99 cents. If you read the nutrition information on the back you find out there about 3 servings in one bag, for about 450 calories. So, if you are in the habit of picking up a bag of chips for a snack, and if you have eaten one bag a day, you can almost gain a pound a week!

There are a lot of other foods that are packaged in a way that makes you think they have fewer calories. The muffins at Starbucks are another example. I try to think of them as cupcakes and not muffins because the term muffin implies that they are healthy, when they really have about 500 calories each.

So, if you want to lose a pound a week, which is realistic, you need to get rid of about 500 calories per day in either exercise, cutting back on food or a combination of the two (the better choice). I know this sounds a little overwhelming but there is a lot of information out there about calorie counts and I would start by figuring out how much you are eating now and then seeing where you can cut back. You would be surprised to find out how much you might be eating and how easy it is to get rid of some of the unnecessary foods you put in your mouth every day. Good Luck!

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.