Treatment:

After deciding that permanent birth control is the best solution, a couple still has the option of either vasectomy for the male or tubal ligation (female sterilization) for the female. Female sterilization is performed three times as often as vasectomy, but vasectomy is a less complicated procedure and poses fewer risks for complications.[For information , see In-Depth Report #91: Birth control options for women.]

Vasectomy is very safe and is nearly 100% effective for preventing pregnancy. It does not protect against sexually transmitted diseases (STDs). Condoms remain the best method for STD prevention for sexually active people.

The decision to have a vasectomy should be carefully considered. A reversal procedure can be performed, but it is a major operation that does not guarantee restored fertility. In addition, these reversal procedures (vasovasostomy and vasoepididymostomy) are much more complicated surgeries than vasectomy.

After-Effects

Surveys indicate that the vast majority of men are satisfied with vasectomy and that this satisfaction persists. Most men who have vasectomies feel relieved that the worry about pregnancy is over, and most couples respond well to their new-found contraceptive freedom.

Vasectomy does not affect a man's hormonal levels and does not impair sexual potency, desire, or satisfaction. Some men may go through a brief period of self-consciousness, wondering whether others notice some difference in their masculinity. For most men, this tentativeness passes quickly. Some couples may experience difficulties, which manifest in sexual dysfunction such as impotence, premature ejaculation, or painful intercourse. In such cases, the underlying cause is usually unresolved emotional issues, not the vasectomy itself.

Who Should Have a Vasectomy

Vasectomies may be right for:

• Men in relationships in which both partners agree they have all the children they want and both do not want to use or are unable to use other methods of contraception
• Men in relationships whose partners have health problems that make pregnancy unsafe
• Men in relationships in which one or both have genetic disorders that they do not want to transmit

Vasectomies may not be right for:

• Men in relationships in which one partner is unsure about his or her desire to have children in the future.
• Men whose current relationships are unstable, going through a stressful phase, or are marked by substantial conflict
• Men who are considering the operation just to please their partners
• Men who are counting on having children later by storing sperm or by surgical reversal of the vasectomy
• Young men, who still have many life changes ahead
• Men who are single (including those divorced or separated) at the time of vasectomy
• Men or couples whose only motive is freedom from distraction imposed by other contraceptive methods during sexual activity

Sperm Banking

Sperm banking can be used in conjunction with vasectomy or vasectomy reversal surgery. Sperm banking involves freezing (cryopreservation) and storage (cryobanking) of sperm. It is usually performed either before a vasectomy, or during or after reversal surgery. If a man later desires to have children, the sperm can be used for assisted reproductive technologies, usually intracytoplasmic sperm injection used in combination with in vitro fertilization. [For more information, see In-Depth Report #67: Infertility in men.]

Sperm banking is no guarantee for successful conception and pregnancy. Sperm can be frozen for many years, but even after 6 months not all sperm cells remain fertile after being unfrozen. In addition, sperm banking is typically not covered by health insurance plans and costs should be considered.

Although most men who have a vasectomy never use their banked sperm, it is understandable if some men are emotionally reassured by the idea that they have sperm preserved "just in case". Still, men who are considering vasectomy should not view sperm banking (or vasectomy reversal) as a guaranteed option if they later change their minds. It is best to undertake vasectomy as a permanent sterilization procedure. If future fathering of children seems a possibly desirable scenario, it is wise to reconsider whether vasectomy is the right decision to make.