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Vasectomy and vasovasostomy

Description

An in-depth report on vasectomy as a method of male birth control and reversal surgeries.

Considerations

Having a vasectomy is a serious decision. The surgery is intended to be permanent. The great majority of men who seek a vasectomy have been married for 10 years or more. Not all are good candidates, however. It is important that both the woman and the man completely agree that they no longer want to have children. They should also agree that permanent birth control is the right decision for them. Ideally, the couple should view the operation as a mutual commitment to an already successful marriage or relationship. Vasectomy generally is not a good idea if the couple's relationship is under great stress. It is not a cure for emotional or sexual problems between a man and woman.

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 for the female.

Studies indicate that 5 -11% of men who have vasectomies regret the decision. In fact, in a 2001 study, 56% of men seeking treatment for fertility were hoping to reverse their vasectomies. Thirty years ago, this percentage was only 5%.

A reversal procedure called vasovasostomy is available, but it is a major operation that provides no guarantee of restored fertility. In a 2000 study of procedures performed between 1980 - 1996, vasectomy rates had leveled off but vasovasostomy rates had increased in men by nearly 70% in the most recent 5-year period compared to the earliest 5-year period.

Good and Poor Candidates for 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. (Couples in which the woman is working when they make the decision are at particular risk for regretting the decision later on.) 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 who are having the operation primarily for the sake of their partners and not wholly for their own reasons. Men or couples whose only motive is freedom from distraction imposed by other contraceptive methods during sexual activity.

The Influence of Short-Term Stress

Vasectomy should not be undertaken in response to temporary stressful situations that might block the desire for children. Such conditions may include illness, temporary financial crisis, death in the family, or birth of a child. Couples should wait through such short-term stresses or seek counseling or psychotherapy to be sure that they are not making a decision they will later regret.

All Future Scenarios. Before deciding on a vasectomy, the couple should consider all future scenarios for their life together, such as the following examples:

• If a couple already has children, how would they feel about a vasectomy if one of their children died?
• If financial stress is triggering the decision for a vasectomy, would improved affluence increase their desire for children?
• How would the man consider the vasectomy if his current relationship ended, either by divorce or the woman's death?

Emotional Implications for the Man and Woman

The word "sterilization" has a deep emotional connotation for many people. Even though a couple may rationally accept the idea of a vasectomy, it is extremely important for each partner to be as open as possible about any negative feelings they might associate with the procedure. Such feelings on the part of either partner can have devastating consequences on a relationship if they surface only after the procedure has been performed. Openness with each other is essential in order to make a decision that is clear of any hidden apprehensions. Neither partner should be too embarrassed to request counseling if the emotional aspects involved in making the decision are too difficult to solve between themselves.

What the man may be feeling:

• A man may have a poor self image, including concerns for his own physical health or sexual ability. Such men are likely to have a difficult time adjusting psychologically to vasectomy.
• A man may not actually really want the procedure but may not want to confront a partner he loves who wants him to have it.

What the woman may be feeling:

• A woman might believe, incorrectly, that a vasectomy is emasculating, but she might not want to express this idea to her partner.
• On the other hand, some women fear that vasectomy may make their partner more attractive and encourage outside affairs. (Research from the 1970s indicates that married men who have a vasectomy are no more likely to indulge in extramarital sex than fertile men.)

Sperm Banking

Storing frozen sperm in a sperm bank before vasectomy might enable men to have children later. Before the vasectomy, the man collects sperm, which are frozen and stored until he wants to have a child. In one study, 1.5% of men who had stored sperm later used it for conception and most were successful. Other studies have shown a lower success rate, however, and it is a very expensive process. Experts believe that a man who wants to bank sperm should probably reconsider his decision to have a vasectomy because such a concern may indicate doubts about giving up his ability to father a child.

• Review Date: 10/20/2006
• Reviewed By: Harvey Simon, M.D., Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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