Vasectomy: What to Know About Reversal, Risks & Effectiveness | Everyday Health

For men considering permanent birth control, a vasectomy is a common and effective option. However, life circumstances change and some men later consider fathering children again. Fortunately, a vasectomy can often be reversed, though it’s a more complex procedure than the initial vasectomy. Here’s what to consider when contemplating a vasectomy and the possibility of reversal.

When Is a Vasectomy the Right Choice?

Approximately 500,000 vasectomies are performed annually in the United States, according to the American Urological Association. It’s a decision that should be made with careful consideration, viewing it as a permanent form of birth control. As Dr. Sarah Vij, a urologist with Cleveland Clinic, explains, “This is really a personal decision, and one you shouldn’t just jump into.” While some may feel pressured by temporary situations like sleep deprivation after a newborn, the decision should be based on a settled desire regarding family size. Dr. Vij emphasizes that any adult male capable of making informed healthcare decisions can choose this method of contraception.

Sharing the Responsibility

Contraception is often perceived as a woman’s responsibility, but a vasectomy offers men a way to share that burden. Effective birth control for women often involves daily pills or an intrauterine device. “We always say that a vasectomy is an act of love,” says Dr. Masson. “It’s wonderful to see so many men taking responsibility for the reproductive health of themselves and their families, and not asking their partner to bear the total burden.”

Effectiveness and What to Expect

A vasectomy is a highly effective form of birth control, with a failure rate of about 1 to 2 in 1,000, according to Dr. Vij. However, it’s not immediately effective. After the procedure, a man must ejaculate to clear any remaining sperm. The time it takes to clear varies significantly, ranging from a few ejaculations to 40 or more. A semen test at three months is typically recommended to confirm clearance, and continued birth control is necessary until a doctor confirms the absence of sperm.

The Procedure and Recovery

A vasectomy is a minimally invasive outpatient procedure lasting about 15 minutes. There are two techniques – one involving an incision and one that doesn’t. Local anesthesia and light tranquilizers are used. Post-procedure discomfort is manageable with rest, nonsteroidal anti-inflammatory drugs, and ice packs. Interestingly, some surgeons have noted an increase in vasectomies performed before the NCAA March Madness basketball tournament, allowing men to recover comfortably while watching games.

Potential Risks

The complication rate for a vasectomy is less than 1 percent, and can include bleeding, infection, inflammation, or ongoing pain. In rare cases, some men may experience long-term testicular pain or pain during ejaculation, known as Post-Vasectomy Pain Syndrome. Another potential, though uncommon, risk is recanalization, where the tubes reconnect, restoring fertility. This occurs in about 1 in 2,000 cases. Other potential risks include sperm granuloma (a hard lump that usually resolves on its own) and scrotal congestion (a feeling of pressure in the testicles, which typically improves over time).

Impact on Sexual Function

A vasectomy does not affect a man’s sexual function. Erections and orgasms remain unaffected, as the majority of ejaculate comes from the prostate and seminal vesicles, not the testicles. “Erections are going to be completely unaffected, and you will still have orgasms and ejaculations,” explains Dr. Masson. “Everything will still look and feel the same; just microscopically, there will be no sperm in the semen.”

Vasectomy Reversal: A Complex Option

If a man later decides he wants to have children, a vasectomy can often be reversed. However, it’s a more complex procedure requiring a surgeon experienced in microsurgery. The cost of a reversal can be substantial, as it is often not covered by insurance, potentially exceeding $20,000. Success rates vary, but are not guaranteed. However, a study found that reversal success rates are comparable in men over 50 as in younger men.

Alternative Options for Fatherhood

For men interested in fatherhood after a vasectomy, surgical sperm extraction is an alternative. This procedure is often faster than a reversal and can be performed on an outpatient basis. However, the extracted sperm requires in vitro fertilization (IVF) to achieve pregnancy. Sperm banking prior to a vasectomy is another option to preserve fertility.

As reversing a vasectomy is possible but not easy, speaking with a partner (if applicable) and a physician or urologist is vital to determine if it’s the right course of action.