Vasectomy By Lisa Glickstein, Ph.D, Triplet Mom Originally printed in June, 2005 June is the month to celebrate Dad – and a day for Dad to reflect on how much pride and pleasure he gets from his kids. There comes a time for many-a-Dad when he’s had just about as much pride and pleasure as one man can stand. Vasectomy falls under “family planning” at about the same point as closing the barn door after the horse (or three, four, or more) is already out. In other words, it is only considered after the family is “complete” – not counting any dogs, cats, guinea pigs, birds or other non-human family members to be added later. What is vasectomy? Vasectomy, while sometimes referred to as male sterilization, is NOT the same procedure as getting your dog “neutered” or “fixed.” In a vasectomy, the tiny tube that connects the testicles to the penis is interrupted so that sperm cannot get out. Nothing else is disturbed. Because it involves a very small incision that can be covered with a band-aid, it is performed in a doctor’s office under local anesthesia, and you can drive yourself home afterward. You need to take it easy for a couple of days, and apply ice to take care of any swelling. Aches or bruising may begin the next day and last for up to three days, and can be treated with over the counter pain relievers like Tylenol or Advil. What about aftereffects? Through a feedback mechanism, the testicles get the message that no sperm is needed and eventually, sperm production (the cell division that leads to sperm cells) stops. This is similar to what happens to milk production in women who choose not to or stop breast-feeding. Since sperm only make up a tiny part of the ejaculate (semen), and since nothing else is disturbed, male orgasm is normal. For many couples, feeling secure about birth control is a great psychological boost and benefits intimacy. Is vasectomy immediately effective for birth control? Can it grow back? No, vasectomy is not immediately effective. It takes some time to “clear the system” of live sperm. Your doctor will recommend an interval (usually a month or so) to continue using your usual birth control method. Then, it is important to have your ejaculate tested to be certain that no live sperm are detected before discontinuing other birth control. Once you are “clear,” it is very unlikely for the procedure to reverse itself. Why vasectomies over other birth control methods? Men have two choices to control their own fertility: condoms and vasectomy. Condoms are the only birth control method that prevent sexually transmitted diseases, and are therefore preferred over all other methods when that is a concern. Many find using condoms objectionable, and if protecting from STD's is not a concern, prefer an alternative birth control method. In addition, condoms, like many birth control methods, have a small but real failure rate. Women have essentially two choices for birth control: hormone-based methods or sterilization. For young women, hormone-based birth control (the Pilltm, patches, shots, implants) can be an excellent choice. However, hormone-based birth control increases risks of heart complications that further increase with age. Some types also increase the risks of breast or pelvic cancers, which similarly increase with a woman’s age and years of use. Many women find that as they get older, they also get more sensitive to the side effects of these treatments, including mood-disorders and menstrual migraine headaches. As with condoms, hormone-based methods have a small but measurable failure rate, even when used as directed. Female sterilization requires laparoscopic or abdominal surgery, and anesthesia, which carry their own risks. Some women do choose to have their “tubes tied” at a c-section of a planned final child. However, many couples are not yet ready to make a decision about family size at that point. For these reasons, vasectomy is the birth control method of choice for many couples. Can vasectomy be reversed? What if you find later that you want to have more children? In many cases, reattaching the cut ends of the tubes can reverse vasectomy. Sperm production then is restored, although the sperm may be of lower quality in the short- or long-term. The genetic material is normal, however. IVF or ICSI may be needed to produce pregnancy. Who should perform my vasectomy? Speak to your primary care doctor and discuss your needs. Urologists – doctors who have specialized training in male anatomy and physiology, perform most vasectomies. Your primary care doctor can refer you to a local urologist.