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Vasectomy

Vasectomy

What is a vasectomy?

Vasectomy, also known as “male sterilization” or “male surgical contraception,” is a permanent contraceptive that blocks the tubes that carry sperm. This makes it impossible to get someone pregnant. It is designed for men who have no intention of having any children or any more children if they are already parents. It does not interfere with a man’s sexual performance in any way.

A vasectomy is done through a simple and completely safe surgical procedure designed to permanently and very effectively prevent pregnancy (1).

Once a vasectomy is done, fertility is not expected to return because the procedure is meant to be permanent. However, if you want to regain your fertility after a vasectomy, you can do so by either undergoing a vasectomy reversal or by having a sperm-retrieval procedure that is done as part of in vitro fertilization. These two options are generally expensive, difficult, and unavailable in a lot of places. If you manage to have reversal surgery or a sperm-retrieval procedure, there is no guarantee that it will lead to pregnancy (2).

When is a vasectomy a good option?

It is important to discuss vasectomy with your partner and determine if it is the right choice for you. A vasectomy may be a good option if

– your family is big enough – you already have enough kids or you do not want any kids at all.
– you and/or your partner have a genetic disorder that you would not want to pass on to your biological child.
– the pregnancy would cause serious health issues. If there is a medical reason why you or your partner should never get pregnant, a vasectomy might be a good option.

The conditions under which a vasectomy can be provided vary from country to country, with some countries allowing it for a broad number of reasons and others being more restrictive. Some countries do not have clear laws and leave the discretion of providing this service up to your health-care provider. If you are considering having a vasectomy, it is important to research what the laws in your country allow (3).

Who can have a vasectomy?

With proper counseling, any man can have a vasectomy. This includes

– married or unmarried men;
– men with or without children;
– young and old men (any man above 18 years old can have a vasectomy, and as long as you are sexually active and in good mental and physical health, there is no upper age limit; whether you are ready for the procedure is left to the judgment of your health-care provider);
– having or not having a partner’s permission;
– men with sickle cell disease;
– men at high risk of sexually transmitted infections (STIs) and diseases, including HIV; and
– men living with HIV, whether or not they are on antiretroviral therapy.

The most important factor is that a vasectomy should only be done to a person who is sure that they won’t regret having the procedure (4).

How does a vasectomy work?

A small incision or puncture is made in the scrotum to allow the health-care provider to reach the two tubes (vasa deferentia) that carry the sperm to the penis. The tubes are then either cut and tied closed or blocked through cauterization (application of electricity or heat).

A vasectomy prevents pregnancy by keeping sperm out of semen. Once you have had a vasectomy, semen is ejaculated, but it cannot cause pregnancy (5).

How effective is a vasectomy?

A vasectomy is one of the most effective contraceptives. Within the first year of use, the method is 99% effective at preventing pregnancy. This effectiveness is, however, not achieved immediately after the procedure. You must use another contraceptive for at least three months after the vasectomy or until you are sure that there is no sperm in your semen. The main cause of pregnancy within the first year after having a vasectomy is inconsistent usage of contraception during the three-month waiting period.

Just like with a tubal ligation, a small risk of pregnancy remains after the first year of usage, up to when the man’s partner reaches menopause.

Within three years of usage, the effectiveness stands at 98%. This is due to factors like improper usage of contraception during the waiting period; the cut end of the vas deferens growing back together; or if the provider made a mistake during the procedure (6).

When does a vasectomy become effective?

According to the American National Institute of Health, it takes 15–20 ejaculations, or three months, for sperm to clear out of semen. In addition, about one out of five men will usually have to wait longer than that.

You must, therefore, continue to use another contraception until the sperm has cleared. If a couple fails to consistently use an effective method of contraceptive within the first three months after a vasectomy, there is a high risk of a pregnancy occurring before the vasectomy has become fully effective.

The only sure way to confirm whether your vasectomy has become effective is by having your semen checked for sperm three months after the procedure. A small sample of your semen will be collected and tested for sperm. If no sperm is found, your vasectomy will be 99% effective at preventing pregnancy. It is recommended that you have at least two semen analyses done.

The first semen analysis can happen at two months after the procedure and the second at three months. If your semen is found to have sperm during your three-month check, visit your health-care provider two to four weeks later for another test. It is also advisable to have annual or periodic checks to ensure that your vasectomy is working as it should.

In some countries, you can do a self-fertility check at home using a home sperm test kit. If you prefer this option, you should check with your health-care provider about the availability of this kit in your country.

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