Dear Doctors: I am 40 years old and the father of three boys. My wife and I don’t plan on having more children. I’m considering a vasectomy, but I worry about what the surgery is like and how permanent it is. Is surgery to reverse a vasectomy difficult?
Dear Reader: A vasectomy is a minimally invasive surgery that provides men with an effective and permanent form of birth control -- well, almost permanent, because yes, a vasectomy can often be reversed. The data show that an estimated 300,000 to 500,000 men undergo a vasectomy each year in the United States. Often due to a change in their family plans, 3% to 6% seek a reversal.
Before we talk about vasectomy and reversals, we should begin with the male reproductive anatomy. The sperm that will fertilize an egg is produced in the testicles. When it matures, sperm moves through a pair of long, thin tubes known as vas deferens. These pass through the pelvic area and join a pair of structures known as the vesicle ducts, or seminal vesicles. They produce a cloudy, gellike fluid that mixes with the sperm. This creates semen, which is the fluid released by the penis during sexual intercourse.
In a vasectomy, a surgeon severs the vas deferens. This prevents the sperm from leaving the man’s body. The surgeon reaches the vas deferens through one or two tiny incisions -- or in some cases punctures -- in the scrotum. The surgeon visually identifies the two tubes then removes a small section of each. To prevent the passage of sperm, the ends of the tubes are either tied off or cauterized. The procedure, which takes 20 to 30 minutes, is typically performed under local anesthesia.
Recovery typically takes several days. Patients are advised to rest and wear a supportive undergarment. Patients usually manage discomfort with ice packs and over-the-counter pain medications. Patients are advised to avoid physical strain and sexual activity for two weeks while the body heals. Changes to the ejaculate aren’t noticeable, as sperm makes up a very small amount of the volume.
A reversal of a vasectomy, known as a vasovasostomy, involves reconnecting the separated portions of the vas deferens. Data show that the surgical technique used has a bearing on success rates. Reversals done visually have a success rate around 80%. This improves to 90% when the surgery is performed using a surgical microscope. There is also evidence of improved success rates with vasectomies that are less than 10 years old. The man’s general health, including whether he is a smoker, also play a role.
For men like yourself, who are concerned about the permanence of the procedure, preserving sperm in a sperm bank can be an option. Many surgeons encourage their patients to take this route, even when they are certain about their decision to have the surgery.
(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
