Procedure Overview: Vasectomy

Danielle Bonk

A vasectomy is a simple medical procedure intended for permanent sterilization in men, similar to tubal ligation for women. It is an effective form of birth control in the US and worldwide. According to the Population Reference Bureau, “approximately 6% of married women using contraception rely on vasectomy.”   

Procedure Information

The procedure itself involves small incisions made in the scrotum followed by the removal of approximately half an inch of each vas deferens (plural: vasa deferensia), or long tube which connects the testes to the penis, to prevent the flow of sperm during ejaculation. Without sperm, it is impossible for a woman to become pregnant. The removal is accomplished through cutting and sealing the vas deferens with heat, stitches, or metal clamps. The site of incision is then closed with dissolvable stitches. The vasectomy procedure generally requires some form of local anesthesia injected into the scrotum at the onset. However, in some cases, a patient may require general anesthesia. An entire vasectomy procedure takes approximately 20 to 30 minutes.    

Since sperm only accounts for about 10% of the ejaculation volume in pre-vasectomy men, ejaculation remains virtually the same after a vasectomy. The sperm which would normally be expelled during ejaculation is reabsorbed into the body. It may take up to several months before a sperm sample shows a zero sperm count, according to WebMD. In the meantime, patients are urged to use another form of birth control.  

Vasectomy Reversal

Although a vasectomy should be considered permanent, there is a reversal procedure known as vasovasectomy. This procedure reconnects the vasa deferensia so that sperm can again flow to the penis during ejaculation. The overall procedure can take between 2 to 4 hours.

Full restoration and sperm count is not guaranteed, however. Over time, a vasectomy patient may develop additional blockages or begin producing sperm antibodies. Either of these may decrease the procedure’s chances of success. Vasectomy reversal is most successful if performed within 3 years of the initial vasectomy. However, vasectomy reversals only have a 30% pregnancy success rate if it is performed 10 years after the initial vasectomy.

A vasovasectomy can also be costly and may not be covered by insurance companies. Typically, a patient in the US may end up paying up to $7,000 out-of-pocket for his vasectomy.

Vasectomy Side Effects

A vasectomy can result in some physical side effects, but serious conditions are rare. WebMD states that sperm granulomas, lumps of leaked sperm in surrounding tissue, can form but are usually painless. The build-up of sperm can sometimes put pressure on the epididymitis, the curved sperm-storage structure behind the testes, causing congestive epididymitis. This condition can become gradually painful but can be treated with medication and/or rest.

A long-term, serious vasectomy side effect includes Post-Vasectomy Pain Syndrome (PVPS). According to The Journal of Urology, PVPS consists of possible life-long genital pain which varies in intensity and that could occur in as little as 5% or as much as 35% of patients. Time, medication, or additional surgery may help or stop this problem altogether.

In regard to life-threatening side effects, years of research has found that a vasectomy does not increase the risk of prostate cancer, nor has it been known to cause death. Those considering a vasectomy should consult their doctor for more information. 

Vasectomy Complication

A vasectomy is generally a low-risk procedure with very few, if any, serious complications. Some common vasectomy complications include temporary bleeding, soreness, and bruising, which can linger a few days. In most cases, this disappears completely. The incision site could also become infected, which happens between 4 - 9% of the time. 

As advised by the CNN Health Library, a patient should see a doctor if any of the following occur:

• Fever
• Swelling that worsens or does not go away
• Difficult urination
• A marble-sized lump in the scrotum
• Bleeding that continues after applied pressure for 10 minutes

 

Vasectomy Cost

The cost of a vasectomy can range anywhere from $150 to $1,200, depending on factors like the surgical technique used and geographic location. A vasectomy normally costs significantly less than its female counterpart, however. In many cases there may even be no out-of-pocket cost since most insurance companies will cover at least part of the procedure, unlike vasovasectomies. 

Pregnancy after a Vasectomy

The chances of getting a woman pregnant after a vasectomy are slim. Vasectomies generally have a higher than 99% chance of effectiveness. In fact, within the first year of getting a vasectomy, between 1 and 2 smen out of 1,000 will get their partners pregnant. 

Failure can still occur in one of two ways: the vasa deferentia spontaneously reconnect or the remaining sperm in the ducts leading to the penis fertilizes an egg. The first is very rare, and the second can be easily avoided. The CNN Health Library states that it generally takes about 20 ejaculations to flush these remaining sperm out. A patient can decrease the chances of pregnancy after a vasectomy by following these three post-op steps:

• Complete a semen analysis six weeks after a vasectomy.
• Complete another semen analysis eight weeks after a vasectomy.
• Use a second form of birth control until two consecutive semen analyses show no sperm in ejaculation.

 

For more information about vasectomy procedures and infertility treatment, visit the US National Library of Medicine and the National Institutes of Health and the Journal of Urology