Vasectomy, or vasoligation, is an elective surgical procedure for male
sterilization or permanent
contraception
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
. During the procedure, the male
vasa deferentia
The vas deferens or ductus deferens is part of the male reproductive system of many vertebrates. The ducts transport sperm from the epididymis to the ejaculatory ducts in anticipation of ejaculation. The vas deferens is a partially coiled tube w ...
are cut and tied or sealed so as to prevent
sperm
Sperm is the male reproductive cell, or gamete, in anisogamous forms of sexual reproduction (forms in which there is a larger, female reproductive cell and a smaller, male one). Animals produce motile sperm with a tail known as a flagellum, whi ...
from entering into the
urethra
The urethra (from Greek οὐρήθρα – ''ourḗthrā'') is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra con ...
and thereby prevent
fertilization
Fertilisation or fertilization (see spelling differences), also known as generative fertilisation, syngamy and impregnation, is the fusion of gametes to give rise to a new individual organism or offspring and initiate its development. Proce ...
of a female through
sexual intercourse
Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...
. Vasectomies are usually performed in a
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
's office, medical clinic, or, when performed on an
animal
Animals are multicellular, eukaryotic organisms in the Kingdom (biology), biological kingdom Animalia. With few exceptions, animals Heterotroph, consume organic material, Cellular respiration#Aerobic respiration, breathe oxygen, are Motilit ...
, in a
veterinary clinic.
Hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
ization is not normally required as the procedure is not complicated, the incisions are small, and the necessary equipment routine. The leading potential complication is
post-vasectomy pain syndrome
Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore e ...
.
There are several methods by which a surgeon might complete a vasectomy procedure, all of which occlude (i.e., "seal") at least one side of each vas deferens. To help reduce anxiety and increase patient comfort, those who have an aversion to needles may consider a "''no-needle''" application of anesthesia while the '
no-scalpel' or 'open-ended' techniques help to accelerate recovery times and increase the chance of healthy recovery.
Due to the simplicity of the surgery, a vasectomy usually takes less than 30 minutes to complete. After a short recovery at the doctor's office (usually less than an hour), the patient is sent home to rest. Because the procedure is minimally invasive, many vasectomy patients find that they can resume their typical sexual behavior within a week, and do so with little or no discomfort.
Because the procedure is considered a permanent method of contraception and is not easily reversed, patients are usually counseled and advised to consider how the long-term outcome of a vasectomy might affect them both emotionally and physically. The procedure is not often encouraged for young single childless people as their chances for biological parenthood are thereby permanently reduced, sometimes completely.
Medical uses
A vasectomy is done to prevent fertility in males. It ensures that in most cases the person will be
sterile
Sterile or sterility may refer to:
*Asepsis, a state of being free from biological contaminants
* Sterile (archaeology), a sediment deposit which contains no evidence of human activity
*Sterilization (microbiology), any process that eliminates or ...
after confirmation of success following surgery. The procedure is regarded as permanent because
vasectomy reversal
Vasectomy, or vasoligation, is an elective surgical procedure for male sterilization or permanent contraception. During the procedure, the male vasa deferentia are cut and tied or sealed so as to prevent sperm from entering into the urethra and ...
is costly and often does not restore the male's sperm count or sperm motility to prevasectomy levels. Those with vasectomies have a very small (nearly zero) chance of successfully impregnating someone, but a vasectomy has no effect on rates of
sexually transmitted infection
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are Transmission (medicine), spread by Human sexual activity, sexual activity, especi ...
s.
After vasectomy, the testes remain in the scrotum where
Leydig cell
Leydig cells, also known as interstitial cells of the testes and interstitial cells of Leydig, are found adjacent to the seminiferous tubules in the testicle and produce testosterone in the presence of luteinizing hormone (LH). They are polyhedral ...
s continue to produce
testosterone
Testosterone is the primary sex hormone and anabolic steroid in males. In humans, testosterone plays a key role in the development of Male reproductive system, male reproductive tissues such as testes and prostate, as well as promoting secondar ...
and other male hormones that continue to be secreted into the bloodstream. Some studies have found that
sexual desire
Sexual desire is an emotion and motivational state characterized by an interest in sexual objects or activities, or by a drive to seek out sexual objects or to engage in sexual activities. It is an aspect of sexuality, which varies significantly ...
after vasectomy may be somewhat diminished.
[
When the vasectomy is complete, sperm cannot exit the body through the ]penis
A penis (plural ''penises'' or ''penes'' () is the primary sexual organ that male animals use to inseminate females (or hermaphrodites) during copulation. Such organs occur in many animals, both vertebrate and invertebrate, but males do n ...
. Sperm is still produced by the testicles but is broken down and absorbed by the body. Much fluid content is absorbed by membranes in the epididymis
The epididymis (; plural: epididymides or ) is a tube that connects a testicle to a vas deferens in the male reproductive system. It is a single, narrow, tightly-coiled tube in adult humans, in length. It serves as an interconnection between the ...
, and much solid content is broken down by the responding macrophage
Macrophages (abbreviated as M φ, MΦ or MP) ( el, large eaters, from Greek ''μακρός'' (') = large, ''φαγεῖν'' (') = to eat) are a type of white blood cell of the immune system that engulfs and digests pathogens, such as cancer cel ...
s and reabsorbed via the bloodstream. Sperm is matured in the epididymis for about a month before leaving the testicles. After vasectomy, the membranes must increase in size to absorb and store more fluid; this triggering of the immune system causes more macrophages to be recruited to break down and reabsorb more solid content. Within one year after vasectomy, sixty to seventy percent of those vasectomized develop antisperm antibodies
Antisperm antibodies (ASA) are antibodies produced against sperm antigens.
Types
Antisperm antibodies are immunoglobulins of IgG, IgA, and/or IgM, which are directed against sperm antigens. ASA can be detected in ejaculate, cervical mucus, ...
.[ In some cases, ]vasitis nodosa
Vasitis nodosa is a complication experienced in approximately 66% of men who undergo vasectomy. It is a benign nodular thickening of the vas deferens, in which small offshoots proliferate, infiltrating surrounding tissue. It can be mistaken for ...
, a benign proliferation of the ductular epithelium, can also result.[ The accumulation of sperm increases pressure in the vas deferens and epididymis. The entry of the sperm into the scrotum can cause ]sperm granuloma
A sperm granuloma is a lump of leaked sperm that appears along the vasa deferentia or epididymides in vasectomized individuals. While majority of sperm granulomas are present along the vas deferens, the rest of them form at the epididymis. Sper ...
s to be formed by the body to contain and absorb the sperm which the body will treat as a foreign biological substance (much like a virus or bacterium).[
]
Efficacy
Vasectomy is the most effective permanent form of contraception available to males. (Removing the entire vas deferens would very likely be more effective, but it is not something that is regularly done.) In nearly every way that vasectomy can be compared to tubal ligation
Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus th ...
it has a more positive outlook. Vasectomy is more cost effective, less invasive, has techniques that are emerging that may facilitate easier reversal, and has a much lower risk of postoperative complications.
Early failure rates, i.e. pregnancy within a few months after vasectomy, typically result from unprotected sexual intercourse
Sexual intercourse (or coitus or copulation) is a sexual activity typically involving the insertion and thrusting of the penis into the vagina for sexual pleasure or reproduction.Sexual intercourse most commonly means penile–vaginal penetrat ...
too soon after the procedure while some sperm continue to pass through the vasa deferentia. Most physicians and surgeons who perform vasectomies recommend one (sometimes two) postprocedural semen specimens to verify a successful vasectomy; however, many people fail to return for verification tests citing inconvenience, embarrassment, forgetfulness, or certainty of sterility.[ In January 2008, the FDA cleared a home test called SpermCheck Vasectomy that allows patients to perform postvasectomy confirmation tests themselves;][ however, compliance for postvasectomy semen analysis in general remains low.
Late failure, i.e. pregnancy following spontaneous recanalization of the vasa deferentia, has also been documented.][ This occurs because the ]epithelium
Epithelium or epithelial tissue is one of the four basic types of animal tissue, along with connective tissue, muscle tissue and nervous tissue. It is a thin, continuous, protective layer of compactly packed cells with a little intercellul ...
of the vas deferens (similar to the epithelium of some other human body parts) is capable of regenerating and creating a new tube if the vas deferens is damaged and/or severed. Even when as much as five centimeters (or two inches) of the vas deferens is removed, the vas deferens can still grow back together and become reattached—thus allowing sperm to once again pass and flow through the vas deferens, restoring one's fertility.
The Royal College of Obstetricians and Gynaecologists
The Royal College of Obstetricians and Gynaecologists (RCOG) is a professional association based in London, United Kingdom. Its members, including people with and without medical degrees, work in the field of obstetrics and gynaecology, that is ...
states there is a generally agreed-upon rate of late failure of about one in 2000 vasectomies— better than tubal ligation
Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus th ...
s for which the failure rate is one in every 200 to 300 cases.[ A 2005 review including both early and late failures described a total of 183 recanalizations from 43,642 vasectomies (0.4%), and sixty pregnancies after 92,184 vasectomies (0.07%).][
]
Complications
Short-term possible complications include infection
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
, bruising
A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...
and bleeding
Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...
into the scrotum resulting in a collection of blood known as a hematoma
A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
. A study in 2012 demonstrated an infection rate of 2.5% postvasectomy. The stitches on the small incisions required are prone to irritation, though this can be minimized by covering them with gauze or small adhesive bandage
An adhesive bandage, also called a sticking plaster, medical plaster, or simply plaster in British English, is a small medical dressing used for injuries not serious enough to require a full-size bandage. They are also known by the genericized tra ...
s. The primary long-term complications are chronic pain conditions or syndromes that can affect any of the scrotal, pelvic or lower-abdominal regions, collectively known as post-vasectomy pain syndrome
Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore e ...
. Though vasectomy results in increases in circulating immune complexes, these increases are transient. Data based on animal and human studies indicate these changes do not result in increased incidence of atherosclerosis
Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheroma, atheromatous plaque. At onset there are usu ...
. The risk of testicular cancer is not affected by vasectomy.[
In 2014 the AUA reaffirmed that vasectomy is not a risk factor for prostate cancer and that it is not necessary for physicians to routinely discuss prostate cancer in their preoperative counseling of vasectomy patients.] There remains ongoing debate regarding whether vasectomy is associated with prostate cancer. A 2017 meta-analysis found no statistically significant increase in risk. A 2019 study of 2.1 million Danish males found that vasectomy increased their incidence of prostate cancer by 15%. A 2020 meta-analysis found that vasectomy increased the incidence by 9%. Other recent studies agree on the 15% increase in risk of developing prostate cancer, but found that people who get a vasectomy are not more likely to die from prostate cancer than those without a vasectomy.
Postvasectomy pain
Post-vasectomy pain syndrome is a chronic and sometimes debilitating condition that may develop immediately or several years after vasectomy.[ The most robust study of post-vasectomy pain, according to the American Urology Association's Vasectomy Guidelines 2012 (amended 2015) surveyed people just before their vasectomy and again 7 months later. Of those that responded and who said they did not have any scrotal pain prior to vasectomy, 7% had scrotal pain seven months later which they described as "Mild, a bit of a nuisance", 1.6% had pain that was "Moderate, require painkillers" and 0.9% had pain that was "quite severe and noticeably affecting their quality of life".] Post-vasectomy pain can be constant orchialgia or epididymal pain (epididymitis
Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may ...
), or it can be pain that occurs only at particular times such as with sexual intercourse, ejaculation, or physical exertion.[
]
Psychological effects
Approximately 90% are generally reported in reviews as being satisfied with having had a vasectomy, while 7–10% of people regret their decision. For those in relationships, regret was less common when both people in the relationship agreed on the procedure.[
Younger people who receive a vasectomy are significantly more likely to regret and seek a reversal of their vasectomy, with one study showing people in their twenties being 12.5 times more likely to undergo a vasectomy reversal later in life (and including some who chose sterilization at a young age). Pre-vasectomy counseling is suggested for younger patients.
]
Dementia
An association between vasectomy and primary progressive aphasia
Primary progressive aphasia (PPA) is a type of neurological syndrome in which language capabilities slowly and progressively become impaired. As with other types of aphasia, the symptoms that accompany PPA depend on what parts of the left hemisph ...
, a rare variety of frontotemporal dementia, was reported. However, it is doubtful that there is a causal relationship. The putative mechanism is a cross-reactivity between brain and sperm, including the shared presence of neural surface antigens. In addition, the cytoskeletal tau protein
The tau proteins (abbreviated from tubulin associated unit) are a group of six highly soluble protein isoforms produced by alternative splicing from the gene ''MAPT'' (microtubule-associated protein tau). They have roles primarily in maintaining ...
has been found only to exist outside of the CNS in the manchette of sperm.
Procedure
The traditional incision approach of vasectomy involves numbing of the scrotum with local anesthetic (although some people's physiology may make access to the vas deferens more difficult in which case general anesthesia may be recommended) after which a scalpel
A scalpel, lancet, or bistoury is a small and extremely sharp bladed instrument used for surgery, anatomical dissection, podiatry and various arts and crafts (either called a hobby knife or an X-acto knife.). Scalpels may be single-use disposa ...
is used to make two small incisions, one on each side of the scrotum at a location that allows the surgeon to bring each vas deferens to the surface for excision. The vasa deferentia are cut (sometimes a section may be removed altogether), separated, and then at least one side is sealed by ligating (suturing
A surgical suture, also known as a stitch or stitches, is a medical device used to hold body tissues together and approximate wound edges after an injury or surgery. Application generally involves using a needle with an attached length of threa ...
), cauterizing
Cauterization (or cauterisation, or cautery) is a medical practice or technique of burn (injury), burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undes ...
( electrocauterization), or clamping. There are several variations to this method that may improve healing, effectiveness, and which help mitigate long-term pain such as post-vasectomy pain syndrome or epididymitis
Epididymitis is a medical condition characterized by inflammation of the epididymis, a curved structure at the back of the testicle. Onset of pain is typically over a day or two. The pain may improve with raising the testicle. Other symptoms may ...
, however the data supporting one over another are limited.
* Fascial interposition: Recanalization of the vas deferens is a known cause of vasectomy failure(s). Fascial interposition ("FI"), in which a tissue barrier is placed between the cut ends of the vas by suturing, may help to prevent this type of failure, increasing the overall success rate of vasectomy while leaving the testicular end within the confines of the fascia.[ ] The fascia
A fascia (; plural fasciae or fascias; adjective fascial; from Latin: "band") is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches to, stabilizes, encloses, and separates muscles and other internal organs. ...
is a fibrous protective sheath that surrounds the vas deferens as well as all other body muscle tissue. This method, when combined with intraluminal cautery (where one or both sides of the vas deferens are electrically "burned" closed to prevent recanalization), has been shown to increase the success rate of vasectomy procedures.
* No-needle anesthesia: Fear of needles
Fear of needles, known in medical literature as needle phobia, is the extreme fear of medical procedures involving injections or hypodermic needles. This can lead to avoidance of medical care, including vaccine hesitancy.
It is occasionally refe ...
for injection of local anesthesia
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It ...
is well known. In 2005, a method of local anesthesia was introduced for vasectomy which allows the surgeon to apply it painlessly with a special jet-injection tool, as opposed to traditional needle application. The numbing agent is forced/pushed onto and deep enough into the scrotal tissue to allow for a virtually pain-free surgery. Lidocaine applied in this manner achieves anesthesia in less than one minute. Initial surveys show a very high satisfaction rate amongst vasectomy patients.[ Once the effects of no-needle anesthesia set in, the vasectomy procedure is performed in the routine manner. However, unlike in conventional local anesthesia where needles and syringes are used on one patient only, the applicator is not single use and cannot be properly cleaned leading to concerns regarding infection control.
* No-scalpel vasectomy (NSV): Also known as a "key-hole" vasectomy,][ is a vasectomy in which a sharp ]hemostat
A hemostat (also called a hemostatic clamp, arterial forceps, or pean after Jules-Émile Péan) is a surgical tool used in many surgical procedures to control bleeding. For this reason, it is common in the initial phases of surgery for the initia ...
(as opposed to a scalpel) is used to puncture the scrotum. This method has come into widespread use as the resulting smaller "incision" or puncture wound typically limits bleeding and hematomas. Also the smaller wound has less chance of infection, resulting in faster healing times compared to the larger/longer incisions made with a scalpel. The surgical wound created by the no-scalpel method usually does not require stitches. NSV is the most commonly performed type of minimally invasive vasectomy, and both describe the method of vasectomy that leads to access of the vas deferens.
* Open-ended vasectomy: In this procedure the testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. This method may avoid testicular pain resulting from increased back-pressure in the epididymis
The epididymis (; plural: epididymides or ) is a tube that connects a testicle to a vas deferens in the male reproductive system. It is a single, narrow, tightly-coiled tube in adult humans, in length. It serves as an interconnection between the ...
.[ Studies suggest that this method may reduce long-term complications such as ]post-vasectomy pain syndrome
Post-vasectomy pain syndrome (PVPS) is a chronic and sometimes debilitating genital pain condition that may develop immediately or several years after vasectomy. Because this condition is a syndrome, there is no single treatment method, therefore e ...
.
* Vas irrigation: Injections of sterile water or euflavine (which kills sperm) are put into the distal portion of the vas at the time of surgery which then brings about a near-immediate sterile ("azoospermatic") condition. The use of euflavine does however, tend to decrease time (or, number of ejaculations) to azoospermia vs. the water irrigation by itself. This additional step in the vasectomy procedure, (and similarly, fascial interposition), has shown positive results but is not as prominently in use, and few surgeons offer it as part of their vasectomy procedure.
Other techniques
The following vasectomy methods have purportedly had a better chance of later reversal but have seen less use by virtue of known higher failure rates (i.e., recanalization). An earlier clip device, the VasClip, is no longer on the market, due to unacceptably high failure rates.
The VasClip method, though considered reversible, has had a higher cost and resulted in lower success rates. Also, because the vasa deferentia are not cut or tied with this method, it could technically be classified as other than a vasectomy. Vasectomy reversal (and the success thereof) was conjectured to be higher as it only required removing the Vas-Clip device. This method achieved limited use, and scant reversal data are available.
Vas occlusion techniques
* Injected plugs: There are two types of injected plugs which can be used to block the vasa deferentia. Medical-grade polyurethane (MPU) or medical-grade silicone rubber (MSR) starts as a liquid polymer that is injected into the vas deferens after which the liquid is clamped in place until is solidifies (usually in a few minutes).
* Intra-vas device: The vasa deferentia can also be occluded by an intra-vas device (IVD). A small cut is made in the lower abdomen after which a soft silicone or urethane plug is inserted into each vas tube thereby blocking (occluding) sperm. This method allows for the vas to remain intact. IVD technique is done in an out-patient setting with local anesthetic, similar to a traditional vasectomy. IVD reversal can be performed under the same conditions making it much less costly than vasovasostomy
Vasovasostomy (literally connection of the vas to the vas) is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.
History
Vasovasostomy is a form of microsurgery first performe ...
which can require general anesthesia and longer surgery time.
Both vas occlusion techniques require the same basic patient setup: local anesthesia, puncturing of the scrotal sac for access of the vas, and then plug or injected plug occlusion. The success of the aforementioned vas occlusion techniques is not clear and data are still limited. Studies have shown, however, that the time to achieve sterility is longer than the more prominent techniques mentioned in the beginning of this article. The satisfaction rate of patients undergoing IVD techniques has a high rate of satisfaction with regard to the surgery experience itself.
Recovery
Sexual intercourse can usually be resumed in about a week (depending on recovery); however, pregnancy is still possible as long as the sperm count
A semen analysis (plural: semen analyses), also called seminogram or spermiogram, evaluates certain characteristics of a male's semen and the sperm contained therein. It is done to help evaluate male fertility, whether for those seeking pregna ...
is above zero. Another method of contraception must be relied upon until a sperm count is performed either two months after the vasectomy or after 10–20 ejaculations have occurred.
After a vasectomy, contraceptive precautions must be continued until azoospermia
Azoospermia is the medical condition of a man whose semen contains no sperm. It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen ...
is confirmed. Usually two semen analyses at three and four months are necessary to confirm azoospermia. The British Andrological Society has recommended that a single semen analysis confirming azoospermia after sixteen weeks is sufficient.
Post-vasectomy, testicles will continue to produce sperm cells. As before vasectomy, unused sperm are reabsorbed by the body.
Conceiving after vasectomy
In order to allow the possibility of reproduction via artificial insemination
Artificial insemination is the deliberate introduction of sperm into a female's cervix or uterine cavity for the purpose of achieving a pregnancy through in vivo fertilization by means other than sexual intercourse. It is a fertility treatme ...
after vasectomy, some opt for cryopreservation of sperm before sterilization. Dr Allan Pacey, senior lecturer in andrology at Sheffield University
, mottoeng = To discover the causes of things
, established = – University of SheffieldPredecessor institutions:
– Sheffield Medical School – Firth College – Sheffield Technical School – University College of Sheffield
, type = Pu ...
and secretary of the British Fertility Society, notes that those he sees for a vasectomy reversal which has not worked express wishing they had known they could have stored sperm. Pacey notes, "The problem is you're asking a man to foresee a future where he might not necessarily be with his current partner—and that may be quite hard to do when she's sitting next to you."
The cost of cryo-preservation (sperm banking) may also be substantially less than alternative vaso-vasectomy procedures, compared to the costs of in-vitro fertilization
In vitro fertilisation (IVF) is a process of fertilisation where an egg is combined with sperm in vitro ("in glass"). The process involves monitoring and stimulating an individual's ovulatory process, removing an ovum or ova (egg or eggs) ...
(IVF) which usually run from $12,000 to $25,000.
Sperm can be aspirated from the testicles or the epididymis, and while there is not enough for successful artificial insemination, there is enough to fertilize an ovum by intracytoplasmic sperm injection
Intracytoplasmic sperm injection (ICSI ) is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of emb ...
. This avoids the problem of antisperm antibodies
Antisperm antibodies (ASA) are antibodies produced against sperm antigens.
Types
Antisperm antibodies are immunoglobulins of IgG, IgA, and/or IgM, which are directed against sperm antigens. ASA can be detected in ejaculate, cervical mucus, ...
and may result in a faster pregnancy. IVF may be less costly per cycle than reversal in some health-care systems, but a single IVF cycle is often insufficient for conception. Disadvantages include the need for procedures on the woman, and the standard potential side-effects of IVF for both the mother and the child.[
]
Vasectomy reversal
Although those considering vasectomies should not think of them as reversible, and most people and their partners are satisfied with the operation,[ life circumstances and outlooks can change, and there is a surgical procedure to reverse vasectomies using ]vasovasostomy
Vasovasostomy (literally connection of the vas to the vas) is a surgery by which vasectomies are partially reversed. Another surgery for vasectomy reversal is vasoepididymostomy.
History
Vasovasostomy is a form of microsurgery first performe ...
(a form of microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which ...
first performed by Earl Owen in 1971[). Vasovasostomy is effective at achieving pregnancy in a variable percentage of cases, and total out-of-pocket costs in the United States are often upwards of $10,000.][ The typical success rate of pregnancy following a vasectomy reversal is around 55% if performed within 10 years, and drops to around 25% if performed after 10 years. After reversal, sperm counts and motility are usually much lower than pre-vasectomy levels. There is evidence that those who had a vasectomy may produce more abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.][ The higher rates of ]aneuploidy
Aneuploidy is the presence of an abnormal number of chromosomes in a cell, for example a human cell having 45 or 47 chromosomes instead of the usual 46. It does not include a difference of one or more complete sets of chromosomes. A cell with any ...
and diploidy
Ploidy () is the number of complete sets of chromosomes in a cell, and hence the number of possible alleles for autosomal and pseudoautosomal genes. Sets of chromosomes refer to the number of maternal and paternal chromosome copies, respectively ...
in the sperm cells of those who have undergone vasectomy reversal may lead to a higher rate of birth defects.[
Some reasons that people seek vasectomy reversals include wanting a family with a new partner following a relationship breakdown or divorce, their original partner dying and subsequently going on to repartner and to want children, the unexpected death of a child, or a long-standing couple changing their minds some time later, often prompted by situations such as improved finances or existing children approaching the age of school or leaving home.][Murphy, Clare.]
Divorce fuels vasectomy reversals
, ''BBC News
BBC News is an operational business division of the British Broadcasting Corporation (BBC) responsible for the gathering and broadcasting of news and current affairs in the UK and around the world. The department is the world's largest broadca ...
'', 18 March 2009. Retrieved 19 September 2012. Patients often comment that they never anticipated the possibility of a relationship breakdown or death, or how that might affect their situation at the time of having their vasectomy. A small number of vasectomy reversals are also performed in attempts to relieve post-vasectomy pain syndrome.
Prevalence
Internationally, vasectomy rates are vastly different. While female sterilisation is the most widely used method worldwide, with 223 million women relying on it, only 28 million women rely on their partner's vasectomy. In the world's 69 least developed countries less than 0.1% of males use vasectomies on average. Of 54 African countries, only ten report measurable vasectomy use and only Swaziland, Botswana, and South Africa exceed 0.1% prevalence.
In North America and Europe vasectomy usage is on the order of 10% with some countries reaching 20%. Despite its high efficacy, in the United States, vasectomy is utilized less than half the rate of the alternative female tubal ligation
Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus th ...
. According to the research, vasectomy in the US is least utilized among black and Latino populations, the groups that have the highest rates of female sterilization.
New Zealand, in contrast, has higher levels of vasectomy than tubal ligation. 18% of all males, and 25% of all married males, have had a vasectomy. The age cohort with the highest level of vasectomy was 40–49, where 57% of males had taken it up. Canada, the UK, Bhutan and the Netherlands all have similar levels of uptake.
History
The first recorded vasectomy was performed on a dog in 1823.[ A short time after that, R. Harrison of London performed the first human vasectomy—not for sterilization purposes, but to bring about atrophy of the prostate. Soon, however, it was believed to have benefits for ]eugenics
Eugenics ( ; ) is a fringe set of beliefs and practices that aim to improve the genetic quality of a human population. Historically, eugenicists have attempted to alter human gene pools by excluding people and groups judged to be inferior or ...
. The first case report of vasectomy in the United States was in 1897, by A. J. Ochsner, a surgeon in Chicago, in a paper titled, "Surgical treatment of habitual criminals". He believed vasectomy to be a simple, effective means for stemming the tide of racial degeneration widely believed to be occurring. In 1902, Harry C. Sharp, the surgeon at the Indiana Reformatory, reported that he had sterilized 42 inmates in an effort to both reduce criminal behavior in those individuals and prevent the birth of future criminals.[
Not all vasectomies were performed with the goal of sterilization. ]Eugen Steinach
Eugen Steinach (28 January 1861 – 14 May 1944) was an Austrian physiologist and pioneer in endocrinology. Steinach played a significant role in discovering the relationship between sex hormones (estrogen and testosterone) and human physical iden ...
(1861–1944), an Austrian physician, believed that a unilateral vasectomy (severing only one of the two vasa deferentia) in older individuals could restore general vigor and sexual potency
Libido (; colloquial: sex drive) is a person's overall sexual drive or desire for Human sexual activity, sexual activity. Libido is influenced by biological, psychological, and social factors. Biologically, the sex hormones and associated neurotr ...
, shrink enlarged prostate
Benign prostatic hyperplasia (BPH), also called prostate enlargement, is a noncancerous increase in size of the prostate gland. Symptoms may include frequent urination, trouble starting to urinate, weak stream, inability to urinate, or loss o ...
s, and cure various ailments by somehow boosting the hormonal output of the vasectomized testicle. This surgery, which became very popular in the 1920s, was undertaken by many wealthy individuals, including Sigmund Freud
Sigmund Freud ( , ; born Sigismund Schlomo Freud; 6 May 1856 – 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating psychopathology, pathologies explained as originatin ...
and W. B. Yeats
William Butler Yeats (13 June 186528 January 1939) was an Irish poet, dramatist, writer and one of the foremost figures of 20th-century literature. He was a driving force behind the Irish Literary Revival and became a pillar of the Irish liter ...
. Since these operations lacked rigorous controlled trials, any rejuvenating effect was likely due to the placebo effect
A placebo ( ) is a substance or treatment which is designed to have no therapeutic value. Common placebos include inert tablets (like sugar pills), inert injections (like Saline (medicine), saline), sham surgery, and other procedures.
In general ...
, and with the later development of synthetic injectable hormones, this operation fell out of vogue.
Vasectomy began to be regarded as a method of consensual birth control
Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth contr ...
during the Second World War
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
. The first vasectomy program on a national scale was launched in 1954 in India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
.
The procedure is seldom performed on dogs, with castration
Castration is any action, surgical, chemical, or otherwise, by which an individual loses use of the testicles: the male gonad. Surgical castration is bilateral orchiectomy (excision of both testicles), while chemical castration uses pharmaceut ...
remaining the preferred reproductive control option for canines. It is regularly performed on bulls.
Society and culture
Availability and legality
Vasectomy costs are (or may be) covered in different countries, as a method of both contraception or population control, with some offering it as a part of a national health insurance. The procedure was generally considered illegal in France
France (), officially the French Republic ( ), is a country primarily located in Western Europe. It also comprises of Overseas France, overseas regions and territories in the Americas and the Atlantic Ocean, Atlantic, Pacific Ocean, Pac ...
until 2001, due to provisions in the Napoleonic Code forbidding "self-mutilation". No French law specifically mentioned vasectomy until a 2001 law on contraception and infanticide permitted the procedure.
The U.S. Affordable Care Act
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act and colloquially known as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by Presid ...
(signed into law in 2010) does not cover vasectomies, although eight states require state-health insurance
Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
plans to cover the cost. These include: Illinois
Illinois ( ) is a U.S. state, state in the Midwestern United States, Midwestern United States. Its largest metropolitan areas include the Chicago metropolitan area, and the Metro East section, of Greater St. Louis. Other smaller metropolita ...
, Maryland
Maryland ( ) is a state in the Mid-Atlantic region of the United States. It shares borders with Virginia, West Virginia, and the District of Columbia to its south and west; Pennsylvania to its north; and Delaware and the Atlantic Ocean to ...
, New Jersey
New Jersey is a state in the Mid-Atlantic and Northeastern regions of the United States. It is bordered on the north and east by the state of New York; on the east, southeast, and south by the Atlantic Ocean; on the west by the Delaware ...
, New Mexico
)
, population_demonym = New Mexican ( es, Neomexicano, Neomejicano, Nuevo Mexicano)
, seat = Santa Fe
, LargestCity = Albuquerque
, LargestMetro = Tiguex
, OfficialLang = None
, Languages = English, Spanish ( New Mexican), Navajo, Ker ...
, New York
New York most commonly refers to:
* New York City, the most populous city in the United States, located in the state of New York
* New York (state), a state in the northeastern United States
New York may also refer to:
Film and television
* '' ...
, Oregon
Oregon () is a U.S. state, state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington (state), Washington, while the Snake River delineates much of it ...
, Vermont
Vermont () is a state in the northeast New England region of the United States. Vermont is bordered by the states of Massachusetts to the south, New Hampshire to the east, and New York to the west, and the Canadian province of Quebec to ...
and Washington
Washington commonly refers to:
* Washington (state), United States
* Washington, D.C., the capital of the United States
** A metonym for the federal government of the United States
** Washington metropolitan area, the metropolitan area centered o ...
.
In 2014, the Iranian parliament voted for a bill that would ban the procedure.
Tourism
Medical tourism, where a patient travels to a less-developed location where a procedure is cheaper to save money and combine convalescence with a vacation, is infrequently used for vasectomy due to its low cost, but is more likely to be used for vasectomy reversal. Many hospitals list vasectomy as being available. Medical tourism has been scrutinized by some governments for quality of care and postoperative care issues.
Shooting of Andrew Rynne
In 1990, chairperson of the Irish Family Planning Association The Irish Family Planning Association (IFPA) is an Irish charity working to enable people to make informed choices about sexuality and reproduction. The organisation promotes the right of all people to sexual and reproductive health information as ...
, and the Republic of Ireland
Ireland ( ga, Éire ), also known as the Republic of Ireland (), is a country in north-western Europe consisting of 26 of the 32 counties of the island of Ireland. The capital and largest city is Dublin, on the eastern side of the island. A ...
's first vasectomy specialist, Andrew Rynne, was shot by a former client, but he survived. The incident is the subject of a short film, ''The Vasectomy Doctor'', by Paul Webster.
See also
* Caroline Deys, a noted vasectomy specialist
* List of surgeries by type
Many surgical procedure names can be broken into parts to indicate the meaning. For example, in gastrectomy, "ectomy" is a suffix meaning the removal of a part of the body. "Gastro-" means stomach. Thus, ''gastrectomy'' refers to the surgical remo ...
* Male contraceptive
Male contraceptives, also known as male birth control, are methods of preventing pregnancy that solely involve the male physiology. The most common kinds of male contraception include condoms, outercourse, and vasectomy. In domestic animals, cas ...
* Orchiectomy
Orchiectomy (also named orchidectomy, and sometimes shortened as orchi or orchie) is a surgical procedure in which one or both testicles are removed. The surgery is performed as treatment for testicular cancer, as part of surgery for transgend ...
* Testicular sperm extraction
Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm ...
* World Vasectomy Day
World Vasectomy Day (WVD) is an annual event to raise global awareness of vasectomy as a male-oriented solution to prevent unintended pregnancies. The goal is for doctors all over the world to perform vasectomies, connected to the event via Skype ...
References
External links
MedlinePlus Encyclopedia
How to treat: vasectomy and reversal, Australian Doctor, 2 July 2014
{{Authority control
Sterilization (medicine)
Contraception for males
1897 introductions
Male genital surgery