Vasectomy is the most highly effective form of contraception and the only reliable method of contraception for men.
The No-Scalpel method is a safe 15-minute procedure performed under local anesthesia (whilst awake). Complications or side effects are uncommon.
Vasectomy involves blocking the tubes (vas deferens) that carry sperm without altering erections or semen quality. Men may feel uneasy about the idea that their sexuality will somehow change, but it’s important to understand the anatomy.
Semen (the ejaculate) is made by the prostate and seminal vesicle glands situated under the bladder. Semen without sperm looks and feels the same. Ejaculation involves the brain, spinal cord and penis. Testosterone is produced by Leydig cells in the testicles and secreted directly into the bloodstream.
The following illustration compares the before-and-after anatomy.
The first step of a vasectomy is to access the vas deferens, also known as the ‘tubes.’ Traditionally, this is done by making two separate incisions on each side of the scrotum, resulting in two wounds that need stitches.On the other hand, a no-scalpel vasectomy accesses the tubes through a single small incision in the middle of the scrotum, making it less invasive and leading to a quicker recovery time. Nowadays, most vasectomies start with this method for accessing the tubes.
The next step is to block the tubes so that sperm cannot pass through. Occlusion can be achieved by either sealing both the upper and lower ends of the vas deferens (known as a closed vasectomy) or by sealing only the upper end while leaving the lower end open (referred to as an ‘open-ended’ vasectomy). The upper end can be sealed with its outside connective tissue layer using a clip or absorbable stitch.
The following flow diagram shows you the steps required to achieve an open-ended vasectomy using an absorbable stitch.
Let’s explore the meaning of “We had another pregnancy after the vasectomy!'”
There are two types of vasectomy failure. The risk of pregnancy is (obviously) higher for a man who does not do the post-vasectomy test, which should be conducted about 12 weeks after the vasectomy to confirm the absence of sperm in the semen.
Early Failure is detected by sperm seen during the post-vasectomy semen analysis. The good news is that this is a known issue, and no pregnancy has occurred. However, the bad news is that the vasectomy will need to be repeated. The early failure rates can be as high as 1% and vary by technique used. Ask your doctor about their specific rates of early failure.
Late Failure refers to a pregnancy that occurs after a confirmed negative semen test. The lifetime risk of pregnancy reflects late failure, occurring in approximately 1 in 3,000 men.
In men who undergo post-vasectomy testing, the likelihood of pregnancy is very low. However, in men who do not undergo testing, the likelihood of pregnancy is higher.
An unintended pregnancy is likely to be more traumatic than having a repeat vasectomy. In other words, late failure is more of a concern than early failure.
Vasectomy is often described as ‘one of the most effective forms of contraception,’ but in reality, it is the most effective – as long as the post-vasectomy test is carried out.
The next most effective form of contraception is the female progestogen implant, also known as ‘the rod,’ which is stated to have a pregnancy rate of 1 in 2,000 per year. When you convert the lifetime risk of pregnancy after a clear post-vasectomy test (1 in 3,000) to an annual risk, vasectomy is at least 10 times more effective than “the rod,” (not taking into account post-marketing figures of a failure rate of the implant as high as 1 in 1,000).
Explore the research on Vasectomy methods & Failure
Let’s now compare the effectiveness of different methods of contraception.
| Risk of Pregnancy PER YEAR | Main Benefits | Main Risks | Issues | |
|---|---|---|---|---|
| Combined Pill | 7% per year (normal use) | Low Failure Rate, can reduce period bleeding, can have cycles back-to-back. Often Beneficial for conditions like acne or hirsutism. | Deep Vein Thrombosis & Cardiovascular Risk Factors to evaluate include Body mass index, Smoking, Migraine with aura, Family history, increasing age, high BP, Cholesterol, Diabetes, kidney disease etc. | Can forget to take the pill. |
| Progestogen Only Pill | 9% per year (normal use) | Used as a 2nd line oral contraceptive when the combined pill is not recommended. No increased cardiovascular or thrombotic risks. | Australian licensed mini pills need to be taken in a 3 hour window each day. | The minipill is unforgiving when forgotten – failure rates are high. |
| Progestogen Injection | 6% per year | No increased cardiovascular or thrombotic risks. Periods often disappear completely within 12 months. | Progestogenic side effects are usually manageable but women may sometimes report weight gain, mood or changes. Periods often erratic to start with. | 3 monthly visits to your doctor & practice nurse to get the injection. Need a pregnancy test if late for your next injection. |
| Progestogen Implant (rod) | 0.05% per year | Periods often disappear completely within 12 months. | Persistent bleeding beyond 6 months in around 15% of women may require the implant to be removed. | 3 yearly implant in the inner side of the left upper arm. |
| Intrauterine Device – Mirena | 0.2% per year | Periods usually disappear completely within 12 months – often good for heavy or painful periods. | Risk of uterine perforation is around 1 in 1000. Rarely infection or migration of the device. | 5 yearly re-insertion. Few GPs currently provide this service & most women need a referral to a gynaecologist. |
| Condom, Cap, Ring | Condom 18% Cap 12% | Caps, Diaphgragm & Vaginal Ring. | no systemic risks. Higher rate of failure than many other methods of contraception. | Suits only a few women and couples – comes down to personal preference & guidance on use from a health practitioner. |
| Female Sterilisation | 0.5% risk | Low failure rate at around 1 in 200 | Higher failure rate & risks (surgical + Anaesthetic) than The Snip. | Day Case in a hospital. |
| Vasectomy | 1 in 3000 lifetime (after test) | The lowest failure rate. Men can get involved! | Post vasectomy discomfort affects around 1 in 50 guys. | The most important thing is to continue contraception until you get the all-clear after the semen analysis. |
Expert no-scalpel vasectomy with optimal use of local anaesthetic is not a painful experience.
Experiencing ‘blue balls’ is mostly a thing of the past.
Testosterone is completely unaffected.
Vasectomy has no effect on libido, erections, or ejaculation. Research suggests that sex can be enhanced after vasectomy by eliminating the fear of unwanted pregnancy.
Studies show ‘no noticeable influence on the volume of ejaculate.‘
We’ve established that a vasectomy does not affect sexual performance or testosterone levels or significantly affect semen quantity or quality.
Why might some men think that getting a vasectomy could affect their masculinity? This perception may stem from the connotations of the word ‘sterilization,’ which is defined as ‘surgery that makes a person or animal unable to produce offspring.’ Unfortunately, the term is very broad and includes both vasectomy and castration.
However, castration involves the removal of the testicles. When a dog is castrated, it becomes infertile. In the case of a human male, castration would make him a eunuch. The only thing that Vasectomy and castration have in common is that they are both surgical procedures that result in a man being unable to father children.
The term ‘vasectomy’ is more precise and less stigmatizing than ‘male sterilization.’ Despite this, many scholarly articles perpetuate the stigma by referring to vasectomy as ‘male sterilization.’
Jump to the research page for more information.
Vasectomy is a surgical procedure, and as with all surgeries, there are potential side effects.
A haematoma refers to internal bleeding that causes scrotal pain and visible swelling. The haematoma will eventually resolve on its own, but a large haematoma (> 6cm) may take several months to heal. Conversely, minor bleeding from the skin is a minor inconvenience that can usually be resolved by pinching the skin for 10 minutes.
A large Haematoma is rare < 1 in 500.
Thankfully, infection after vasectomy is rarer than most people think. Pain, mild swelling and bruising are more likely to reflect temporary inflammatory healing and usually go away without antibiotics. Clinical assessment and experience dictate when to start antibiotics. However, high-volume vasectomy providers find that antibiotics are rarely required.
Antibiotics are prescribed in <1% of vasectomies.
An abscess is very rare but requires surgical drainage. Fornier’s gangrene is (thankfully) exceptionally rare, less than 1 in 10,000, although the risk is higher in men with poorly controlled diabetes.
How do you play ball with your partner who drops the hint that she is ‘over hormones?’ How do you handle the bombshell? ‘Honey, I’m pregnant!’ Men are not used to grabbing a front-row seat in the contraception department. ‘No worries, mate, she’ll be right’ doesn’t work for contraception.
The top ‘six’ reasons why vasectomy is the contraception of choice for many men:
Ultimately, it’s about setting family size rather than leaving it to chance.
Up to 6% of men who have had a vasectomy seek a reversal within ten years of the procedure.
Couples with babies might want to defer a vasectomy until their baby is more than six months of age because of the small risk of Sudden Infant Death Syndrome (SIDS). The risk of SIDS (‘cot death’) is around 1 in 2000 babies. The age of maximum risk occurs between the age of 2 and 4 months of age.
Fatherless men under 30 years of age are at a significantly higher risk of seeking reversal later on. A study found that men who underwent vasectomy reversal were 12.5 times more likely to have had a vasectomy in their 20s than when they were older.
Younger men should, therefore, consult with friends and family, just as they would for any major life decision. Talk to older men without kids as well as fathers to gain different perspectives. Additionally, it’s a good idea to consider delaying the decision, considering sperm banking (see below).
Brain development, and expected or unexpected life events may change your priorities.
Younger men should be aware that the country’s governing body regulates doctors and may be subject to evaluation by other doctors. In essence, doctors operate within the general parameters established by the medical profession in that jurisdiction.
Anecdotally, Australian doctors are perhaps more ‘conservative’ than their counterparts in the USA. Frustrating as that may be, it may be difficult for men under 25 years of age to find an Australian doctor who is willing to perform a vasectomy for them.
The practical way forward for men under 25 is to visit their primary care doctor and discuss the options, which might include a supportive referral letter that explicitly outlines their reasons and circumstances. Sperm banking (see next section) should be seriously considered (see next section).
Your other option is to continue effective contraception for a while longer, as this is what most younger men successfully do.
A 25-year-old man who has not fathered will be asked to accept the possibility that he might seek a reversal at some time in the future. After all, that’s what the research shows. Saying that ‘I know that I will never, ever, want kids’ isn’t acknowledging that circumstances might change. Saying, ‘I know there is always a chance that I may change my mind later, but I still want to get a vasectomy’ is acknowledging uncertainty.
Vasectomy is suitable for a man who is certain that he does not want to father a child in the future. However, men who are at risk for regret should seriously consider sperm banking before undergoing a vasectomy.
The initial cost of sperm banking is about $700 AUD ($300-400 USD), and cryo-storage can cost up to $650 AUD ($400 USD) per year. A referral from your doctor might help reduce the service cost.
For certainty, you should consider what price you are willing to pay to cover the risk that you would wish to father after a vasectomy.
The cost of sperm pricing is at least 10 times (potentially a lot more) cheaper than the cost of raising a child. However, it is still uncommon for men to want to invest thousands of dollars to store their sperm as a precaution.
Please note that a specialist referral is necessary to receive any Medicare rebate. Ask your primary care doctor for a referral, and arrange any necessary tests, such as blood tests for HIV, Hepatitis B & C, and Syphilis.
The required blood tests may vary depending on the healthcare provider. Common tests include HIV, Hepatitis B & C, and Syphilis before seeing a specialist.
A semen sample is assessed for quality, including quantity, motility, and morphology. Based on the results, one to five samples may be frozen for preservation.
For one in 20 men, the uncertainties of life are reflected in seeking a Vasectomy reversal.
There is a tension between an effective vasectomy method and one that is easier to reverse. After all, the easiest vasectomy to reverse is one that did not work in the first place.
Vasectomy involves cauterizing the vas deferens and cutting it, while reversal reconnects the viable vas that has not been cauterized. In other words, the less cautery, the better for reversing – at least in theory.
Open-ended vasectomy may less challenging to reverse due to less cautery, in contrast to closed vasectomy, which often requires more cautery.
The closed method typically relies entirely upon cautery to block the vas deferens. Cauterizing a long segment (eg. >5cm) is required to keep the failure rate to a minimum (still around 1%).
In comparison, an ‘open-ended‘ vasectomy relies on separating the ends (fascial interposition using a clip or dissolvable stitch) to block the tube. Cautery is only used for the upper end. Additionally, during surgery, the doctor may expect to achieve perfect end separation, potentially eliminating the need for cautery (unproven).
It is important to remember that the primary goal of a vasectomy is to prevent the passage of sperm and not necessarily to optimize the chances of a successful reversal. However, for younger men or those who have not yet fathered children, the potential for a future reversal may be a consideration when deciding on the amount of cautery used.
After a vasectomy, sperm can be extracted from the scrotum using a needle (via ICSI) for use in IVF. However the success rate of IVF is around 30%, but it may be much lower depending on fertility factors such as maternal age.
A peer-reviewed article states that Vasectomy Reversal, compared with IVF, ‘is typically more cost-effective and is the favoured approach for patients desiring multiple pregnancies with unimpaired female partner fertility.‘
A successful vasectomy reversal is indicated by the presence of a large number of motile (mobile) sperm, although this is not always guaranteed to result in a pregnancy.
The success rate ranges from 50% to over 90%, depending on various factors.
The interval between the vasectomy and a reversal is the most important factor. A large 1991 study is shows a gradual reduction in success as follows:
There are two types of reversal operations: vasovasostomy, which re-connects the two ‘ends’ of each Vas Deferens, and Vasoepididymostomy, which connects the epididymis with the upper end.
Vasovastomy is the most common procedure, while Vasoepididymostomy is reserved for more complex cases. A vasoepididymostomy is a more demanding surgery because the Vas deferens is larger than the Epididymis. In other words, two tubes of different diameters are connected.
Vasectomy reversal requires microsurgery that is technically demanding – ‘The vas deferens (VD) has a luminal diameter of 0.3–0.5 mm … Performing microsurgery on such a delicate tissue is certainly challenging, and as with any procedure, outcomes improve with experience.’
Researching the success rate of vasectomy reversal in your area is ideal. According to a 2021 study of 107 reversal doctors in the USA, there is a significant lack of transparency in the publicly available information from vasectomy reversal practices.
How can you find out which Urologist to see? Search ‘vasoepididymostomy’ to pick up those urologists who can perform this surgery when standard reversal surgery (Vasovasostomy) will not work. Look at their website and get a feel for how many vasectomy reversals they do.
See your primary care doctor and get a referral to a Urologist who performs the surgery regularly.
The total price for a vasectomy reversal might be around $10,000 AUD, with a Medicare rebate of under $1,000. Private health cover can reduce out-of-pocket expenses by several thousand dollars.
Contact us
Phone: 07 3505 5919
GP Referrals
Medical Objects: Dr Dick Beatty
Fax: 07 4351 4851
Email: referral@thevasectomist.com.au
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