What is Vasectomy and the Different Types of Vasectomies?

A vasectomy is a surgical procedure involving cutting the tubes carrying sperm to the penis from the testicles. The procedure can be done in an office, hospital, or clinic setting and takes about 30 minutes. There are two types of vasectomies:

1. Traditional vasectomies

Traditional vasectomies involve making an incision on the scrotum and removing a section of each tube carrying sperm to the penis from the testicles.

2. No-scalpel vasectomies

No-scalpel vasectomies do not require any incisions and instead use a small clamp to stop the flow of sperm by pinching it shut at a point where the tube is close to coming through the skin.

The History of Vasectomy

The history of vasectomy isn’t as old as one would think. It was first performed in the 18th century by a surgeon named Gabriel Daniel Larrey. The procedure acted as a treatment for men who had wounded genitals during battle. In the 19th century, it came to be used for birth control and was performed in the United States for the first time. The first use of vasectomy for birth control was in 1899 by a surgeon named James Leonard Pince and his assistant, Dr. Charles Horatio McCulloch, operating on a man with an enlarged prostate gland.

The surgery was performed during their first-ever attempt at the procedure and proved successful. In 1920, Dr. Pince published in the New England Journal of Medicine that he could prevent pregnancies in 12 out of 13 men. During the 1920s, he would perform vasectomies in doctors’ offices and at hospitals across America. The procedure’s success rate was high, but some critics questioned the safety of such a quick fix for birth control and suggested the need for a longer-term plan.

In 1927, Dr. Pince published a paper addressing these criticisms and became highly influential in vasectomy’s acceptance in the United States. He argued that men need a long-term solution and should be allowed to abstain from procreating for 1–2 years to give adequate time for their sperm levels to drop. In 1977, the United Kingdom’s Committee on Social Obligations and Responsibilities recommended vasectomy as a non-invasive method of birth control for couples who can’t conceive without medical assistance. In the 1980s, vasectomy was a public health option for the first time in Brazil.

There was much media attention about this because most Brazilian men had only a low rate of vasectomy and the country’s birth rates were high. In 2003, the guidelines for Brazilian healthcare providers recommended vasectomy as an effective and less costly method of birth control. Vasectomy mostly happens in a doctor’s office or clinic but can also be done in an operating room under general anesthesia (local or regional anesthesia).

It can take up to three months before a vasectomy is effective. It can take ten years for all sperms in the testes and epididymis (a tube near the testes) to be gone. After a vasectomy, the function of the testes and epididymis change and cause:

  • A decrease in testosterone levels
  • An increase in sperm count within a year of the vasectomy
  • A reduction in sperm motility within 3-6 months of the vasectomy

Risks of Vasectomy with Sperm Banking and ICSI

Sperm banking is a precautionary measure many men take after a vasectomy. Men should bank their sperm before the procedure so that if the vasectomy fails, they can attempt ICSI. However, there is no risk of pregnancy after a vasectomy. There is a meager chance of having a failed vasectomy, which varies from 0-1%.

Causes of Vasectomy Failure

1. Vasectomy reversal

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A high percentage of vasectomies can be easily reversed. The doctor can reconnect vas deferens ends so that one can ejaculate sperm again. One can impregnate, but the success rate of the reversal mainly depends on the time it has taken the original vasectomy. If done within ten years of vasectomy, it has a 75% success rate. The chances of a successful reversal reduce after ten years of vasectomy. Success in vasectomy reversal isn’t a guarantee for pregnancy. Doctors consider many other factors in evaluating whether they can help people get pregnant. People need to ask their doctor if they have any questions.

2. Having sex too soon

It’s still possible for men to impregnate their partner after having a vasectomy because it takes a few weeks for the sperm to be cleared. Couples should use another form of contraception until then. Typically, doctors schedule an appointment three months after the operation to check whether there are sperms. The procedure is successful if there is no sperm in the semen sample. If there are any living sperm, physicians may schedule an appointment to confirm whether it stops. In many cases, all that is left may be gone during the second visit.

3. Late vasectomy failure

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Vasectomies are very effective and often last a lifetime. Experts believe there is a 0.04-0.08% chance of failure or 1 in 2000 cases. This number varies depending on factors such as age, smoking status, and time since the vasectomy. Some doctors have found that the number of sperm may not drop as much following a vasectomy as previously thought because humans have complex testicles that can produce sperm cells even after being cut off from the rest of the body. It’s important to know where the sperm are still around for partners to take care of specific areas. One should speak to a doctor and learn about the operation and how it went down. In some cases, tubes may reanalyze and release sperm. For such a case, one should consider repeating the vasectomy procedure.

4. Early recanalization

Vasectomies were fully effective for more than 70% of those who underwent the procedure. The separate ends of the vas deferens rarely reconnect. The scar tissue can join and link up, resulting in a reconnection. If the scar tissue has open channels, sperm can go through them, resulting in ejaculation. This is very common within the first 90 days after vasectomy. Sometimes, if the scar tissue doesn’t block sperm, the partner could become pregnant during this period. The doctor can do a semen analysis to check for blockages before that window has passed and suggest other contraceptive methods until one is ready for that step.

5. Medical error

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Some men get a vasectomy with incomplete separated tubes. The vas deferens can heal again if the doctor doesn’t remove adequate tissue. The doctor might not seal one end of the tube properly. They can quickly identify the problem during a scheduled follow-up appointment if this happens. This is mainly because the sample will contain live sperm. The doctor will examine to determine the issue. They can repeat the vasectomy procedure in case of the vas deferens reconnection.

Vasectomy doesn’t change how one feels during an orgasm or ejaculating. The semen doesn’t change; it looks, feels, and tastes the same. The only change is that one can’t impregnate. This procedure is gaining popularity worldwide, especially in the U.S. However, a high percentage of Africans are against this.