Vasectomy in the Era Without Roe V. Wade
It has been approximately a month since the Supreme Court overturned Roe v. Wade and the country has started to see the impact and some of the unintended consequences and behavioral shifts due to this monumental decision. One of those phenomena appears to be an increase in men around the United States calling urologists’ offices inquiring about vasectomies and scheduling consultations at a much higher rate than before. In fact, my practice has seen a three to fourfold rate increase in calls about vasectomy. Over the last month, I was interviewed about this new trend by many major media outlets including The Washington Post, The Today Show, Yahoo News, Bloomberg, The Daily Caller, and The BBC. I believe this is drawing lots of attention from the news in part because men now have to take a more active role and responsibility in their sexual health choices because the consequences in some states will literally be life changing.
Vasectomy is considered permanent male sterilization and therefor should only be performed on men who are certain they are finished fathering children. Typically, the ideal candidate is a man who already has a family with children whose wife cannot use any other form of female contraception and doesn’t want to get a tubal ligation procedure (permanent female sterilization). On occasion, men who have not had children and know they do not want to ever father genetic children request vasectomy. Vasectomy should not be performed on men who may want to have children in the future since there is no guarantee that a vasectomy reversal, while highly effective when done by a skilled microsurgeon, will lead to a pregnancy. Vasectomy is not a good method for temporary male birth control and men who want to use this strategy should be discouraged and educated as to the reasons why.
During a vasectomy, the doctor blocks the vas deferens or sperm duct that carry the sperm up from the testicle inside the body where they mix with the ejaculatory fluid. While there are several techniques of performing a vasectomy, the essence is to block and cut the vas, remove a small segment and cauterize (burn) the cut ends to prevent them from reconnecting. I have used the No-Scalpel vasectomy technique for 27 years with excellent success. The skin is punctured without a cut and is so small that is seals on it’s own usually with out the need to use any stitches, just a band-aid. Patients typically recover quicker and have fewer complications as opposed to a traditional vasectomy. The failure rate should be less than 1/1000-2000 patients. Vasectomy is easier to perform and likely safer than a tubal ligation in women. As easy as it sounds, any procedure, even minor, can have complications so we approach patient selection and the procedure itself with care and respect.
A vasectomy reversal restores the cut and scarred ends of the vas by reconnecting them microsurgically. The vas tube is about the size of a piece of spaghetti and the channel the sperm swim through is the size of a pen dot or 1/3 mm. The sutures used to reconnect the inner channel are thinner than a human hair. The procedure is quite challenging for all but the most skilled technicians. Alternatives to reversal include surgically removing sperm from a man who had a vasectomy and having their female partner undergo IVF (in-vitro fertilization). Sperm are selected and injected directly into an egg that has been removed from a woman’s ovary and in this was all the reproductive plumbing and blockages are averted. Embryos are created and implanted into the woman’s uterus.
Its been very interesting to observe that without the ability for a woman to easily have access to an abortion, men are taking the responsibilities for their reproductive health and options more seriously. As explained, vasectomy is not appropriate for all men who don’t wish to father children…. either intentionally or by accident. The fact that this conversation is taking place on a larger scale than ever before and highlighted in the media is a good thing. Men should become more educated about their bodies and their choices just as women have become over the last few generations.
Learn more about Dr. Werthman’s vasectomy procedure here.