What do you do when you’re 35, have 3 kids and for various reasons have run out of acceptable contraceptive options? You have a surgical sterilization, that’s what.
But here’s the question – who gets snipped, the male or the female member of the couple? I almost always advise that the male should be the one.
It’s not personal, guys. It’s because vasectomy is a brief office procedure performed under local anesthesia, compared to a tubal ligation, which is an intra-abdominal procedure performed under general anesthesia. A no-scalpel vasectomy can be performed in as little as 7 minutes, with exceedingly low rates of complications.
“As a couple,” I usually say, ” “Your safest option is a vasectomy”.
But a patient recently objected to the idea of a vasectomy, because it was really her decision to stop having children. Hubby would have kept on going if she had been willing.
“If anything ever happened to me, I would want him to be able to have more children,” she said.
Now this was a woman who had already had several C-sections. Neither she nor her huband liked the idea of her having another surgical procedure. What to do?
“Have him freeze some sperm before the vasectomy”, I said. “That way he may still be able to father children in the future if anything ever happens to you.”
And that’s what they did.
Sperm Banking Before Vasectomy
Sperm banking before vasectomy is not a guarantee of future fertility, since frozen and thawed sperm may be less viable than fresh sperm. Overall, pregnancy rates using cryo-preserved sperm are about 50% lower than with fresh sperm. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) may improve these odds.
How long can frozen sperm be saved? Well, pregnancies have been reported using thawed sperm that have been frozen up to 21 years!
Sperm banking is not terribly expensive, with costs of about $500 per year. Sperm should be frozen and thawed as a test prior to vasectomy to see if they survive storage. And experts advise banking multiple samples in two separate sperm banks as insurance against lab accidents.
When weighed against the option of vasectomy reversal surgery, hedging your bets by sperm banking before getting snipped seems a reasonable option.
A word of caution, though. Urologists who perorm vasectomy generally advise that vasectomy be reserved for men who are really sure they want no more children.
In other words, if are considering banking some sperm because you’re not sure if you will want children in the future, then consider the possibility that you may not be ready for permanent sterilization.
Hey! What are you doing listening in on what I tell my patients! I’ll bet you’re using almost exactly the same words, too. (I tell the wife, “You won’t feel a thing.”)
Brava, doctor! Fabulous suggestion.
I’m amazed at the number of men who flat out refuse to have this simple procedure done after their wife of many years has carried and delivered multiple children.
Only to be outdone by my amazement at the number of women who won’t push the issue.
Incidentally, what has your experience been with Essure? No one in my community is doing them yet.
#1-
I like that line – I think I’ll use it…
Dr Smak – Some of our docs are doing essure and it seems to be going well. THey are not doing it in the office however, so it still means a trip to the OR.
I often wonder why we don’t do tubals under local the way they are done in the developing world. We do the whole laparoscopic thing. But there’s nothing like a quick tiny pfannensteil and BTL, in and out of the OR in less than half an hour!
A friend of mine had 2 children:
The first because he could. (before vasectomy)
The second because he couldn’t (after vasectomy)
About eight years ago I was exploring having a tubal. My husband and I never wanted children but we found out the hard way early in our marriage that we were both fertile. Seven years later I was tired of being on birth control pills and I was in my late 30’s, so it was time to look into something permanent. After I met with the gyn/surg in the practice where I was a patient and really coming to understand the invasive/unpleasant nature of the procedure I went home and relayed the conversation to my husband, who was positively allergic to doctors. I laid it all out the same way the surgeon had with me and then I told him that if he really couldn’t handle having a vasectomy I would go through with it, but I wanted him to give it some additional thought. I’m proud to say he called his Dr. for a referral to a urologist the next day and had the vasectomy about 6 weeks later.
As a side note, while searching for a great gyn. I went for an annual exam to one (female) doctor who refused to even discuss performing a tubal on me because I had never had a child and I was under 40. I was shocked that she shut me down like that, a much better response would have been “I won’t perform them on women [under 40/who haven’t had children/whatever] but I can refer you to someone else”. Needless to say, I continued my search for a gyn.
Couldn’t the woman also have the option of the new Essure permanent procedure?
Schruggling says:
There was no question for me. The risk of a tubal is so unnecessary for my wife and I. She was lucky enough to have three easy deliveries (OK, I didn’t define the term easy…perhaps uncomplicated fits better)that for her to have a tubal, it would be a stand alone surgery, which is ridiculous.
When we were pregnant with our third, I made an appointment with my urologist to discuss vas. He told me he would not do the procedure until the baby was born and had time to consider if we wanted any more. I was a little shocked by that, but once we thought about it, it was actually easier to do it after the baby was born anyway. He was clear to say that he personally would never do a vas on a guy without kids under 45. As it turns out, he is a micros surgeon and spends a lot of time doing reversals…
The appointment for the procedure was at 4 pm on a Friday afternoon. I drove myself there, was there 10 minutes for prep, 10 minutes for procedure and 30 minutes for observation. Worst part of the entire procedure was the humiliating shaving of my (whisper when you read this in your mind) scrotum. It was a male nurse, and he was wayyyyy too used to shaving me’s privates!
It was the sutureless procedure with only a local. I had an option for a valium to help relax me and the vas deferens, but I declined. I joked with the uro during the procedure that I would set off the metal detectors in the airport all the time with the titanium caps he put on each end of the vas deferens. He had to tell me not to laugh while he was working!
I felt fine at the office. About an hour after getting home I started to get uncomfortable, but by no means hurting. I took only ibuprofin. Ice was my best friend that weekend.
I stayed on the couch all weekend long icing and watching TV. The bruising was a bit disconcerting, and I was sore for sure, but fine if I didn’t walk around much.
I was at work on Monday, and felt fine. Within a week I was 100% – in all regards.
Once I was cleared as “marine-free” about a month later, the end result has been great. No difference from before in terms of experience, and the spontoneity has been great as compared to before because we always used condoms as our BC. That required more planning and detracted from things a bit. I was very happy to retire the condoms…
I am sharing all of this in the hopes that guys get the sense of just how routine and easy this was to manage, and that I didn’t have to put my wife into a far riskier situation. In addition, she was sooooo happy with me, she cooked great food, and brought them to me on the couch in front of the TV. Normally verboten…I was the KING of the house that weekend for sure!
Hope this helps the cause!
I was amused by my urologist telling me that when they tie the tubes, sometimes they can come undone years down the road, despite having a 0 sperm count in the months after the procedure.
Rare, I know, but apparently it happened to one of the urologist’s patients. Needless to say, the man in question was not amused to find THAT out when his wife got pregnant.
At least he can rest assured it’s his child.
KatieZ: ? the vasectomy failed?
ccinnkeeper: Thanks for sharing your story. I know that regret after sterilization is highest among women under 30 and I would do my best to discourage such a person from doing it. That said, I recall doing tubals on women who had no kids – I think they were all over 30, though.
Anonymous: Yes, essure is an option, but for various reasons, not for this woman. It is still a relatively new procedure, though, and we don;t have long term data . We only recently got long term data on tubal ligation…
Schtruggling:
How much do I love your honesty and willingness to share? Thansk so much.
PS – Are the fire pit and pool done yet?
Sheena: Nothing is perfect, including sterilization. I always tell my [atients who have had tubals that although pregnancy is highly unlikely, it is not impossible, and if they ever think they are pregnant, they are not crazy. Indeed they are at increased risk for an ectopic pregnancy and need to get in to see me right away.
Schruggling says:
I am glad to share…it really isn’t that bid of a deal. It’s more an ego thing with men, which is ridiculous, but a real issue.
Fire pit is in place and the concrete for the pool is getting shot on Friday. We think the whole thing should be done in August sometime…