Why the vasectomy just doesn’t cut it for all men

(Photo courtesy of Sansum Clinic)

This blog post is written by Male Contraceptive Initiative's Youth Advisory Board Member Claudia Brewer

When we hear “male birth control,” the vasectomy may be the first thing that springs to mind for many of us. Despite this, there’s a lot of confusion out there surrounding this procedure: Is it permanent, or reversible? Does it fulfill all of men’s contraceptive needs? To get to the bottom of these questions, I did some research and spoke with Dr. Alex Koper, a urologist at Sansum Clinic with 40 years of experience performing and counseling for vasectomies.

A crash course on the procedure
The vasectomy is an outpatient surgical procedure that involves severing and sealing the vas deferens, which are the tubes that carry sperm from the epididymis to the ejaculatory ducts. This means that a man’s semen will not contain any sperm when he ejaculates, which stops him from impregnating his partner. It’s a highly effective birth control method, with a failure rate of less than 1%. The procedure is also super low-risk, and very few men have side effects.

Reversibility cannot be counted on
When I first began researching vasectomies, I was under the impression that they were 100% reversible. Perhaps it was that infamous “snip, snap, snip, snap” scene from The Office, but I thought that vasectomy reversal was always a possibility, albeit with a bit of a hassle.

There’s some truth to that, but it definitely isn’t the whole story. As time passes after a vasectomy, fibrosis occurs in the testes. Men’s sperm counts start to plummet when scar tissue develops in the seminiferous tubules, which are key for sperm production. This means that, even if the severed vas deferens are reconnected in a reversal procedure, a man may be unable to produce sperm to impregnate his partner. Dr. Koper says, “If you do it within five years, the chances are very high that it'll work. If you do it more than 10 years, chances are that it won't work. And between five and 10 years, sometimes it works, sometimes it doesn't.”

Dr. Koper also mentioned that men can choose to freeze their sperm in a sperm bank, but says this is pretty expensive. Overall, he says, “Patients should consider a vasectomy to be permanent. A vasectomy can be reversed, but it’s not usually covered by insurance. It’s expensive. And it’s not 100% successful.”

Who it works for (and who it doesn’t)
For men who are older and family-complete, the vasectomy may be a great option. Dr. Koper says, “For most people, it’s a positive experience. They usually already have kids, they don’t want more, and their marital life is better because they don’t have to worry about a surprise pregnancy.”

However, because it isn’t reliably reversible, the vasectomy is a poor choice for young men at the beginning of their reproductive years who may want to have children later in life. Dr. Koper says that if any young, college-age men come into his office to ask about a vasectomy, he will usually try to talk them out of it. This highlights the importance of reversibility in male contraception (and contraception in general). The vasectomy option checks almost every box: it’s super effective, pretty minimally invasive, few side effects… but it falls short in that reversibility category, which rules it out for a lot of men.

Filling unmet needs
It’s clear that the vasectomy isn’t for everyone. And it shouldn’t be, just as no one female contraceptive option is expected to be a one-size-fits-all solution. Women have a whole menu of choices that cater to different needs and preferences, and this is what we hope to see in the future of male contraception.

I asked Dr. Koper how he thought that patients in his practice might respond to novel male contraception options. He said, “I think if there were some sort of an equivalent of a male birth control pill or a male birth control shot, people would really like that. And it gives men a little bit more control because right now, the only real option for men is to use condoms, and so really the birth control thing is up to the woman. I think if there were some other options for men that would be very well received.”

​I hope that in the future, physicians like Dr. Koper will be able to offer patients a plethora of contraceptive procedures, devices, and medications. This future may be a long ways away, but as the field continues to advance, I am excited to see what moving beyond the vasectomy will do for men, their partners, and the contraceptive landscape at large.