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Vasectomy Discussion

“I don’t really need to bring a specimen back in, right?”

This is a question I get as a specialist who focuses on vasectomies on a weekly basis. My answer is always the same……….”yes”

The best information we have available to us in the literature today is that about one in 2,000 vasectomies fail.  Or in other words, one of every 2,000 vasectomies may eventually result in a pregnancy.

The next question I get is “How is the even possible?”

The vas deferens is simply a tube that the sperm travel through.  When it is cut it tries to heal just like your skin would try to heal if it were cut.  We do not walk around with open wounds but in fact we see the edges miraculously grow back together when any of us have a cut in the skin.  The same cascade of events takes place after a vasectomy is carried out.  The two ends have the same type of stimulus to release growth factors to heal.  If a technique that has been shown to have low failure rates is used the vas get back together 1 in 2000 vasectomies.  In the same fashion as skin healing, most of the stimulus to heal is likely over within a few weeks of the procedure .  Despite this, there are several cases of vasectomies failing years after the procedure.

 “Well, what are the techniques that have been show to have low failure rates?”

The American Urologic Association has released guidelines on vasectomy.  In these guidelines there are several techniques described as low failure rate. The most common to be performed is the removal of a segment of vas deferens with cautery and use of permanent occlusive suture or clips.  Open ended vasectomy is also an alternative if  there is separation of the two ends of the vas between tissues in something called facial interposition.  The failure rate also may be affected by the experience of the physician performing the vasectomy.

“Do you use that technique?”

Yes I offer both open ended as well as cut clipped cauterized separated options.

“If it could fail at anytime then how do I know when it is best to bring in a specimen?”

The initial specimen is easy.  It takes between 20-30 ejaculations to flush out the pipes, so to speak.  So the first specimen should be after this level of activity.  The second specimen or even a third specimen becomes more of a guessing game.  There is no standard to the number of specimens to bring in or how much time between specimens.  My recommendation is that the second specimen be at least 6 weeks after the first specimen if the first specimen is negative.  This is not based on firm data, but common sense that says most healing is likely to be complete within the first couple of months after a vasectomy.  This does not mean that it will never fail after 6-8 weeks.  In fact, there is no evidence that failures are more likely in the first 6-8 weeks.  We set the timing based more on what makes sense, then on firm data.  It would also make sense to check a specimen before any long-term birth control such as an IUD were to be removed.  It would always be reasonable to have more than two specimens checked. However, at some time there has to be an acceptance of the fact that there will always be a very low failure rate.  Of note that one in 2000 failure makes vasectomy the MOST effective form of long term birth control.

Short answer is yes, have a specimen checked at least two times before giving up secondary birth control measures.  That is unless you don’t mind a surprise birthday party!!!

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