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Male Infertility

Vasectomy

Vasectomy Reversal

Glossary

Vasectomy

Introduction

Vasectomy is a common office procedure performed with the intent of achieving permanent sterilization. An office consultation, with the patient’s wife in attendance, is required before a vasectomy can be scheduled. Approximately 500,000-750,000 vasectomies are performed annually in the United States

The Male Reproductive Tract

Sperm are produced in the testicle and travel into the epididymis (a small crescent shaped organ attached to the back of the testicle) where they are stored for two weeks. After they leave the epididymis, sperm are discharged into the vas deferens that delivers them into the urethra at the time of ejaculation. Live sperm are stored along the entire length of the vas deferens and sperm constitute less than 1% of the total volume of the ejaculate. Men have one testicle, epididymis, and vas deferens on each side, although in rare cases the vas deferens may be absent on one side.

The Procedure

After suitable preparation, which includes showering with an antibacterial soap and shaving the scrotal area, a local anesthetic (Xylocaine) is administered into the scrotal area and a quarter inch segment of each vas deferens is removed through a small skin incision on each side. The cut ends of each vas are cauterized (sealed) and separated from each other. The scrotal incisions are closed with one or two absorbable (doesn’t require removal) sutures. Although it is common to be apprehensive, the procedure is usually quite painless and takes about 30-45 minutes.

After the Vasectomy

Patients undergoing a vasectomy should be driven home since they will have taken a pre-operative sedative (Valium). The local anesthetic will usually wear off in an hour, after which most patients experience mild to moderate discomfort in the scrotum, groin, or lower abdomen. Prescription pain medication is rarely required, although it is available should severe pain occur. It is best to lie down for 4 to 6 hours after the vasectomy and to place an ice pack on the scrotum during that time. The following day one can assume "normal" daily activities, however it is best to refrain from any physical activity (lifting, jogging, etc.) or sexual activity for 3 to 5 days. After that, patients may resume full activity provided it does not result in increased pain. It is not uncommon to experience mild intermittent discomfort in the scrotum for several weeks after the vasectomy due to congestion of sperm in the epididymis.

Follow-up

After the vasectomy, three regular follow-up visits will be required:

At 7 to 10 days for a "wound check"

At 6 weeks for the first semen check

At 12 weeks for the second semen check

Since sperm are stored along the entire vas deferens, a vasectomy does not result in immediate sterility. Several ejaculations are required to evacuate all sperm. Therefore, patients must continue with strict birth control for at least three months after a vasectomy. If no sperm are present at the 6 and 12 week semen check, birth control can be safely discontinued. Please note that the patient himself must appear for scheduled post-operative appointments. Semen samples will be checked and the results reported immediately. Samples should be collected at home in a clean glass container and cannot be more than six hours old.

Complications

Complications occur in about 5% of patients undergoing a vasectomy, but usually resolve without treatment.

• Bleeding: bleeding into the scrotum can occur within the first 24 hours. If scrotal swelling occurs, please notify your doctor. Minor oozing of blood from the skin incisions and dark discoloration are common and of no concern.
   
• Infection: infections can occur either at the site of the scrotal incisions, or deeper within the scrotum. Superficial skin infections are minor and usually resolve with warm soaks and antibiotics. Deep scrotal infections are rare but very difficult to eradicate and may require surgical drainage.
   
• Sperm Granuloma: a sperm granuloma is a small lump at the vasectomy site or in the epididymis due to the accumulation or leakage of sperm. It usually occurs within the first three months after a vasectomy, but may occur years later. Sperm granulomas usually resolve spontaneously, but the lump can be removed surgically if it remains painful
   
• Vasectomy Failure: Failure of the vasectomy to result in permanent sterility occurs in approximately 1 in 500 patients. This usually occurs immediately after the vasectomy when sperm form a new connection between the separated ends of the vas deferens. Because this can occur even years after a vasectomy, the results of a vasectomy cannot be guaranteed.
   
• Sperm Antibodies: New proteins called sperm antibodies are found in the serum of up to 70% of patients undergoing a vasectomy. Sperm antibodies are not harmful.
   
• Impotence: Rarely a man can become impotent following a vasectomy. Post-vasectomy impotence is psychological and usually responds to counseling.
   
• Vasectomy Reversal: Vasectomy reversal is common today, and using standard microsurgical techniques fertility can be restored to 50 to 60% of patients if the interval between the vasectomy and the reversal is less than 10 yrs
   
• Prostate Cancer: There have been occasional medical reports suggesting a causal relationship between vasectomies and prostate cancer. However, to-date there has been no convincing evidence of a link between vasectomies and prostate cancer.

Sperm Bank

Semen collected before a vasectomy can be frozen and stored in a sperm bank for an extended period of time. However, pregnancy following insemination with frozen semen is certainly not guaranteed.