Category: Vasectomy

I HAD THE PROCEDURE. THE VAS IS CUT. THE PASSAGE FOR SPERM IS SEVERED. SO WHY DO I HAVE TO WAIT?

After a vasectomy you have to wait 3 months (and 30 ejaculations) for the procedure to take effect

THAT’S RIGHT – before finally inaugurating intercourse without additional contraception, you have to wait a while!

This happens for a very mundane reason – after being produced by the testicles, sperm are not stored there at all. They travel to the area of the prostate, where they combine with the other components of the ejaculate and wait there for ejaculation. Every man has such a stored reserve of ejaculate. After the vas is cut, this reserve must be emptied before you can have sex without protection. That is why a minimum of 30 ejaculations or 3 months are needed. Once the desired semen analysis result has been achieved, you can safely have sex without additional contraception.

And why do I have to test my semen at all?

Semen analysis after a vasectomy should be considered a mandatory step. Its importance should not be underestimated. Skipping the semen test can result in an unwanted pregnancy.

First, we test the semen to check whether the vasectomy was effective at all. Of course, with the Open Ended method the failure rate is exceptionally low, half a per mille (one case in 2,000), but the effectiveness of the procedure should always be verified. That way we avoid surprises in the future. We also gain certainty that everything went according to plan.

Second, 3 months is the time the average patient needs to clear the semen present in 30 consecutive ejaculations.

For some patients this time may be somewhat longer, e.g. by a month. In that case we inform the patient of the need to repeat the test after the indicated time or after another 10-15 ejaculations. The patient knows he must continue using protection until a satisfactory semen analysis result is achieved. Some patients need 40-50 ejaculations to fully clear the remaining sperm.

After a vasectomy, a simplified semen analysis is performed – the detailed sperm parameters (count, motility, progressive movement) are not assessed. To check the effectiveness of the procedure, we only check for the presence of sperm in the ejaculate. Detailed information about semen analysis after a vasectomy can be found here.

 

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Currently, apart from the classic vasectomy methods using a scalpel, the most common procedure worldwide is minimally invasive no-scalpel vasectomy (No Scalpel Vasectomy). It involves closing both ends of the cut vas deferens completely. This variant, as mentioned earlier, is currently the most commonly performed in the world. Unfortunately, it is associated with a failure rate of up to 13% and a high rate of pain complications.

Below is an animation of the classic no-scalpel vasectomy variant, which in some centres carries a failure rate of up to 13% and a high complication rate.

Watch the film. See if you can spot the differences! It is not easy at all!

Now read the description of the so-called Canadian method (OEFI) and try to say how it differs from the no-scalpel vasectomy variant shown in the animation above.

The effectiveness of the various methods can be found in the American Urological Association’s Vasectomy Guidelines (material in English).

Vasectomy and the male pill

Vasectomy – will an alternative to this surgical male contraception appear?

For years, work on hormonal male contraception has been going on without success. The most promising is the work on combining progestogens with androgens (testosterone). The effectiveness of such preparations is not as high as that of hormonal contraception for women. Moreover, side effects occur much more often and are more serious.

Until recently, apart from the condom, men had no way to relieve their partners in this respect. Only the no-scalpel vasectomy, as a minimally invasive and painless method, enabled them to take this chivalrous duty on their own shoulders.

Vasectomy is, moreover, a reversible method. A man who has undergone a vasectomy can have children in the future. It suffices to have the separated vasa reconnected, i.e. a reversal (vasectomy reversal) – a microsurgical operation that nowadays has a very high success rate – or to undergo in vitro fertilisation, in which, after a vasectomy, sperm are retrieved directly from the testicles.

Work is also under way on other pharmacological forms of male contraception – but none of them has come close even to hormone-based approaches, let alone to vasectomy.

Evaluating vasectomy itself is complicated by the fact that many centres performing the procedure currently use completely different variants of the method. The vas may be cut, or a fragment excised; it may be closed by tying (clamping) with external ligatures, or clamped with a titanium clip. What is more, some centres bring one end outside the sheath of the spermatic cord. In some it is the testicular end that is brought out, in others the end leading to the prostate and penis. The opening in the sheath is also closed in different ways, sometimes with thread, sometimes with a titanium clip. Another variant is thermo- or electrocoagulation of the vas. Sometimes, without cutting the vas at all, it is heated from the outside over a few centimetres, causing it to shrink and become blocked. Mix all these variables together and you get dozens of no-scalpel vasectomy variants.

The American Urological Association is striving to standardise the way no-scalpel vasectomy is performed worldwide.