Bedno.com Andrew  Do  See
Vasectomy Info
Resources and my story.
Vasectomies:
http://www.vasectomy-information.com
The website of alt.support.vasectomy - comprehesnive and with a mailing list.
http://www.nichd.nih.gov/publications/pubs/vasect.htm
National Institute of Health.
http://www.my-vasectomy.com
One man's fully photographed experience.
http://menshealth.about.com/health/menshealth/cs/vasectomy
About.com subject guide.

Reversals:
http://www.urologyorlando.com/vasect.htm
http://www.vasectomyreversal.com
http://www.vasectomyreversals.com
http://www.vasectomyreversalspecialists.com
http://www.vasweb.com/revlpage.htm
http://members.aol.com/vasrevers/procedureframe.html
http://www.male-infertility.com
http://www.earlowen.com.au/vasectom.htm
http://www.malereproduction.com

Consensus:
There are repeated statements on-line to the effect that vasectomy is reversible, decreasing with time from almost certain in the first 2yrs, to over 80-90% within 2-10yrs. The cost runs $4000-12000 depending on surgery type. I consider it an option in part only because I expect to be able to afford it. Reversals are most likely not covered by insurance. The surgery type is determined from an initial examination of the quality of the sperm ducts. Also, conceivably there are two chances to get it right and there are workable in-vitro worst case solutions. Some of the online statements of reversibility provide statistical background, but the total samples is low. The best example was from less than 500 surgeries. They reported over 97% showing return of necessary volume of viable sperm. All sources however quoted pregnancies generally resulting in only 50% or so of case. This follow-up was not even monitored by some surgeons. This is not an unreasonable percentage and may often be due to other variables. My own Urologist was initially strict with me that I must understand that this is permanent. Afterwards though when he asked if I had questions, and I asked if it was reversible should I really really wish it, he was almost dismissively positive about it. Be clear that surgeons will not guarantee a reversal.

The National Institute of Health takes a hard line that Vasectomy should be considered permanent. They report that about 1 in 6 men has had it, and is more likely in in proportion with education and income. It is the third most widely used method among married couples, after female sterilization and the pill. It is the single most often performed elective surgery. I did not know this. Men widely report improved sex following vasectomy. Large scale health studies of vasectomy have shown no clear correlation with increased arteriosclerosis (a popular concern). Some studies have shown a slight correlation with superior overall health. There are several conditions which do occur in one of every few thousand individuals. These include occasional swelling or tenderness, developing immune response to sperm, and standard post-operative infection risks. Be aware also that a man is still fertile for a week or two following the procedure. Ideally, find a surgeon who is using the newer (1988) "no scalpel" technique.

Personal Story:
On Thursday April 6th, 2000, I had a Vasectomy. Though dating a MARVELOUS young woman with whom I hope to have children someday, it seemed like our best choice. I am 38 with a 12 year old from a prior marriage (age and existing children are screening questions asked by the Urologist). I feel chemical solutions are undesirable for women for several reasons. IUD's can be felt (sorry, it's true). I also personally hate condoms. I hate involving something so artificial in something so intimate, and I tested clean. These facts combined with the fact that I think it is CRITICAL to the point of UNCONDITIONAL to not have an unplanned pregnancy made Vasectomy a reasonable gamble. BUT - no surgery is good surgery. This hurts like hell, for days on end, is done in an uncomfortable operating environment, and bleeds a while. In retrospect I do not feel that I was provided adequate pre or post operative information. I would have appreciated something printed about pain and wound care. It feels like I was kicked in the balls REALLY HARD! Also, I was unprepared for a massive emotional aspect for many hours immediately following the surgery. Finally, this procedure does leave one subtley changed physically, in ways that an aware man will notice, such as a different texture to the semen and slightly different feelings inside. On the whole though, I'm totally happy, and filled with lusty plans.

Thoughts a year later:
It's pretty nice. No physical awareness of it at all. Since I regularly hang with the pierced and tattooed, I call it a body-mod. I'm living with the decision, clock running out on reversibility. I've noticed that it became at least a tiny character attribute about me in friend's minds. I've noticed my own awareness that I am no longer truely a part of the fertile groups with which I play, but I'm OK with this. Perhaps the commitment bought this Peter Pan some wisdom. Lastly, I get funny reactions when people find out; surprised or supportive, and always interested. Additional notes on reversals:
Vasectomy Reversals have become a fairly common procedure over the past twenty years due to dramatically improved success with microscopic techniques. Only two conditions must be satisfied for sperm to be returned to a patient's semen with vasectomy reversal. The patient must have sperm available to pass through the reconnection and also the reconnection must be essentially watertight. The surgeon's goal is to achieve a very precise circumferential reconnection of the sperm canal edges by using meticulously placed microsurgical sutures.

Things to Consider:

What is the "patency rate" of the surgeon you are considering? Worth asking, but often the answers need analysis!
The "patency rate" is the frequency of the post-op confirmation of sperm in every patient's semen. This is almost routinely obtained. The "pregnancy rate" is always less, because many variables besides sperm presence are involved. The longer time interval to determine pregnancy or not loses many patients from follow-up. There are unrealistic claims by more than just a few reversal surgeons, like a "90% Baby Rate", that are absurd. Presumed normal couples without sterilization to overcome don't do that well statistically! Some surgeons will give another surgeon's or a medical center's published patency rate. That indicates either they have not personally performed very many reversals, or their personal results have not been very good. Only a surgeon's personal statistics deserve any consideration at all. Unfortunately, it's not uncommon for statistics to be stated somewhat deceptively. An example is that some surgeons report 97-98 % success rates for returning sperm to a patient's semen by simply re-connecting the upper and lower vas ends after removing the vasectomy blockage. This procedure is called "vasovasostomy" (VV). This is incredibly good, until you discover that they have excluded all their patients with poor or bad findings at surgery by performing on them the difficult bypass operation called "vasoepididymostomy" (VE), instead of vasovasostomy. Valid statistics require consecutive cases, not selected cases after some are excluded. Some report obtaining "98-99% success rates with patients having live sperm in either vas at the time of surgery". This really isn't exceptionally good and it excludes more than half of all patients, because 50-60% of all reversal patients do not have live sperm seen at the time of their reversals. You simply have to be careful, perhaps a little cynical, when reviewing statistics, because the actual results are often not as they initially seem.

2004.02.02