Family Planning

Dr. Wilson having a discussionDecision Making

There are several choices available for contraception. Each couple must choose the method which best suits their needs. Your doctor or your partner’s doctor can help you choose what is best for you.

Temporary and reversible methods of birth control include condoms, spermicides, diaphragm, IUD, the pill, the patch, and the Depo shot. Permanent methods include female sterilization by tubal ligation and male sterilization by vasectomy. These procedures cannot be performed in a way that makes them easier to reverse. This means only those who have decided not to have more (or any) children should choose permanent sterilization.

While no one can predict the future, you must take into consideration the possibility of unforeseen changes in your life or in the lives of your partner and children. Can you imagine a situation in which you would regret having chosen sterilization? Would you consider adoption? You should also consider the risks and consequences of having an unintended pregnancy while using a reversible method of contraception instead of sterilization.

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Benefits of Vasectomysmiling couple

Vasectomy is the most reliable of all birth control methods. A tested, successful vasectomy is 50 times more reliable than the birth control pill, 300 times more reliable than condoms in preventing pregnancy.

Vasectomy is a convenient office procedure. The procedure itself takes 5 to 10 minutes and the benefits last a lifetime.

Vasectomy is, over time, the least expensive method of birth control. Over several years, it would cost more to use the pill, the IUD, even condoms, than the one-time cost of a vasectomy.

Vasectomy is the only currently available method other than condoms that allows the man to take responsibility for preventing pregnancy.

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What if I Change My Mind Later?

Unfortunately, one cannot simply “undo” sterilization.

If your life plan changes unexpectedly, the options for having children after a vasectomy include adoption, attempted vasectomy reversal, or pregnancy by artificial insemination using either frozen stored sperm, fresh donor sperm, or sperm surgically withdrawn from the testes. All forms of assisted fertility involve a considerable commitment of resources and are not generally covered by health insurance.

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Vasectomy Reversal

A small percentage of men with vasectomy have undergone surgery to attempt to restore their fertility. The procedure, called a vasovasostomy, can be performed by a specialist experienced in microsurgery, using a microscope in the operating room. Often general anesthetic is necessary to prevent motion during the surgery, which lasts 1½ to 3 hours.

Within a few weeks or months, about 50% to 70% of men will achieve sperm counts high enough to expect a pregnancy, while as many as 50% will not achieve pregnancy. For intervals over 10 years since vasectomy, success rates are about 30%. Of course, the age and fertility of the female partner affects success. If pregnancy occurs, there is no special concern about abnormalities related to the sperm produced after vasectomy.

For those who fail, it may still be possible to retrieve sperm from the semen or by extraction from the testicles and then to microscopically implant a sperm into an egg in vitro. If an embryo forms, then it is transplanted into the woman’s uterus. This highly specialized form of in vitro fertilization is called intracytoplasmic sperm implantation, or ICSI, and requires specialized laboratory facilities. It is generally more expensive and less successful than vasectomy reversal.

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Sperm Banking

Storing sperm prior to vasectomy offers another potential back-up for later fertility, but no guarantee.

Stored sperm is less vigorous than fresh, and requires special fertility assistance procedures. The sperm banking service is provided by a fertility clinic or laboratory, such as Pacific Northwest Fertility (206.515.0000) in Seattle.

A preliminary freeze-thaw test will determine if a man’s sperm is likely to survive the frozen storage. If so, then several samples need to be collected over a few weeks and stored under liquid nitrogen before undergoing vasectomy. Planning ahead for sperm collection and deciding how much to store and when to eventually discard banked sperm are aspects to consider about sperm banking.