Here’s Why Following Up With Vasectomies Is Important

A vasectomy baby probably isn't the surprise you're looking for.

October 6, 2017
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But how could this happen? Vasectomies are often touted as virtually foolproof forms of contraception. One word, ever so important in doctor dealings: follow-up.

Tim, for his part, did his due diligence: He visited the Florida clinic that performed his vasectomy five months afterwards for a routine follow-up. The clinic, apparently, didn’t send back the results. After noticing his wife was displaying signs of pregnancy, Tim contacted the clinic, suspecting his procedure failed. The clinic later confirmed that one of his vas deferens was “unsuccessfully clipped,” as he told People.

Though it doesn’t happen often, vasectomies can indeed fail. Based on its 2004 research study, the Center for Disease Control found that only about 1 percent of procedures failed (i.e., pregnancy occurred). A faulty procedure, in the Brummels’ case, also can happen, but is exceedingly rare.

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The greater risk—and broader takeaway from the Brummels’ story—is that sperm can still be active and viable in the immediate months following a vasectomy, making follow-up visits to a doctor absolute must-do’s for a successful procedure.

Some sperm are still viable immediately after a vasectomy.

A vasectomy, says Dr. Tara O’Connell, who practices medicine in Orange County, California, “is not stopping the production of sperm, but stopping the highway [the] sperm takes to get out in the world.” Hence the very term vasectomy: an –ectomy, or “cutting,” of the vas (deferens).

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But we shouldn’t take “cutting” too literally. O’Connell explains that urologists—who, along with some family practitioners, primarily perform this reversible, outpatient procedure—also block sperm passage by tying off or cauterizing the vasa deferentia.

Following a vasectomy, though, sperm that’s already been produced and transported out of the testes can survive—and can lead to precisely what the procedure is designed to prevent: pregnancy.

“You have to make sure you have zero sperm in the system,” O’Connell says.

Urologist Knows Best

O’Connell underscores the importance of what urologists call the post-vasectomy semen analysis (PVSA).

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Urologists, here, are specifically looking for sperm that is immotile, or incapable of motion and thus effectively dead.

Based on decades of research, the AUA has issued a comprehensive set of guidelines for vasectomies. Key takeaways for the patient, translated into layperson’s terms, include:

  • A man can still get a woman pregnant in the months after a vasectomy.
  • Couples should use some form of contraception until the doctor confirms the sperm count is clear.
  • The man should get tested approximately three months after the procedure; the AUA recommends a range of eight to 16 weeks, with the specific timing at the doctor’s discretion.
  • If the test identifies motile sperm, he should have additional testing, about a month or two later, until the count is clear .
  • If the test still doesn’t come back clear six months after the vasectomy, the doctor may recommend a repeat procedure.

Seems simple enough, right?

Post-vasectomy compliance isn’t always easy.

“I had to go back three times to get cleared,” says Chris Caporicci, husband, father of four, and business owner in Orange County, of his vasectomy. “If there were any signs [of sperm], you had to give it another two months. Any more signs, two more months. It took me six months to clear—quite a while.”

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As noted, only 1 percent of vasectomies fail, as determined by unintended pregnancies, or “vasectomy babies,” that happen after the procedure. And although unsuccessful clippings like Tim Brummels’ do occur and vasa deferentia can occasionally grow back, noncompliance with post-vasectomy testing appears to be a significant cause.

Research in 2006 concluded that fewer than a quarter of men fully complied with the recommended PVSA—stack that up against findings in 2003 that attributed 51 percent of vasectomy babies “to unprotected intercourse during the immediate post-vasectomy period” when sperm can still be active.

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Caporicci highlights some of the barriers to post-vasectomy compliance: work, time, and comfort. Patients are instructed to flush their system, so to speak, dozens of times before submitting a sample for analysis. The British Andrology Society, for instance, has recommended at least 24 times in 16 weeks.

The length of the post-operative protocol also deters compliance, with a 2006 vasectomy study finding that only half of its participants submitted samples for analysis 12 weeks after the procedure—AUA’s PVSA sweet spot. Then there’s the awkwardness, with some men feeling uncomfortable providing and hand-delivering a sample in a doctor’s office or laboratory.

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On the issue of compliance—and on vasectomies more generally—O’Connell insightfully drills down into deeper issues of identity.

“Women are used to their bodies changing” throughout their lives, she says. “Women have practiced how to go through menstrual cycles and birthing children and seeing themselves change.”

It’s daunting for a man to have this manly function taken away.

O’Connell cites personal experience. When her husband, also a doctor, had a vasectomy, she wryly observed that he was very concerned about soreness and swelling he experienced, a normal and short-term side effect of the procedure. “I kinda had to suspend my judgment and remind myself of the newness that it was for him,” she says, contrasting, with a loving laugh, his experience to the far more dramatic changes she experienced when birthing their four children.

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Men certainly become more aware of their bodies during puberty, but it’s not until they are much older that they typically confront prostate, colonic, erectile, and contraceptive concerns. Women, on the other hand, deal with soreness and swelling, to name only two symptoms, during periods, on birth control, and throughout pregnancies from young adulthood and into older age. And these changes tend to make women far more conscious of their reproductive system, how it shapes what they feel and look like, and how its affects everyday choices and behavior.

When it comes to vasectomies, O’Connell says, “It’s often men’s first experience in thinking about who they thought they were in their bodies.” For the first time, some men are directly thinking about their own fertility—their masculinity—which they’ve long taken for granted given the relative stability of their reproductive system throughout adulthood.

“It’s a big deal,” O’Connell adds. “It’s daunting for a man to have this manly function taken away.”

But women’s permanent contraception options are even more complicated.

The female equivalent of a vasectomy, tubal ligation, is even more daunting—and invasive and expensive. Tubal ligation, colloquially known as “getting one’s tubes tied,” functions just like a vasectomy and, with a 99 percent success rate, is considered equally effective. This operation closes off the fallopian tubes, where eggs travel from the ovaries for fertilization.

But operation is a key word here. Unlike vasectomies, traditional tubal ligation requires surgery, which spikes risks and costs. Hysterectomies, which prevent pregnancies by virtue of the removal of a woman’s uterus, are even more fraught; Dr. O’Connell notes no one undergoes them for the purposes of birth control. “The vasectomy is an easier, more accessible, quicker procedure,” she says.

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Still, in the U.S., tubal ligations have outnumbered vasectomies. A 2010 report estimated there were about 175,000 to 350,000 vasectomies performed between 1998 and 2002 compared to about 550,000 to 790,000 tubal ligations in the same period. In countries like Canada and New Zealand, however, those rates are flipped. What gives?

For one, the U.S. has a comparatively high rate of caesarean sections at nearly a third of all births, and many mothers are increasingly electing for them in order to schedule birth—and also getting tubal ligations while the doctor is already performing the surgery in the area.

For another, new, non-surgical forms of tubal ligation, called hysteroscopic sterilization, have become available. Debuting in 2002, Essure is a proprietary method which inserts a coil in the fallopian tubes, and, if and only if properly placed, has been found “the most effective of all female or male sterilization techniques” at 99.74 percent, based on the result of a 2009 study.

Despite the quickness of the procedure and its efficacy, Essure has since been suffering some serious blowback. As medical and pharmaceutical watchdog Drugwatcher writes, starting in 2009 Essure patients “were beginning to come forward and reveal their issues, such as fallopian tube perforation, persistent pain and bleeding, unwanted pregnancies and other complications,” thanks especially to the deterioration of and adverse reactions to the device’s signature nickel coil. What’s more, to remove the device, doctors have to perform hysterectomies. Thousands of lawsuits have since been filed against its manufacturer, Bayer.

“It’s Almost Like a Rite of Passage”

New technologies may promise an improvement over traditional tubal ligations—but perhaps not necessarily over traditional male attitudes towards vasectomies. Aside from squeamishness about the process, some men mistakenly fear vasectomies will lower their testosterone and sex drive, while others may hold on to beliefs that contraception is a woman’s responsibility.

It’s almost like a rite of passage among your buds. ‘Yeah, I had the bag of frozen peas on my crotch.’

But such men should take it from Chris Caporicci. “The vasectomy itself went very easily. It was quick,” he says. “If you don’t want to have more children, it’s the most sensible way to do it. If you don’t, your spouse has to get her tubes tied or be on medication. For the guy, basically they just go in with this little device and cauterize the tube that the sperm come in and that’s the end. You still produce sperm it’s just that it can’t go where it needs to go.

Caporicci gets men’s concerns, though, and offers: “It’s almost like a rite of passage among your buds. ‘Yeah, I had the bag of frozen peas on my crotch,’” he mimics a conversation with the guys. “It’s a no brainer.”

Just make sure, post-vasectomy, to remember the Brummels. And make sure to heed the doctor’s advice; as O’Connell says, “Like all areas of medicine, you have to follow the steps through as a patient.”

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