Becoming a father after a vasectomy
A small cut with a big effect: between 30,000 and 50,000 men sterilize themselve in Germany every year. The procedure of choice is called vasectomy. We will explain how a vasectomy works, how it can be reversed and what costs can be expected. We also explain how couples who want to have children can become parents despite a vasectomy.
Becoming a father after a vasectomy
What is a vasectomy?
Vasectomy refers to the cutting of the vas deferens in men. It is considered a reliable method of contraception, has relatively few complications and involves a much lower surgical risk compared to the sterilization in women. Vasectomy should not be confused with castration, in which the testicles are removed, drastically altering the hormonal balance.
Sterilization or vasectomy does not interfere with hormonal balance: sperm production continues. By cutting the vas deferens, there are merely no more sperm in the ejaculate — sperm transport is permanently interrupted. After a vasectomy, the partner feels just as much pleasure during sex as before and the procedure also has no direct influence on erection and orgasm.
How does a vasectomy work?
In a classic vasectomy, a small incision is made in the skin of the scrotum after local anesthesia, through which the vas deferens of both testicles are exposed. Then, approximately 2 cm long pieces are taken from the left and right vas deferens. The severed and thus shortened vas deferens are sclerosed at their open ends, sutured and repositioned. The testicles are sutured in the next step. The classic method takes about 15 minutes per testicle.
Modern procedures such as the so-called non-scalpel vasectomy offer an even gentler form of male sterilization: here, the skin on the scrotum is no longer cut with a scalpel, but punctured in one or two places. Vasectomy without a scalpel takes only about 15 to 20 minutes.
The small opening is simply covered with a sterile dressing and heals on its own.
How safe is a vasectomy?
Whether a contraceptive method is safe or less safe can be measured by the “Pearl Index.” The lower the “Pearl Index,” the safer the method. Vasectomy is one of the safest methods of preventing unwanted pregnancy; according to ProFamilia, its Pearl Index is 0.1. By comparison, the Pearl Index of the birth control pill ranges from 0.1 to 0.9.
From now on, one thing should be clear to you: a vasectomy is only a small cut, but it has far-reaching consequences. The decision for or against male sterilization should therefore not be taken lightly. There are ways to reverse a vasectomy (see below to find out how), but there is no guarantee that you will be able to conceive again.
Therefore, the German Society of Urology also advises against a vasectomy if no children have been conceived so far, the man is younger than 30 years old, suffers from chronic testicular pain or is currently not in a partnership. Also, an emotional crisis should not serve as a reason for this procedure.
What are the costs for a vasectomy?
Depending on the practice, you should expect to pay around 500 euros (including follow-up examinations). The health insurance companies do not cover the costs.
Vasectomy and the desire to have children
Vasectomy is recommended for men who do not wish to have children or who have completed their family planning. But what if after a vasectomy there is still a desire to have children? This is the case for about 30% of sterilized men. And still about 6–10% of men who have had a vasectomy decide to have it reversed.
Is it possible to reverse a vasectomy?
Yes, it is possible. A repeat surgery, called a vasovasostomy, reconnects the severed vas deferens. Here, a special surgical microscope allows the surgeon to enlarge the tiny vas deferens up to 20 times in order to reconnect their ends. After all, 90% of the operations are crowned with success and the ability to procreate is restored.
There is disagreement as to whether the time factor plays a major role or not. Many sources in the Internet report that the longer the period between vasectomy and refertilization, the lower the probability of pregnancy. For example, the German Federal Center for Health Education (BZgA) states on its website Familienplanung.de that only half of sterilized men will father a child again if the refertilization took place within three years of the vasectomy. If the procedure took place even longer ago, the chances deteriorate further. However, there are also other, more hopeful prognoses, which state that the connection between time and chances of success simply does not exist. Rather, they say, it’s crucial that “the diagnostic and partnership parameters are right.”
What are the costs for a refertilization / vasovasostomy?
At least 2000 euros must be expected and thei are not covered by the health insurance.
Becoming a father through assisted reproduction
If a refertilization is not possible or if it is not to be reversed despite the desire to have children, couples can consider another option after vasectomy: Testicular sperm extraction (TESE). Here, tissue samples are taken from the testicles via a small procedure and examined for sperm that are capable of fertilization. If these are found, the samples can be frozen and used for fertility treatment (ICSI). TESE requires a thorough preliminary examination including a spermiogram. It costs around 2500 to 3000 euros, which is also due proportionately if no fertilizable sperm are found. However, health insurance companies usually contribute to the costs of surgical procedures to obtain sperm if certain conditions are met.
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