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11 June 2009

Clinical Update: Vasectomy

By Sam Nag, FRCS. Consultant Surgeon, BPAS.

BACKGROUND: An article on BBC News Online in March 2009 claimed that ‘second marriages or starting afresh with a new partner mean a number of men are spending large sums of money trying to reverse their vasectomies’. Clare Murphy reported that vasectomy is more popular in the UK than almost anywhere else, with 16% of men under 70 undergoing the procedure. But if the man later decides he wants to father a child, or more children, vasectomy reversal is difficult to obtain.

Murphy reports that ‘reversals are all but banned on the NHS’: the UK Government imposed this ban in 2004 ‘after high demands for the operation put pressure on NHS services’. While it was claimed that the procedures would still be allowed in ‘exceptional circumstances’, left to be determined by individual health trusts, the case of a Staffordshire man last year who was refused a reversal despite losing his young son to cancer ‘was seen as highlighting the extent of rationing’.

Murphy reports that despite the difficulties of vasectomy reversal, clinics report brisk business. She quotes Dr Andrew Dawson, who runs a reversals clinic in Hartlepool which carries out 200 procedures each year. ‘We see many people with second wives who had two or three children in a previous relationship and thought they were done, only for their marriage to break down,’ Dr Dawson said. ‘But there are also some couples who change their mind about more children at key moments - such as when their children go off to school, or university. I don’t believe more counselling at the time of the original vasectomy is the answer - for most people that decision was the right one for them at that time.’

Commenting on this story, Dr Sam Nag, a consultant surgeon who carries out reversals for BPAS, said:

‘If you are going to put it in terms of cancer drugs versus vasectomy reversals it’s not hard to see which should win. But if the NHS is going to offer vasectomies - and it should, as this is a cost effective and efficient way of preventing pregnancy - then there should be funding of reversals. People’s lives can change dramatically - we should accept that rather than adopting this “you made your bed now lie in it” attitude.’

Below, Dr Sam Nag gives the facts about vasectomy.

CLINICAL UPDATE: VASECTOMY

Q) What is the purpose of vasectomy?

The purpose of vasectomy is to render a man sterile and hence incapable of fatherhood.

Q) How is vasectomy performed?

After a local anaesthetic infiltration on scrotum a keyhole / small incision is made. The vas (sperm duct) is exposed and divided. The cut ends are then tied / sealed. Very rarely a general anaesthetic is chosen for a specific reason.

Q) How effective is the procedure?

Most men become sterile after 3 months. A small number of men may take longer to become sperm-free. The failure rate is 1 – 2%, mainly due to the re-joining of the vas. This would be detected in post-vasectomy tests and a re-operation under general anaesthetic is done.

CORRECTION: The lifetime failure rate of vasectomy, after clearance has been given (two negative counts), is 1 in 2000, or 0.05%. This is usually referred to as ‘late recanalisation failure’, and is the correct figure to be cited in relation to vasectomy failure. The editor apologises for any confusion caused.

Q) Are there any complications and side-effects?

Most men resume normal activity after 2-3 days. Recovery can be delayed by 1 – 2 weeks if there is a wound problem e.g. infection (2 -3%) occurs. This settles with antibiotics in a few days. Vasectomy does not affect the sex-life of men and there is no increased risk of cancer of testis or prostate.

Q) Can vasectomy be reversed?

Yes, but not always successfully. Vas re-joining success may be 80– 90%, but the chances of pregnancy are 25 – 50%. High parental age and long time length since vasectomy are the main causes of low pregnancy rate. Unlike vasectomy, this operation is very expensive, not usually available in NHS.

Q) How great is the demand for the reversal of vasectomy?

Most requests for reversals are from new relationships following unforeseen circumstances like divorce. The female partner may or may not have had children before. About 6% vasectomised men come back for a reversal of vasectomy and a successful outcome can change their life dramatically. Vasectomy is more popular in the UK than almost anywhere else.

This article is published in the Summer 2009 edition of Abortion Review. Download this edition here.

Also read:

Abortion Review topic archive: Clinical Update Q&A

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