Once you’ve made up your mind that you never want to have any more children,
there’s no more reliable form of contraception than vasectomy. But one
precaution: To lower the risk of your vasectomy failing, make sure the surgeon
who does yours is qualified and has a lot of experience.
When done correctly by an experienced physician, as few as 1 in 1,000
vasectomies fail to do their job — preventing you from ejaculating sperm when
you have an orgasm, thus preventing pregnancy. But when performed by doctors
who do vasectomies fewer than 50 times a year, the failure rate is as high as
10% to 17% or more.
Do you insist on rising at five to run each morning, even when your back is
aching, black ice coats the streets, and your wife beseeches you to stay in
bed? Do you only feel good when you’re training for triathlons? Is eating
merely a way to replenish for the next race? Then you, my Spandex-clad friend,
may have an exercise addiction.
To understand how a vasectomy works, you need to understand a bit of your
own anatomy. Sperm are made in your testes and stored in an adjacent sac called
the epididymis. From there, they travel, whipping their tails, through a
15-inch, shoestring-sized tube called the vas deferens. Inside your abdomen,
the vas connects with the semen-producing prostate gland and seminal vesicles
adjacent to the bladder.
This is the launching pad for the male contribution to reproduction. If the
sperm don’t get to the pad, there’s still blastoff, but it’s the unmanned
version — no sperm astronauts to couple with the ova in her space.
To perform a vasectomy, the surgeon first kneads the scrotum until he can
feel the vas — a process that looks something like a guy trying to find the
tie-string after it has retracted into the waistband of his sweatpants. After
finding it, the doctor pokes a hole (the best surgeons use a needle rather than
a scalpel) in the scrotum and uses tiny clamps to pull out a short length of
The best vasectomy technique
Surgeons have used a variety of techniques to cut, inactivate, and close the
two ends of the vas. The best technique, according to recent surveys, is called
“intraluminal cauterization with fascial interposition.” With this technique,
the surgeon slices the vas in two, scars the inside — or lumina — of one tube
with a heated needle. Then the surgeon pulls up the fascia — tissue surrounding
the tube — and clamps or sutures it over the tube end.
Sewing up the tube prevents “recanalization,” which can occur when
microscopic channels grow between the severed ends of the vas. When that
happens, sperm can find their way through these microchannels and into the
One review of 14,000 men who’d had various types of vasectomy reported six
conceptions among their partners, but as many as 10% of men in some surveys
have significant amounts of sperm in their semen a few months after a
Michel Labrecque, MD, PhD, a professor of family medicine at Laval
University in Quebec and one of the world’s authorities on the procedure,
recalls that earlier in his career, when he clipped each end of the vas and did
not cauterize it, up to 1 in 300 of his patients got their mates pregnant.
“With the technique I’m using now, it went down to 1 in 7,000,” Labrecque
says. “I redo one vasectomy per year at the most. With interposition, you are
putting tissues between the two cut ends, so it’s like a double zip lock.”
“Ultimately, the experience of the surgeon performing the vasectomy is the
most important factor in achieving success with minimal complications,” adds
Ninaad Awsare, a British urology researcher.