Are Vasectomies the New Condom?

As a 24-year-old construction worker who hadn't entirely ruled out the idea of having more kids someday, James Wade was not the typical vasectomy patient. But one fall morning in 2002, he sat in a doctor's office in rural Eagle River Alaska and—as his wife Shari looked on with their baby boy in her lap—had the tubes that carry sperm from his testicles through his penis delicately snipped.

"It was nothing," he recalls of the 8-minute procedure. "It felt like getting a shot."

Six years later, as the memory of Shari's brutal first pregnancy faded, he found himself in another doctor's hands, having those severed tubes stitched back together. Within a year came a second son, and a second vasectomy, enabling James and Shari to enjoy their robust twice-a-day sex life without driving hundreds of miles to the nearest town to stock up on condoms. When in 2016, they started imagining a baby girl, James plunked down $10,000 for yet another reversal. Now, they're trying for their third child.

"If you add up the cost of birth control for all of those years, it's really not that big of a difference," says James, now 39. "And as sexually active as we are, this is way more fool-proof."

The Wades are no doubt a rare case. But they illustrate a trend urologists and men's health advocates are saying they're seeing nationwide: Guys want more control over contraception. They see condoms as a hassle. And a growing few are willing to go to great lengths to have worry-free sex until they're ready for fatherhood. While vasectomies are still considered "permanent," intended only for men who are done having kids or never want them, some doctors say they are seeing more young, childless men using them as a temporary stop gap. Thanks to medical advances that have made vasectomies less invasive, and new microsurgery techniques that have made reversals more successful, San Francisco urologist Paul Turek goes so far as to call vasectomy "the new condom."

"Right now, I view vasectomy as reversible birth control, and so do many of my patients," says Turek, noting that a quarter of his vasectomy patients are under 30. Some have a vasectomy with the idea they'll reverse it when ready. Critics of the idea say this is a risky bet. Some hedge that bet by banking sperm before getting snipped. Others, like Wade, figure they're probably done having kids (his wife wasn't so sure) and then change their mind.

Meanwhile, at least two companies are racing to address the issue in a more practical manner, working to develop a sort of vasectomy-lite that would block the sperm-transporting vas deferens tubes with a polymer fluid easily flushed out later.

"The potential permanence of vasectomy is a really powerful barrier to men," says Elaine Lissner, whose Berkeley-based nonprofit the Parsemus Foundation has been working on such a technology, Vasalgel, since 2005. She sees it as more a matter of social justice than an entrepreneurial mission. If more guys had vasectomies, fewer women would need to take hormone-altering pills for years, or undergo the far more invasive surgery of having their tubes tied. Unintended pregnancies would also plummet, she predicts. "There would be many more men interested in vasectomy if they knew that somehow they could just leave the door of possibility open a little bit."

March is among the most popular months for vasectomies, with the number of procedures going up 30 to 50 percent as clever basketball fans time their recovery to coincide with the NCAA March Madness Tournament. Some clinics even offer "Vas Madness" discounts, complete with pizza coupons and ice bags emblazoned with team logos.

"It neutralizes the stigma around vasectomy and turns it into an excuse to lie around and watch basketball for a few days," Turek says.

That stigma is substantial. While vasectomy is relatively cheap ($500 to $1000), often covered by insurance, and a fraction of what a tubal ligation cots, women are three times more likely to be sterilized than men. About one third of men use condoms, even though they fail about 18 percent of the time, according to the Centers for Disease Control.

In all, studies show, just 6 percent of couples use vasectomies for birth control.

Turek blames fear of pain. "It's not like operating on a finger or toe. The scrotum is a special place in a man that he has spent his whole life defending."

In reality, complications are rare (1 to 2 percent), and the procedure is simple. A physician creates a small opening in the scrotum, exposing the vasa deferentia—two tubes that carry sperm from the testes to the urethra (deferentia is the plural of deferens, in case you wondered). Then he or she severs them and ties or cauterizes them. Most men are awake under local anesthetic during the procedure, and off pain pills within two days. Wade went sheep hunting 48 hours after having his first vasectomy.

As far as sex goes, many couples report their sex gets better and more frequent and spontaneous post-vasectomy.

"It really helps your relationship when you don't have to think about birth control," says Shari, who can't take birth control pills due to the side effects. After their second son was born, they didn't hesitate signing James up for a second vasectomy. "In the back of my mind I figured, it's reversible if we ever want to try for another," she says. In all, about six percent of men who have vasectomies ultimately have them reversed.

Just how reversible vasectomies are is a matter of debate. Until recently, conventional wisdom held that the longer it's been, the harder they are to reverse. That is true to a degree, says Turek, but in the hands of a skilled surgeon, success rates are still quite good.

One 2013 study looked at 1,229 vasectomy reversal patients, average age 42, and found that 84 percent had moving sperm in their semen again afterward. If the vasectomy was less than 15 years old that rate was 93 percent; if it was more than 15 years old it was still 75 percent.

Those numbers have caught the attention of a small but growing number of young Silicon Valley entrepreneurs who have found their way to Turek's office.

"These are wealthy, busy, tech industry guys who don't like variables they can't control. They don't want to have to worry about a fingernail puncturing the condom as she puts it on. They want birth control that just works without them having to do anything. And they have the money."

Turek stresses that vasectomies (unlike condoms) do not prevent sexually transmitted diseases. And he still always warns his clients that vasectomy is considered a "permanent" option: "They look at me and say, 'I have seen the data. You're not fooling me.'"

Michael Eisenberg, director of male reproductive medicine at Stanford University, says he believes that in the hands of skilled surgeon, like Turek or himself, reversals can indeed be quite successful. The trouble is, there aren't that many skilled surgeons and the delicate three or four-hour microsurgery is highly complex. Turek likens it to hand-stitching a suit in the operating room.

"I suppose it depends on how you handle risk, but in general I think vasectomy is a better option for men who are done with family building," says Eisenberg.

Others note that simply having motile sperm after a reversal doesn't necessarily mean a man can father a child. Sperm counts and sperm health can wane over time and in reality, "take home baby" rates post-vasectomy actually range from 50 to 70 percent.

Male contraceptive advocate Lissner finds Turek's "vasectomy as the new condom" idea "provocative" and might even buy it with one key caveat. If she were a guy, she says, she'd bank some sperm before going under the snippers.

"I'd want a belt and suspenders approach," she says. If a reversal down the line works, great. If not, there's still a vial of healthy young sperm frozen in a liquid nitrogen refrigerator somewhere (average for sperm banking runs around $1,000 for the initial appointment and $250 per year for storage).

In some cases, that reversal might not even be necessary.

As far back as the 1940s, plenty of women have gotten pregnant via the low-tech intrauterine insemination (IUI)—aka "turkey baster" approach— no hormones or surgeries required.

Famed chemist Carl Djerassi, best known as the "Father of the birth control pill," envisioned a day when young men routinely froze their sperm and got vasectomies, sex could be just for fun, and babies could be conceived via artificial insemination, whether the couple was fertile or not.

"Fertile male sperm has already been preserved inexpensively for years," he said in an interview with The Telegraph before his 2015 death. "Provided one first demonstrated that such storage is possible for several decades rather than just years, many young men might consider early vasectomy as a viable alternative to effective birth control."

In recent years, message boards on Reddit have been lighting up with posts from young would-be-in-the-distant-future fathers considering the snip. "As an 18-year-old man, the smartest decision I can make with my body right now is to have a vasectomy," proclaimed one user in a post that garnered hundreds of responses.

"I have a large amount of savings, I plan on building my wealth, I'm just about to start my career, and I do not want an unwanted pregnancy to destroy everything I've worked to create," said another post by a recent college grad planning on getting his sperm frozen and having a vasectomy.

Five years from now, guys might not have to go to such great lengths. Earlier this year, Lissner and scientists at the University of California Davis published a paper showing that Vasalgel, when injected into the vasa deferentia of 16 adult rhesus monkeys, effectively prevented them from impregnating their mates when housed with three to six females over two breeding seasons. "It worked like nobody's business," says Lissner, who is now moving on to animal trials to see if sterilization can be reversed by washing the polymer out.

Meanwhile, a biotech startup called Contraline (of which Turek is a medical advisor) is rushing to get a similar product to market. Company founder Kevin Eisenfrats, a 23-year-old University of Virginia grad who wrote his college essay about the dearth of reliable male contraception, says his approach would be even less invasive than vasectomy or Vasalgel, requiring no incision in the scrotum at all. Instead, doctors would use a needle guided by ultrasound to inject a polymer called Echo-V into the vas. "It would be quick, like getting a flu shot," he says. His goal is to be FDA approved by 2021.

That revolution will come far too late for the Wades who, over the years, have spent well over $20,000 on procedures plus travel (to Tacoma, WA, for his first reversal, and to Turek in California for his second). But they have no regrets.

Today, they're enjoying springtime in Alaska, hiking, hunting and fishing with their two sons, now 16 and 8 and sneaking off when they can to try to conceive that little girl. "If it happens, it happens—it was meant to be," Shari says. "We're just going with the flow."