Vasectomies are a safe and effective form of birth control, and they’re more common than you might think — more than 500,000 are performed each year. While vasectomies are permanent forms of birth control, life happens and plans can change. After a vasectomy, men have two main options if they want to continue building their families: a vasectomy reversal, or IVF with surgical sperm retrieval. 

What’s a vasectomy?

It’s an outpatient procedure where a urologist cuts and cauterizes or ties the ends of the vas deferens, or the tubes that carry sperm, to prevent sperm from mixing with semen. The procedure is short, doesn’t require patients to go under anesthesia, and for most people, the recovery time is about 2 days.

How soon does a vasectomy go into effect as birth control?

A vasectomy isn’t immediately effective, and it’s important to use contraception until your follow-up appointment and semen test, usually scheduled three months after the procedure. This is because sperm can remain in the vas deferens for a long time — weeks or even months — and it’s still possible to get pregnant through unprotected sex during that window. Once the results of the test show that there’s no sperm in the semen, you’re good to go.

Does a vasectomy protect against STIs?

No. Semen can still carry STIs, even if there isn’t sperm in it.

Does a man still produce sperm after a vasectomy?

Yes. A vasectomy doesn’t impact the testes, and they’ll still produce sperm — it’s just that the sperm won’t make its way into semen.

What happens when a man ejaculates after a vasectomy?

He still ejaculates and can orgasm the same way he did before his vasectomy. However, after those three months post-procedure, his ejaculate won’t contain sperm. Instead, the sperm will break down and be absorbed by his body. And, in case anyone’s wondering, the Cleveland Clinic notes that a vasectomy doesn’t impact the amount of semen produced or the way it tastes. 

Does insurance cover a vasectomy?

Generally, yes. Most insurance plans cover vasectomies. One interesting (and frustrating) point to note: some younger people seeking vasectomies or tubal ligations have reported getting pushback from their doctors because of their ages.

What if you change your mind after a vasectomy and want to be able to get your partner pregnant again?

First things first: You’re not alone. Stanford estimates that 30,000 men per year change their minds and undergo a reversal procedure.

There are two main options if you want to use your own sperm — a vasectomy reversal and IVF with surgical sperm removal — and even more options if you’re open to adopting a child or using donor sperm. 

In a vasectomy reversal, the urologist reconnects the ends of the vas deferens so that sperm can pass through once again. It can take a few months for sperm to appear in semen again, but after that, it’s possible for couples to become pregnant after penetrative sex. 

In a surgical sperm retrieval, a doctor inserts a needle into the testicle to remove sperm and a small amount of tissue. When the retrieval is done in conjunction with IVF, it’s typically done on the same day as the egg retrieval, so that the sperm and egg can be joined in the lab without being frozen first. An embryologist will select the best quality sperm and inject it directly into the egg (a procedure called ICSI) in hopes of creating a healthy embryo. From there, the embryos will grow in the lab and can be transferred to the uterus or frozen and stored for later use. 

What are the pros and cons of vasectomy reversals and surgical sperm retrievals?

Pros of a vasectomy reversal

-You can often work with the same doctor you saw for your vasectomy

-It’s less expensive than a cycle of IVF

Cons of a vasectomy reversal

-Most insurance companies won’t cover a vasectomy reversal, and depending on where you live, it can cost between $5,000–$15,000 out of pocket

-While the results are generally very good, there’s always a risk that the reversal won’t work

-Once you’ve finished building your family, you may need to have a second vasectomy to prevent future pregnancies

Similarities between vasectomy reversal and surgical sperm retrieval

-Results are generally very good for both procedures, and eventual live birth results are comparable

-In most cases, both procedures can be done in a doctor’s office with local anesthesia, so you’ll be awake the whole time and can go home the same day

-Recovery times are short for both procedures 

Pros of surgical sperm retrieval

-Study participants said that surgical sperm retrieval was less painful than a vasectomy or a vasectomy reversal, and that the recovery time was shorter

-Sperm retrieved can be cryopreserved and stored for later use if you’re considering having more than one child through IVF

Cons of surgical sperm retrieval

-There’s no guarantee that the retrieved sperm will result in healthy embryos, even if both the egg and sperm are high quality

-When it’s combined with IVF (and cryopreservation, if you decide to store the rest of of the retrieved sperm), it’s more expensive than a vasectomy reversal

-Insurance coverage for surgical sperm retrieval depends on your plan, and many don’t cover it right now

Wrapping up

While people get vasectomies as permanent birth control, many change their minds and seek ways to reverse or work around the vasectomy. Vasectomy reversals and surgical sperm removals are both common, safe, and effective, but they’re often expensive and aren’t covered by insurance. If you’re considering your options, get in touch with the urologist that did your vasectomy.

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