Can vasectomy come undone? Not exactly.
A vasectomy can fail but it is not because the tubes come ‘undone’. Vasectomy fails because the tubes can reconnect.
What is the vasectomy failure rate? It depends. A vasectomy failure rate depends on the methods used during the vasectomy.
A vasectomy cannot come undone like tied shoe laces but the ends of the vas deferens can rejoin under certain situations.
Older vasectomy methods such as tying and cutting the vas deferens tubes can have failure rates as high as 10% !
Newer vasectomy methods, like His Choice No Cut Vasectomy, can have failure rates as low as 0.05%.
No matter what method is used you will never have a zero percent chance of failure. Vasectomy failure is always possible because no birth control method is absolutely 100% effective.
Older vasectomy techniques like cutting and tying small portions of the tubes have been observed to have persistent sperm getting across the vasectomy sites in as many as 1 out of 10 patients.
One previous medical study examined men who were having vasectomy reversal surgery to become pregnant. This study found that 10% of patients had small amounts of sperm in their semen samples before reversal study. This study proved vasectomy occlusive failure (tubes not fully healing closed) was higher than most believed. Most of these occlusive failures were the result of older vasectomy methods of cutting and tying the tubes.
These older vasectomy methods are responsible for many of the stories we hear about vasectomies failing.
More modern methods of vasectomy using coagulation (burning), mucosal cautery (burning inside of the tubes), and fascial interposition (diverging the two cut ends) can give some of the lowest risks of vasectomy failure when compared to older vasectomy techniques.
If you have asked yourself can vasectomy come undone then keep reading and we will explain why some patients have vasectomy failure.
Older vasectomy methods, higher failure rates!
Traditional, also referred to as conventional vasectomy, was one of the first vasectomy methods. This method continue to be performed today.
Conventional vasectomy usually involves using a scalpel to make a small incision on each side of the scrotum.
How a doctor gets through the scrotal skin does not have any effect on the vasectomy failure rate.
The skin incision is a cosmetic issue because scalpel skin incisions are larger and require sutures to close. These incision look uglier after they heal. These incisions are also associated with a higher risk of pain and infection after vasectomy.
How a doctor divides the vas deferens tubes greatly influences the chance of vasectomy failure.
During a conventional scalpel vasectomy, once the doctor gets through the scrotal skin they will tie off a once inch section of the tube and then cut out the section between the sutures. This is called ligation (tying) and resection (remove by cutting).
This older technique has been observed to have up to a 10% failure rate. Failure does not always mean pregnancy…but with these older vasectomies some patients may have up to a 10% occlusive failure rate. This means the technique was not exactly good enough to cause 100% occlusion of the vas deferens tubes.
A 10% occlusive failure rate does not directly translate into a 10% chance of pregnancy….but it does show sperm can get through these vasectomy sites more commonly than one might think.
Although it takes sperm in large numbers to have a reasonable chance of pregnancy, we all know it only takes one hardy sperm to cause pregnancy!
Why are the older techniques still being performed?
The two simplest answers to explain why doctors continue to use older techniques are:
- Most doctors are comfortable using methods they were originally taught. Why reinvent the wheel and increase your risk of complications when you start a new learning curve?
- Many of these doctors are not doing enough vasectomy procedures to notice small differences in failure rates.
If a vasectomy technique has a failure rate of 0.5% (5 out of 1000) then you have to do a lot of vasectomies to notice these failures.
If a method has a 0.5% failure rate, a doctor who performs 300 vasectomy procedures may observe a failure every 1 to 2 years.
On the other hand, a doctor who performs 1000 vasectomy procedures per year may observe up to 5 vasectomy failures each year.
The perception of the lower volume doctor is that vasectomy failures are not common. The perception of the higher volume doctor is that vasectomy failures are more common. The higher volume vasectomy doctors will have 5 painful conversations with 5 upset patients every year, whereas the other doctor has fewer painful conversations over a longer period of time. The failure rates are the same but the perceptions are different.
What is the vasectomy failure rate?
When you discuss failure rates of vasectomy you need to know the vasectomy method and the time in which the failure was diagnosed (early or late).
If you are a statistics kind of person and want to know what is the vasectomy failure rate of all the different vasectomy techniques then we encourage you to read the 2015 American Urological Associate Vasectomy Guidelines.
If you review the data on vasectomy failure rates provided by the American Urological Association you will clearly see that the ligation and resection methods have much higher failure rates in studies ranging from 0% to 13%. In these studies the tubes were closed with a variety of methods ranging from suture to clips.
His Choice No Cut Vasectomy is a modern, no scalpel, minimally invasive vasectomy technique.
Instead of tying and cutting, the His Choice vasectomy method:
- Uses coagulation to divide each tube
- Mucosal cautery (lightly burning the inside of the top divided portion of the vas deferens)
- Fascial interposition of the lower cut end of the vas deferens (diverting the two cut ends away from each other so they don’t reconnect as easily)
- Open end technique on the lower end (no sudden increase in epididymis immediately after vasectomy)
Early failure rate. The vasectomy failure rate with the techniques used in the His Choice vasectomy method is approximately 0.3% (3 out of 1000 patients) in the first three months.
Late failure rate. Once the after vasectomy semen sample confirms the absence of sperm then the chance of a later vasectomy failure drops to approximately 0.05% (5 out of 10,000 patients).
His Choice vasectomy is extremely reliable once the three month after vasectomy semen sample confirms a negative sample. Although this late failure rate is low even the His Choice Vasectomy method not 100% effective.
No method is 100% perfect…but we can get you pretty darn close to perfection!
Why do vasectomies fail?
Why do vasectomies fail? There are two reasons vasectomies fail.
Vasectomies fail because people fail. Vasectomies fail because the cut tubes can rejoin through a process known as recanalization.
- Patient noncompliance
- Reconnection of the vas deferens
Patient noncompliance. Most vasectomy ‘failures’ resulting in pregnancies happen within the first 3 months of the vasectomy procedure because patients do not always follow after vasectomy instructions to continue using birth control until we have proved the vasectomy has worked with a semen sample test.
Many patients will become lax in their use of birth control immediately after their vasectomy. These patients either do not understand (despite our great patient education) or they discount the fact there are millions of live sperm above the vasectomy sites. This is the most common reason why pregnancy happens soon after a vasectomy procedure.
Vas deferens recanalization. Recanalization is when the sperm flow is restored through the area of the vasectomy site. It is when flow resumes from the lower to the upper end.
Remember the famous line in the movie Jurassic Park, “Life will find a way…”
If recanalization happens it is usually within the first 3 months of the vasectomy but a small number of recanalization vasectomy failures can happen 12 months or more after vasectomy.
Vasectomy failure: Noncompliance is most common reason
The most common reason for ‘vasectomy failure’ is patient noncompliance. Noncompliance is the medical term for not listening to medical instructions. It is what you might call “being a knuckle head”.
There are millions of live sperm stored inside the pelvis above the vasectomy sites. Even after a successful vasectomy, patients have live sperm stored above the vasectomy sites and inside enlarged portions of the vas deferens behind the prostate.
These sperm will remain there until they spill out into the urine, slowly die and get resorbed, or are released with ejaculation.
There are millions of stored sperm. Some are healthy and motile. Some are healthy but sluggish. Some are deformed and do not swim well or may not swim at all. Many sperm are dead and adherent to the walls of the vas deferens.
Most of the healthy, motile sperm will be evacuated by ejaculation within the first six (6) weeks of the vasectomy procedure. These are the sperm that can cause pregnancy soon after vasectomy.
Many pregnancies after vasectomy are caused within the first 3 months from live healthy sperm above the vasectomy sites. This is the most common reason for pregnancy after vasectomy.
We strongly recommend you use an effective form of birth control after your vasectomy procedure until semen sample testing confirms the absence of motile sperm.
Vasectomy failure: Early occlusive failure is second reason
Technically a vasectomy does not come ‘undone’ but the tubes can rejoin in the right circumstances.
When most people think of something coming undone after a vasectomy…they usually think of the clips or suture coming off the tubes and the tubes spontaneously coming open. It is not quite so simple. Vasectomies don’t fail by coming undone…instead they fail by recanalization.
If recanalization is going to happen it will most often happen during active healing within the first 3 months of a vasectomy.
This occurs when the upper and lower ends come back into alignment after the vasectomy. The body responds to tissue damage from the vasectomy with healing tissue. The medical term for early healing tissue is granulation tissue.
After vasectomy, the testicles continue to make sperm. These sperm escape the lower end and create small channels through the granulation tissue. If these channels connect to the upper vas deferens sperm flow can be restored. This reconnection can result in live sperm getting across the vasectomy site.
Restored channels through granulation tissue that successfully reconnects to the upper end is why this process is called recanalization.
As time passes after the vasectomy, soft granulation tissue is gradually replaced with more solid, longer lasting collagen fibers (scar tissue).
Sperm have a much harder time causing recanalization through the more durable collagen fibers. This is why late vasectomy occlusive failures are less common.
Can vasectomy come undone? Think of trapped miners
A helpful analogy is to consider sperm to be like miners trapped in a collapsed tunnel. As soon as the tunnel collapses, the miners will start digging to find their way out. Many will not make it…but a lucky few may be able to create small escape passages to the outside world.
Can a collapsed mine come undone? No…but the collapsed mine can be repaired.
Time is of the essence. The best chance for the miners to escape is within hours to days of the tunnel collapse. The longer they take to find an exit then their chance of survival will decrease because they will run out of food and air. As more time passes, the chances of escape rapidly decreases. The same is true after vasectomy.
This is why the most likely time for occlusive vasectomy failure (reconnection) is within the first 3 months of having a vasectomy.
Providers who perform traditional vasectomy and simply remove a section of the vas deferens are not understanding and accounting for the ability of sperm to be able to penetrate the early healing tissue and establish a reconnection. This is why the His Choice method uses mucosal coagulation of the upper end and diversion of the two cut ends. Both the burning and the diversion minimize the risk of failure.
Early occlusive failures are diagnosed when a patient reports pregnancy soon after vasectomy and the 3 month after vasectomy semen sample shows motile sperm. You should not have live, moving sperm in your semen sample 3 months after vasectomy.
The chance of early vasectomy failure after a His Choice Vasectomy is 0.3% or 3 out of every 1000 patients. Most of these early pregnancies are because patients prematurely stopped using birth control. Some of these early pregnancies are due to early occlusive vasectomy failure.
Vasectomy failure: Third reason late occlusive failure
Late occlusive failure is defined as the presence of any motile (living, moving) sperm twelve (12) months or more after a vasectomy procedure. The chance of a late vasectomy failure with the His Choice vasectomy method is 0.05%.
Late occlusive failure can occur because of small, early reconnections that were not detected by semen analysis or because of the development of a late reconnection.
Small early reconnections. Most occlusive failures can be diagnosed with today’s modern testing methods because when the vas deferens tubes do reconnect you will usually get large numbers of motile sperm getting across the vasectomy sites. It is theoretically possible that sperm in very small numbers could be crossing the vasectomy site and these sperm can be hard to detect when in low numbers.
Late reconnections. Late reconnections are also possible but not as common as early reconnections.
Most reconnections happen within the first 3 months of the vasectomy procedure. The soft, granulation tissue that forms immediately after a vasectomy procedure is gradually replaced by more solid, collagen containing scar tissue. The sperm have a much harder time penetrating this collagen containing scar tissue. So if they are going to ‘break through’ it is usually in the first several months of the vasectomy procedure.
Once a three month after vasectomy semen sample confirms the absence of motile sperm, the chance of late occlusive vasectomy failure after His Choice Vasectomy decreases to 0.05% … or 5 out of every 10,000 patients.
Late vasectomy failures are usually diagnosed by a confirmed pregnancy 12 months or more after the vasectomy procedure.
Many of the patients who have late vasectomy failures will show motile sperm in their semen sample test. Amazingly some of the patients who have late vasectomy failure will not have detectable sperm in their semen sample.
Semen sample testing is not as accurate as most people believe for detecting sperm in small amounts.
How many semen sample test after vasectomy?
The answer depends on what technique was used for your vasectomy.
If you had ligation and resection vasectomy then you may need several test to confirm your vasectomy was successful.
If you have had a His Choice Vasectomy then you only need one well timed after vasectomy semen sample test 3 months or more after your vasectomy.
We recommend one after vasectomy semen sample test after vasectomy. The key is waiting for approximately 3 months before having the semen tested.
- We recommend waiting at least three (3) months after vasectomy
- You also need to have a minimum of twenty (20) ejaculations over the 3 months
- Both conditions have to happen
Why do some doctors recommend multiple semen sample test?
Some vasectomy providers recommend a minimum of two semen sample tests after vasectomy. A few may perform 3 or 4 semen samples after vasectomy.
Most providers who recommend performing multiple semen sample test after vasectomy use older vasectomy techniques associated with higher vasectomy failure rates. Some of these older, conventional vasectomy techniques can result in vasectomy occlusive failure in up to 9% of patients.
Even if these providers are not using older techniques many of them have been adversely influenced by their recollections or experience with vasectomy failures resulting from older vasectomy techniques.
Providers who perform these techniques may experience more failures and may be more hyper-vigilant about testing. This is why they continue to recommend multiple semen sample test.
With His Choice vasectomy you can be reassured your vasectomy has worked as intended if your 3 month semen sample show the absence of motile sperm.
Most vasectomy occlusive failures will happen within the first 3 months of having a vasectomy. Most of these occlusive failures will result in live sperm getting across the vasectomy sites.
One single test is all that is required for most patients to prove a His Choice Vasectomy was effective. If your 3 month after vasectomy semen sample is negative for motile sperm your chances of causing pregnancy in the future are extremely low.
Worried about vasectomy failure?
If patients are worried about vasectomy failure then we recommend you use any of the commercially available over the counter after vasectomy testing kits.
A commonly available FDA approved home testing kit is SpermCheck vasectomy. This test can be ordered on Amazon and easily be performed in the privacy of your home. You dont even need a lab to interpret the results. You simply read the test results like you would a pregnancy test.
If you have had a His Choice Vasectomy, we want you to have confidence you have chosen one of the most effective methods of permanent birth control with a low rate of failure.
Once your 3 month after vasectomy semen sample confirms absence of sperm you can relax knowing you are using a highly effective method for prevention of pregnancy.
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