Vasectomy: Fessing Up to Failure

Posted on by Paul Turek, MD

Did you hear that Texas Longhorns star quarterback Shane Buechele revealed that he was born after his dad had a vasectomy? Tonight Show host Jimmy Fallon jumped on this, saying that “he was his very first quarterback sneak.”

Up the Middle

“What causes this?” you ask. Well, it’s complicated, and it isn’t. One reason vasectomies fail is because the two ends of the vas deferens get back together after the procedure. It really only has to happen on one side to cause trouble. This is called “recanalization” and is generally a technical (read surgical) issue and should occur in far fewer than 1% of cases. Characterized by a persistent sperm count after the procedure, it typically happens within a few months after the vasectomy, when the scar tissue created by the procedure is still soft enough for sperm to bore through it, to get to wherever it is that they need to go. Sneaky little fellows. The way to miminize this: choose your vasectomist wisely. Experience and skill matter a lot when it comes to the family jewels.

End Around

But there’s another reason for snip-slip-ups. This has more to do with operator-failure than a manufacturing defect. Basically, it’s a failure to follow directions! It takes about 90% of men 3 months to clear all of the residual sperm from the vasal tubing after a vasectomy. Theoretically, 25-30 ejaculates should do it. Hard to believe, but the “pump” within the system is inefficient at getting sperm out quickly and so perfectly happy, motile sperm can come out for weeks after a vasectomy. Have unprotected sex too early after the procedure, and bam, knocked up all over again.

Hail Mary Pass

Here’s a case in which I took advantage of the slow clearance curve of sperm after vasectomy. A young man came to see me in the office for a vasectomy reversal. He regretted having the vasectomy, as he wanted more kids. When I asked him if he could remember when he had the vasectomy, he paused, gazed up at the ceiling, looked back at me and quietly said: “Last Wednesday.”
Knowing the physiology, I suggested an alternative to a vasectomy reversal. “Why don’t you bank some ejaculated sperm? It’ll be there for weeks.” And that is precisely what he did, and happily too as he avoided the knife.
So, remember these little tidbits of biology as you consider getting your wings clipped. Keep the bang but not the bite.