Vasectomy

See also Male Infertility.

The procedure

Division and occlusion of both vas deferens, usually as a day procedure under local anaesthetic. The no-scalpel technique (a small puncture rather than an incision) is now the standard approach in most practices, associated with less bleeding, pain, and complications than the traditional incisional technique. Some GPs perform vasectomy themselves after specific training; otherwise refer to a GP proceduralist or urologist.

Counselling before referral should cover:

• Vasectomy should be considered permanent — while reversal is possible (below), success isn’t guaranteed and reversal surgery is not MBS-rebated/PBS-subsidised in the same way as the original procedure.
• Not immediately effective — sperm can persist in the proximal vas/seminal vesicles for weeks to months. Continue other contraception until clearance is confirmed.
• Post-vasectomy semen analysis (PVSA) confirms azoospermia (or rare non-motile sperm below the accepted threshold) — timing and protocol vary by provider, but is typically checked at least 8–12 weeks post-procedure and after a minimum number of ejaculations; do not rely on the procedure alone without confirmatory testing.
• Failure rate is low (roughly 1 in 2,000 after a confirmed clear PVSA) but not zero.
• Small risks of bleeding, infection, haematoma, and chronic post-vasectomy pain (uncommon, but should be mentioned).
• Does not affect testosterone production, libido, or erectile function.

Vasectomy reversal

Relevant to discuss with any patient considering vasectomy, since regret and changed circumstances (new partner, loss of a child) are not rare reasons for later reversal requests.

• Vasovasostomy (reconnecting the cut ends) is usually possible; vasoepididymostomy (a more complex bypass procedure) is needed more often as the interval since vasectomy lengthens, reflecting secondary epididymal blockage over time.
• Patency (return of sperm to the ejaculate) remains achievable in a substantial majority even after a long interval — collated Australian data suggest roughly 82% of patients regain sperm in the ejaculate even after more than 10 years, though pregnancy rates are lower than patency rates and decline further with time, partly reflecting age-related female fertility decline over the same interval.
• Microsurgical technique is the standard for reversal, and outcomes are meaningfully better with a urologist subspecialised in male reproductive microsurgery — refer accordingly rather than to a general urology list.
• Reversal is a significant out-of-pocket cost in Australia in most cases; couples should be counselled that IVF/ICSI with surgical sperm retrieval (see Male Infertility) is an alternative path to conception that doesn’t depend on reversal succeeding.