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THE HEALTHY MAN

A Way Men Can Take Charge of Birth Control

September 11, 2000|Timothy Gower

Scientists in Great Britain may soon bring about a revolution in contraception: the male birth control pill. In July, a team of researchers at Edinburgh University reported on a study involving 60 men in Scotland and China who were given a special hormone pill once a day. After six months, the men were 100% infertile, not a single sperm cell to be found among them, with no side effects.

Don't bother asking your doctor about the "male pill" any time soon, however. The drug will need to be tested in large groups of men before it can be approved by the U.S. Food and Drug Administration. Give it at least five years, observers say. Until then, however, your doctor can tell you about another very effective birth-control option. I refer, of course, to that old snip-and-tuck procedure known as the vasectomy.

Each year, about a half million U.S. men undergo this surgery, according to AVSC International, a New York-based organization that promotes family planning. To avoid sterilizing a fellow who will end up regretting the decision, most surgeons conduct a brief interview with the candidate before consenting to perform the procedure.

"I like my guys to have at least a couple of children and be 30 years old or more," says Dr. Arnold Belker, a professor of urology at the University of Louisville School of Medicine in Kentucky. If a guy doesn't fit Belker's criteria, he says, the candidate "has to convince me he has some reason that those criteria shouldn't apply to him." Different doctors, of course, may have different criteria.

The vasectomy gets its name from the vas deferens, a tube about the width of a window blind cord, which delivers sperm from the testis to the prostate, where those microscopic reproductive cells mix with semen and other fluids. (Each of a man's two testes has its own vas deferens.)

A surgeon first injects a local anesthetic into the scrotum. (Quit flinching--according to Belker, the sensation is no worse than a mosquito bite.) Once the scrotum is numb, the surgeon makes a small opening in the flesh. Scalpels used to be the tool of choice for creating the opening, but today, many surgeons perform the "no-scalpel vasectomy," a technique imported from China. Instead of a blade, a surgical tool is used to make a tiny puncture in the scrotum. Since there's no incision, stitches aren't necessary and men feel less pain. Using a special clamp, the doctor reaches in and brings the vas deferens to the opening. The tube is then snipped in half, shutting down the pipeline to the prostate.

Before tucking the vas deferens back into place, the surgeon first closes each end of the newly severed tube. Some doctors use a ligature to pinch the open ends shut. Belker prefers to cauterize the ends, which he says appears to reduce the risk of sperm leak--which, he notes, could eventually cause the two tube ends to fuse back together.

Since a vasectomy does not stop sperm production, a guy who thinks he's shooting blanks could suddenly be rearmed with live ammo. The odds of a "spontaneous reconnection" are only about one in 2,000 or even higher, says Belker. But while the chances that a man with a vasectomy will impregnate a woman are extremely low, he adds, "it's real. It can happen. There's no way anyone doing a vasectomy could or should guarantee that the patient will forever be sterile."

Vasectomies are performed on an outpatient basis and usually require only about 20 minutes. Many clinics schedule them for Fridays, since men are sent home with orders to take it easy for a few days. They're also told to wear a jock for a week for added support during recovery, and to avoid sex for the same period. Most important, the patient receives a red-letter warning: You aren't sterile yet. Unprotected sex can still lead to pregnancy until all the sperm is cleared from the segment of the vas deferens that remains connected to the prostate. It usually takes about four months, says Belker, but patients need to submit semen samples "until we tell them they're sperm-free."

Some men take longer than others to clear their tubes. "My record holder," says Belker with just a hint of awe in his voice, "took 13 months before his sperm finally disappeared."

Then again, men who have had vasectomies occasionally decide they want their sperm to reappear, usually because they remarry. Belker is one of the country's leading authorities on vasectomy reversal. Don't be too impressed by ads for clinics that use newfangled laser techniques to perform reversals, he warns, because there's no evidence that they work any better than microsurgery methods that have been around for a few decades.

Likewise, the procedure isn't a guarantee of renewed fertility. On average, slightly more than half of all men who have their tubes reconnected are able to impregnate their partners, and the odds diminish the longer you wait. Which is why Belker counsels men to think of a vasectomy as permanent--not as "turn it off today, turn it back on tomorrow," he says.

*

Massachusetts freelance writer Timothy Gower is the author of "Staying at the Top of Your Game" (Avon Books, 1999). He can be reached at tgower@mediaone.net. The Healthy Man runs the second Monday of the month.

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