Could vasectomies be the next big thing in temporary contraception?

Vasectomy has always been thought of as a permanent form of contraception, which is accurate—except that vasectomies can be reversed based on a large body of historical data.

“Standard of care is to go into a vasectomy talking with patients about it being permanent,” said Ajay. K. Nangia, MBBS, FACS, professor and vice chair of urology at the University of Kansas Medical Center in Kansas City. “Yet, since the 1970s, we have been reversing them. How do we portray vasectomies truthfully to our patients, as permanent contraception that can be reversed successfully, with a pregnancy rate of 30% to 75%, but yet not temporary contraception 25% to 70% of the time?”

How to frame vasectomy is not a theoretical question of medical ethics, Dr. Nangia added. It is a dilemma for many urologists.

“Since Roe vs. Wade was overturned, I have seen a huge increase in my practice of men in their 30s and 40s who have no children asking for vasectomies,” he said. “I have had young men coming in telling me they want it done because they don’t want kids now and asking if it is reversible in case they change their minds later.”

Dr. Nangia will moderate a timely Crossfire debate, “Can Vasectomies Be Considered Temporary Contraception?” from 10 to 10:30 a.m. during the morning Plenary in Hall B1. One of the key issues is data. Most of studies cited for and against vasectomy as permanent/temporary contraception are decades old, Dr. Nangia noted.

Standards of care consider vasectomy as permanent contraception, he said. Reversal requires exacting microsurgery, currently costs more than $8,000 at most facilities and is generally not covered by insurance. At the same time, microsurgical techniques have improved since the surveys of vasectomy reversal were conducted a generation ago.

For vasectomies performed less than three years prior to reversal in the 1990s, about 75% were successful, based on pregnancy reports. For reversals performed more than 15 years post-vasectomy, success rates fell below 30%. That compares to greater than 99% reversibility for female oral contraceptives. 

The ideal contraceptive method would be 100% effective, 100% reversible and 100% without side effects, Dr. Nangia noted. Hormonal and implantable contraception for females comes closer than any currently available male contraceptive approaches.

Condoms have a 3% failure rate in perfect use and a 15% failure rate in typical use. A reversible hormonal male contraceptive is in Phase IIb trials, Dr. Nangia added, with results expected for late 2024 or into 2025. No male hormonal contraceptive has ever reached Phase III in the US.

‘This reversibility question has been around for years but has become pertinent since the loss of Roe protections,” Dr. Nangia said. “That decision brought into the open a question that we haven’t asked a lot, at least not in public forums. Our standards of care say vasectomy is permanent, yet we successfully reverse vasectomy on a regular basis. There are some very real questions about our standards of care and our actual conduct.”