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Every year about a million men around the world have vasectomies so their wives won't have to worry about contraception. Also every year about 10,000 men who have had vasectomies discover that the procedure was not successful when they get their partners pregnant.

Most men would be surprised to learn that vasectomy isn't usually intended to make men absolutely sterile. The objective of the procedure is not necessarily to make sure that men have absolutely no sperm in their semen.

Vasectomy is also considered successful when there are fewer than 100,000 non-motile (non-swimming) sperm in a 1 ml sample of the man's semen.

Doctors as a matter of procedure ask their patients to come in a few weeks after the surgery to give a semen sample so the lab can make sure it is free of semen. Fewer than 25 percent of men who have just had a vasectomy keep their follow-up appointments, especially if they are under 30, or they have large families already. As a result, in the small number of cases in which the procedure is unsuccessful, neither the man receiving the vasectomy not the doctor knows that the surgery was a failure until there is a pregnancy.

Because most vascetomies are at least partially successful, the chances of pregnancy are just reduced, not eliminated.

Women cannot become pregnant except for one to five days just after ovulation, so most sexual intercourse will not have been timed so that there could be a pregnancy. Add to that most of the man's sperm won't have the flagella they need to travel up the cervix into the uterus to the opening of the fallopian tube to meet the just-released egg. However, sooner or later, just one sperm will have both the necessary swimming apparatus and ideal conditions to fertilize an egg, and pregnancy will result, if the success of the surgery is not confirmed by a semen sample donated a few weeks after the procedure.

When men don't keep their followup appointments, usually it's because they have a sense that somehow they are limiting their sex lives by having a vasectomy. Survey researchers have found that the opposite is really the case. On average, men have intercourse one to two times more often after vasectomy than before. A vasectomy absolutely is not the end of a man's sex life, but some men just don't want to find out.

What about reversing vasectomy?

Vasovasostomy and vasoepididymostomy are two procedures designed to bypass obstructions in the male genital tract. They can relieve pain in elderly men who have a problem with swollen testicles, or they can bypass the obstruction in the vas deferens, the tube that conducts sperm out of the testes to the prostate, hat was left by vasectomy.

Reversing vasectomy is a complicated procedure. The doctor will first biopsy the testes, the sperm-producing sacs in the testicles, to make sure there is still active sperm production. The doctor may do this the same day as the operation, getting test results back in just a few minutes, to avoid forming scar tissue that could interfere with the reconnection surgery.

The success of surgery to reverse vasectomy depends a great deal on how long it has been since the vasectomy has been performed. When the vasectomy was done three years or less before reversal is attempted, 97 percent of men recover their fertility and 76 percent of couples get pregnant. When the vasectomy was done fifteen years or more before the reversal, 75 percent of men recover their fertility but only 30 percent of couples get pregnant, largely because it is harder to get pregnant after the age of 35 due to changes in the viability of both sperm and egg. When vasectomy cannot be reversed, sperm aspiration from the testes may be used for IVF.

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