How big Should Our Family Be?
June 1st, 2009 by Richard J. Alley
The decision to have children is one of the most sacred and important decisions two people can make. The thinking process should include the consideration of your lives as adults and whether a child or children will fit into that life. You have to question your flexibility and willingness to turn that currently childless life of yours upside down. Finances, education, coming decades of hands-on care, indeed the whole future should be re-imagined with children in it. The responsibility of another life is an awesome one.
The decision to not have children, or any more children, is equally important. Are two children enough? Three? Is one all we have the time and love for? Determining the number of people you envision in your family is Step One in deciding to become voluntarily sterile. How to get that way is a whole other discussion.
Know the facts
One method is a vasectomy. A vasectomy is a simple procedure normally done under local anesthetic by a urologist. A small incision is made in the scrotum which allows access to the vas deferens, the tubes that carry sperm from the testes to the urethra. The vas deferens are cut and either tied, stitched, or cauterized.
The procedure, which takes 10 to 15 minutes to complete, is done in the urologist’s office and is covered by most insurance plans for the cost of an office visit co-pay. For two to three days following the surgery, doctors recommend staying off your feet as much as possible, wearing an athletic supporter, and placing an ice pack or bag of frozen peas on the area to reduce swelling. Heavy lifting and exercise should also be avoided for one week.
Sterilization is not immediate, since there is a supply of sperm that must first dissipate. Until then, another form of birth control should be used. To insure sterility, you must take a specimen of semen to the doctor after a certain number of ejaculations to be tested for viable sperm.
How common is the procedure?
About half a million men undergo a vasectomy each year, which ends one’s ability to have children naturally. (You can have sperm placed in a sperm bank, which can be used for artificial insemination post-surgery.) While most men have valid concerns and are willing to be informed about the procedure and its effects, others choose to believe myths or concede to their own unfounded fears, namely that the procedure might effect one’s sex drive or the ability to have erections and orgasms.
The truth is, there is no difference in sexual libido or performance once the surgery is complete.
The operation, though effective, is not entirely risk-free. Dangers include infection, bruising and swelling at the site of the incision, or the appearance of a sperm granuloma, a small, harmless lump that may form where the vas deferens is sealed off. Long-term testicular discomfort may occur, but is very rare. There is also the fear, real or imagined, of a surprise reversal, another common myth.
“The likelihood is virtually zero that a vasectomy will reverse itself,” says Dr. Paul Eber, a urologist with the Conrad Pearson Clinic in Germantown, the Mid-South’s largest urology group.
And, though these risks and fears are important and should be discussed with your doctor, the truth is a vasectomy is a simpler affair than other forms of permanent sterilization, such as a tubal ligation, or getting one’s “tubes tied.” Tubal ligation is a form of birth control in which a woman’s fallopian tubes are severed, and is a much more invasive and costly procedure with a longer recovery time. Incidents of post-operative complications are also more likely with tubal ligation than with vasectomies.
Yet many men are reluctant to undergo the procedure.
“Men don’t want vasectomies because of perceived pain; they ‘know’ it’s going to impact erectile function, or a manly persona that says ‘there’s just no way I’m getting a vasectomy.’ Or, they just don’t want a doctor touching them ‘down there.’ There are so many falsehoods that prevent men from getting a vasectomy,” says Eber.
How simple a procedure is it normally? Eber tells his own story as a means to soothe his patients. His wife was pregnant with their fourth child when she called him at work to tell him he was having a vasectomy done that day. On his lunch break, he and a colleague went into one of the rooms, the procedure was done, and “I pulled up my shorts and pants and went into the next room with my next patient.”
Not that the odd mishap can’t happen. “They cut me with the scalpel before the locally administered anesthetic had worked. I nearly leapt off the table!” says Nigel Smith of his vasectomy.
Smith had one child and was 39 when he and his wife decided their family was complete. He had his vasectomy done in England, where he’s from, for free under the National Health System. Within a year, he and his wife separated. “I did wonder how the decision would affect future relationships,” he says. With his second wife, “the question of reversal was raised, but I have to say I really couldn’t anticipate that. I was 43 when we had the conversation and I really didn’t fancy starting the second family.”
A permanent means of birth control
While some reversals have been successful, a vasectomy should be considered a permanent means of birth control. “A vasectomy reversal would cost about $7,000 or $8,000 and there’s no guarantee; insurance won’t cover a reversal, either,” says Eber, who performed one of his group’s five reversals last year.
Chris C. and his wife, the parents of two children, were counseled by his doctor on the permanence, the possibility of reversal, and the option of banking sperm for the future. “We talked about having more, but everything just felt right so we decided I would have ‘the procedure.’ We didn’t really talk about any other methods. To me, it was just easier in the grand scheme of things to have a vasectomy,” he says.
The average age patient Eber sees is mid-30s. He counsels more strongly those with only one child and, though less prevalent, men with no children.
“I tell young parents that if your idea of a family is mom, dad, and two kids, then wait until your second newborn is out of the danger range for SIDS. It’s not a pleasant thing to think about, but thought should be given to it,” says Eber, who prefers same-day consultation and surgery.
According to a recent New York Times story, vasectomies typically rise during a down economy, when parents become more focused on the financial burden of child-rearing. However, the numbers in the first quarter of 2009 have been lower than last year, notes Eber, “Because of deductibles, elective surgeries are generally put off until later in the year and a slower first quarter would be normal.” The Conrad Pearson group of 13 doctors performed nearly 600 vasectomies last year, with Eber responsible for 92 of the surgeries.
“I’ve had brief moments when I doubted the decision, when I experience odd milestones in my children’s lives,” says Jerry Camp, who had his vasectomy at the age of 31 with three children. “I wonder what my next child might be like, but only for a moment and then the moment is gone.”
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