While vasectomy has long been thought of as permanent, ending your ability to have kids, this is clearly not the case for Jets quarterback Antonio Cromartie, who had twins last year with his wife Terricka, conceived well after his vasectomy a couple years ago. The couple found out about the pregnancy completely on accident one day when his wife went to the ER with a bad stomach. However, it was clearly not an issue for the footballer and they kept the baby. He’s now welcoming their 14th child into their home.
Why do vasectomies fail?
Vasectomy failure is the occurrence of pregnancy or failure to achieve azoospermia after a reasonable period of time following vasectomy. The positive result of Post Vasectomy Semen Analysis (PVSA) can be stressful for couples looking forward to anxiety-free intercourse, without the threat of pregnancy.
The most common reason is intercourse immediately after the vasectomy without protection. Even after the vas deferens (the tube that carries sperm) is cut and sealed, sperm will still be in the tube and it takes some time in order to ensure the vas is completely cleared out. Men typically have to ejaculate 20-25 times before all the sperm is gone. Unprotected sex before this time can definitely lead to unintentional pregnancy. This is the reason that you continue to use protection for three months after your vasectomy.
The second most likely, though less common, is recanalization failure. Actually, recanalization is the most common reason for technical failure in vasectomy, and it could happen even in a experienced surgeon. In vasectomies, the vas deferens is cut and the ends are blocked. Recanalization occurs when the sperm is still allowed to pass and go into the ejaculate. Sperm try and often succeed in penetrating through the end of the blocked vas. After a couple months of this, there can be many tiny holes in end of the vas deferens where sperm may flow out through pseudo channels.
Recanalization following vasectomy should be suspected if motile sperms or rising sperm concentrations are seen after a initial or routine PVSA has shown azoospermia or Rare Non-motile Sperms (RNMS). Recanalization can be either transient or persistent based on the results of serial PVSAs. Pregnancy due to recanalization is estimated to occur after approximately 1 in 2000 vasectomies or less often. The incidence of recanalization is very likely greater than the reported rate of pregnancy after post-vasectomy azoospermia because not all recanalizations result in pregnancy.
About half of the recanalizations will close (seal by scarrring) by itself in 6 months and contraceptive success will be achieved, the patients don’t need to repeat vasectomy. Other 50% patients who have persistent recanalization need to repeat vasectomy.
The third and least common is technical failure resulting from a surgical error such as occluding one vas twice without occluding the other vas or failure to identify the very rare situation of vas duplication on one side. An extra vas is a very rare condition. Very occationally, the wrong tube (unusual large blood vessels) can be mistakenly blocked. Technical failure is characterized by persistently normal or nearly normal motile sperm counts and sperm motility after vasectomy, as if the procedure was never done! It happens more often in a inexperienced family physicians or surgeons.
It is recommended to get sperm tested three months after the vasectomy to ensure that it worked. But our patients usually don’t need to have a semen analysis periodically if the vasectomy performed in our clinic is confirmed to be successful. Dr. Shu has performed about 1500 cases of vasectomies, all of them being successful!
Vasectomy is a big life decision. It is important to know if the vasectomy was successful or not, so get your sperm tested after your vasectomy!