Some men and women choose sterilization to prevent pregnancy
By Meredith Holt
Forum News Service
MOORHEAD, Minn. – For the majority of their relationship, Lukas Brandon’s wife was the “birth controller.”
But after a failed IUD and problems with birth control pills, he decided it was time for him to take control, says the 35-year-old Moorhead father of two.
“I had been talking for years about how there is a need for a male equivalent of birth control pills, but barring that, vasectomies are about the only way for a man to actively control whether or not he fathers a child,” he says.
The couple agreed that two children was the right number for them and that their family was complete. The next step, they decided, was a vasectomy.
Sanford Health Drs. Jason Myrmoe and Jordan Coauette say sterilization procedures are fairly common in the Fargo-Moorhead area.
Myrmoe, a family physician, does four vasectomies a week and usually books out about a month in advance; more are done in urology. OB-GYN Coauette says in her department, multiple tubal ligations are done a day.
“Tubal ligations and vasectomies are the two most common forms of sort of permanent sterilization because they’re very low risk, they’re easy to do, and they’re highly effective,” Myrmoe says.
And most people, the doctors say, choose to have them done because they either don’t want to have children, or, like Brandon, they know they’re done having children.
But they have to be 100 percent sure.
“With these, once it’s done, you’re done,” Myrmoe says.
Brandon, who had the procedure done shortly before his 32nd birthday, says he has no regrets about having a vasectomy.
“It’s a relief to feel ‘complete’ reproductively and to know my partner supports me in that decision,” he says.
Myrmoe says vasectomies can be done at any age, but most of his patients are in their 30s and 40s.
He says most men, though they have questions, have already made up their minds to have a vasectomy by the time they come in to see him.
“Guys, as a general rule, don’t like to go to doctors,” he says. “And so getting men to come in to a physician is difficult, but then to come in for this type of procedure is much more difficult, given the location and what’s going to be done.”
Most are primarily concerned about how long it will take to recover and if their sex lives will be affected (they won’t).
With any surgery comes the risk of bleeding, but Myrmoe says since there aren’t any major blood vessels in the scrotum, it rarely happens.
The biggest risk comes from trying to do too much too quickly, he says. That’s when men end up with painful swelling.
“It is a fairly minimally invasive surgery, but given its location, any kind of heavy straining or lifting, or even just working out, can put a lot of pressure in the groin and result in some complications,” he says.
So recovery time largely depends on how well the patient follows doctor’s orders.
Brandon describes his post-vasectomy pain as “a real fundamental hurt” and says he didn’t gain his strength back until Day 5.
But when a friend asked him if he’d do it all over again, his answer was easy: “Yes, yes I would. Two kids is enough, and since I’m still waiting on a male birth control pill, surgery is the way to go.”
Patients are counseled to use a backup method of birth control in the first three months after surgery because sperm can remain in the vas deferens.
Myrmoe says the success rate of reversals varies and some men can develop “sperm antibodies.”
“Basically, your body thinks your sperm is like a virus or a bacteria, and so it can end up attacking the sperm, and then the sperm ‘health’ can be compromised,” he says.
OB-GYN Coauette says most women request sterilization procedures for the same reason as men – they know they’re done having children – and they want one less thing to worry about.
“They want something reliable they don’t have to think about once it’s done,” she says.
For women, there are three ways to get a tubal ligation:
-- Surgically, during a C-section or right after a vaginal delivery.
-- Surgically, through the belly button.
-- With a new outpatient procedure in which coils are placed in the uterus through the cervix.
“It’s quick, it’s fast, you can go back to work,” she says of the third option, called Essure.
Coauette carefully goes over the options with her patients before they make their decision, adding that the informed consent process is even more critical with anything permanent.
“Studies have shown that women under 30 actually have a higher regret after a tubal ligation or any sterilization than women older than 30,” she says.
After a tubal ligation, some women complain that their periods are heavier.
“Well, it likely isn’t, it’s just that you’re not on any hormonal contraception anymore,” she says.
Coauette says, for the most part, tubal reversals (“re-tying” the tubes) are a thing of the past.
She says the overall rate of any pregnancy in five years after a reversal is 13 per 1,000.
“If your husband dies, if you get remarried, things like that, and you decide you want to restart your family, in-vitro fertilization would be your best option for getting pregnant,” she says.
Long-lasting, reversible methods of birth control available
FARGO – Lori Ellingson, a nurse practitioner with Fargo Cass Public Health, says women have become increasingly interested in long-term methods of birth control.
“By far, the pill is still the most popular method, but we have more and more each year that are really wanting to go the longer term,” she says.
Hormonal and nonhormonal implants are reliable (almost as effective as getting a tubal ligation, Ellingson says), cost-effective, reversible and not subject to user error like missing pills, she says.
“They’re care-free; they don’t have to take a pill every day, they don’t have to worry about coming in for a shot,” she says.
Ellingson says they’re appropriate for anyone who wants to delay a pregnancy and a good choice for women who are done having children but don’t want to take the permanent sterilization route.
Here, she outlines the three most popular forms of long-term birth control, in order of how long they can be used:
-- Nexplanon (www.nexplanon-usa.com) is a hormone-releasing implant that’s inserted in the upper arm. Can be removed at any time. Lasts: three years.
-- Mirena (www.mirena-us.com) is a flexible plastic intrauterine device, or IUD, that releases hormones. Can be removed at any time. Lasts: five years.
-- ParaGard (www.paragard.com) is a hormone-free intrauterine copper contraceptive. Can be removed at any time. Lasts: 10 years.
Ellingson says some health care providers are hesitant to place IUDs in women who’ve never been pregnant, but research shows it’s safe.
“We always discuss all of the risks and benefits very thoroughly beforehand so the woman can make a good informed decision whether that’s the right method for her,” she says.