The myth of reliable vasectomy reversal is selling us a half-truth.
It’s Men’s Health Week at Playboy and we’re exploring the increasingly DIY state of men’s healthcare. From the peptides ruling Hollywood to the Reddit forums replacing doctors, men are taking their health into their own hands. Here’s what you need to know.
Since the Supreme Court overturned Roe v. Wade, opening the door to waves of anti-abortion legislation across the US, thinkpieces and social media posts have promoted vasectomies as a way to balance out (at least a little) the gendered burden of contraception. “All men should get a vasectomy,” some said, claiming that the procedure is safe, easy, and reversible—a slam dunk for men who want to protect their partners from unwanted pregnancy, but who still may want to have children in the future. In theory, it sounds progressive and noble, but there’s one problem: vasectomies aren’t meant to be reversed.
“Vasectomies are meant to be permanent. We tell patients that vasectomies are meant to be an expression of satisfaction with one’s own fertility,” Dr. Esgar Guarín, MD, an Iowa-based vasectomy provider with almost two decades of experience, explains. Since the Court rescinded the right to a legal abortion in 2022, his clinic, Simplevas, has seen their patient load double. It’s not just Dr. Guarín that’s seeing this: since 2022, vasectomies—a procedure in which the tubes in the scrotum that carry sperm are cut or blocked, rendering the person infertile— have spiked in popularity in nearly all states.
To be clear, vasectomy reversal is a real thing: it’s a microsurgery where a surgeon will reconnect the vas deferens (the sperm tubes). But this isn’t necessarily the same as restoring one’s fertility or ‘undoing’ the impact of a vasectomy. According to Dr. Guarín, fertility can often be restored, with rates of sperm recovery sitting at 71 to 97%. “What people are looking for are rates of successful pregnancy, which can be anywhere from 30% and 70%.” Even so, Dr. Dr. Guarín stresses that there’s no guarantee.
Unlike a vasectomy (which, nowadays at clinics like Dr. Guarín’s, takes about 15 minutes, is done with local anesthetic, no scalpels, and has virtually no downtime), reversal isn’t easy. It can take a skilled surgeon several hours under general anesthesia. “Even when you have access to a surgeon who can do a reversal because you’re located in a place with access to those and with surgeons interested, it’s not a guarantee of a future pregnancy,” Dr. Guarín explains. This is especially true if it’s been several years since the initial vasectomy. A man getting a vasectomy at 18 and hoping to reverse it at 30 and have kids (especially if he’s banking on a reversal) will be a harder position than someone who changes their mind just a couple years later. “In this case, by his 30s, the chances of success for this individual are much lower,” Dr. Guarín explains.
Waiting until you’re sure about not wanting to have (biological) children is the clear advice from physicians like Dr. Guarín. However, there are other options, like sperm banking, available to men who might want to keep their options open, so long as they understand the costs and risks associated with it (often several thousand dollars for initial freezing and at least a few hundred a year to store the sperm, then a few thousand for insemination—or more if it’s done through IVF). All in all, it’s far more complicated than ‘just reversing it.’
Dr. Guarín gained media attention for providing free vasectomies from his mobile clinic (yes, a vasectomy van) following the overturning of Roe v. Wade. Within the first 48 hours of the ruling, his clinic saw a 300% spike in website traffic. Planned Parenthood reported a 1200% increase in vasectomy-related web traffic since the ruling, and at least five studies so far have shown stark increases in men seeking vasectomies. “I didn’t think the reaction would be sustained. I really thought it would just be a news cycle thing,” says Dr. Guarín. “It was clear that [patients] had been relying on their partners of the moment for contraception, which shows they knew they didn’t want children and saw the absence of the last option, abortion, was no longer there,” he says. Men taking responsibility for their own fertility is comforting, but bittersweet: ‘It seems like it took the taking away of rights for men to finally say ‘hey, I gotta do something,’ and that’s not the way we wanted them to become part of the conversation,” Dr. Guarín says.
Away from the noise of online thinkpieces and Twitter threads, vasectomies have extremely low rates of regret. And this isn’t thanks to misinformation online— it’s because physicians like Dr. Guarín and sexual health providers and educators like Planned Parenthood are clear about who vasectomies are best for: those certain about not having additional children. The bad news is that, aside from condoms, there isn’t a reliable male contraceptive like there is for females.
The good news? Research is getting closer and closer to figuring it out. ‘I think in the next six to 10 years, we will have something out there, but we shall see. But the future for male contraception is there,’ Dr. Guarín explains, like existing projects that temporarily obstruct the vas deferens and can block sperm for at least a few years (almost like an IUD). Until then, there is no silver bullet to the gendered burden of contraception in a climate where reproductive rights are under attack. “What will fix things is understanding that we all play a role in reproduction. If everyone got a vasectomy, the objectification of women will continue. The belief that women shouldn’t have rights over their own bodies will continue. Sterilizing everyone won’t fix this.”