Vasectomy Consent & Instructions

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1Vasectomy Informed Consent
2Important Billing Information
3Instructions Following Vasectomy


Vasectomy Informed Consent

It is important that you have sufficient information about a vasectomy before you have the procedure. This informed consent has been written so that you and your significant other can learn the benefits, risks and complications to make sure you really do want to proceed with the procedure. By signing the last page of this document, you officially give your consent to have the procedure.

First, you and your significant other (if she chooses to) will participate in a counseling visit to go over anything that was not fully understood and/or if there are any questions you may want to ask. Your

Significant other is welcome to sign the consent from, but it is not required.

Second, during this time the doctor will examine you in order to make sure that the procedure will be possible. Shaving is not required for the procedure.

The main points of this informed consent are:

  • Are you sure you never want to be a father of another child?
  • Do you realize the procedure can fail at making you sterile?
  • The procedure is not easily reversible.
  • Your sperm can be frozen and stored for at least10 years.
  • What are the risks and complications of this procedure?
  • What does the procedure involve?
  • When can normal activities be resumed?
  • Contraceptive precautions must be taken until sperm count is zero.
1) Are you sure you never want to be a father of another child?

A vasectomy is potentially irreversible and you must consider that this will be true in your case. The most common reasons for regretting having a vasectomy at some point in the future are:

  1. Divorce or death of your wife and remarrying to a partner who wants to have children.
  2. Making too quick of a decision too young and later wanting children within a stable marriage.
  3. The death of one or more of your existing children.

By the time you come to the clinic, you and your significant other should have thought about these possibilities and any others that may apply to you. Some other methods of contraception are not irreversible. Therefore, if you have any doubts it is wiser to put off the decision to have a vasectomy and carry on with other contraception until you are sure as can be that you never want to be a father to another child.

2) Do you realize the procedure can fail at making you sterile?

Although a vasectomy is the most reliable form of contraception, in rare cases one vas deferens joins itself together again so that sperm can be released once more from the testes (recanalization). This happens in about 1 in 500 cases within 3 months of the procedure. These cases are detected because the follow up semen samples are found to contain an increased number of sperm. The procedure can then be repeated. Unfortunately, in about 1 in 3000 cases a Vas deferens can rejoin itself after 3 months and after all sperm have disappeared from the follow up semen sample. This means that a vasectomy is successful in 2999 out of 3000 cases.

3) The procedure is not easily reversible

It would be unfair not to mention that there are ways to try to restore fertility after vasectomy. The best option would be a vasectomy reversal. This procedure may restore the vas deferens to be able to pass sperm but within creasing years after a vasectomy the number of sperm falls and may not be sufficient to restore fertility by normal sexual intercourse. It may be possible to extract sperm from the epididymis (a coiled tube between the testis and vas deferens) or from the testes followed by fertilization of one or more of your significant other’s eggs in a “test tube’(also known as in-vitro fertilization or IVF).

4) Your sperm can be frozen and stored for at least 10 years

A much simpler “insurance policy” against becoming irreversibly infertile is to have your sperm frozen and stored before a vasectomy. The usual maximum storage time for sperm is 10 years. You may contact Mid-Iowa Fertility at 515-222-3060 or any other fertility clinic that specializes in this process.

5) What are the risks and complications of this procedure?

  1. Inflammation or Infection-ranging from mild inflammation to a serious infection or abscess of the skin, vas deferens, or testicle. Treatment may include observation only, antibiotics or very rarely surgical treatment.
  2. Hematoma Blood clot or bruise that usually clears upon its own but may require medical or surgical treatment.
  3. Adhesion-Skin attaches to vas deferens or a connection forming between the vas deferens and skin (called a fistula). This may require surgical correction.
  4. Hydrocele-Fluid build up in the scrotum. This may clear up on its own or may need surgical correction to remove the fluid.
  5. Spermatic Granuloma-Swelling caused by leakage of sperm from the vas deferens. This usually resolves on its own or may need to be drained surgically.
  6. Pain-Transient discomfort or pain in the testicles may be experienced from time to time. In very few cases, persistent chronic pain can develop after a vasectomy. This can occur even when there are no other complications of the procedure and, unfortunately, we have no way of predicting who is going to develop such chronic pain. However, if one of your testes is painful or tender before you have a vasectomy the risks of getting worse pain after a vasectomy are increased. It is well worth discussing this possible complication before proceeding with the procedure.
  7. Recanalization-The growing back together of the cut ends of the vas deferens, which may restore fertility. This is most likely to occur within the four month period following the procedure. Rarely, this occurs or is recognized at a later time.
  8. Sexual Problems-In about 4 in 1000 cases, decreased sexual desire or inability to have an erection is reported. Such problems are believed to be emotional, because there is no known way the procedure itself can cause them.
  9. Vasectomy and Cancer-A number of medical studies have looked at the relationship between vasectomy and later development of prostate cancer. Two such studies have shown no relationship, while another two studies have shown there may be a weak link between vasectomy and prostate cancer. Overall, all that can be said at this time is that taken as a whole, there is little evidence for a causal association between vasectomy and prostate cancer. All men between 50 and 70 years of age, regardless of whether they have had a vasectomy, should be screened once a year for prostate cancer.
6) What does the procedure involve?

The procedure can be done under a general anesthetic if you have a particular aversion to having a local anesthetic. Most men find local anesthetic perfectly satisfactory without the side effects of a general anesthetic. This avoids the need to fast before the procedure and not being able to drive 24 hours after the procedure (hence, transportation would be required to go home after the procedure).

Through one or two small skin incisions each vas deferens is located. A section is excised (to reduce the chance of the divided ends being able to join together again) and the ends are tied off With an absorbable suture. The skin incision is closed with absorbable sutures so there is no need to have the stitches removed. Since the body digests the stitches there can be a little oozing or discharge from the skin incision until the stitches fall out.

Before the anesthetic wears off you should avoid as much activity as possible. Once the anesthetic has worn off you may feel between slight discomfort, which would indicate to take things easy, to a degree of pain, which may require you to take Tylenol Extra Strength (take as directed on the bottle). After the procedure, you do not need to schedule a follow up appointment unless something out of the normal healing process were to occur.

A small lump can develop on the cut ends of the vas deferens nearest to the testis. This lump (sperm granuloma), which does not get bigger than a large pea, is a natural part of the healing process in some people. Such lumps can be tender while healing occurs but this tenderness normally settles down with time.

7) When can normal activities be resumed?

If you have had a general anesthetic, you must avoid driving or going back to work for 24 hours. If you had a local anesthetic, you may get back to normal activity within the limits set by pain and discomfort. Therefore, if your work does not involve significant physical activity you could go back to work the next day (if you have a desk job). However, if you have a physical job you may need to get a work note restricting the lifting of 10 pounds or more, squatting, bending or strenuous activity for 7-10 days after the procedure. Use common sense about returning to vigorous sporting activities such as weight lifting, running, biking, etc. You will not be able to submerge yourself in any water e.g. pool, tub, lake, river or jacuzzi for 10 days after the procedure.

8) Contraceptive precautions must be taken until sperm count is zero

When you ejaculate, millions of sperm are released from a “sperm bank ” behind the bladder, not the testicles. This sperm bank is slowly topped off by sperm migrating from the testis along the vas deferens, which is continuous until a vasectomy is performed. Therefore, you are still fertile immediately after the procedure, i.e. the procedure does not remove the sperm bank. The way to be assure as possible that you have subsequently become infertile is to examine your semen, in the pathology laboratory 3 months and at least 35 ejaculations after your vasectomy, to check that all sperm have disappeared. Sometimes this takes longer and you may have to produce more semen samples for this investigation. As mentioned earlier, sperm may not disappear in about 1 in 500 cases and the vasectomy has to be repeated. However, when we receive your lab report, indicating that there are no sperm in the semen sample, we will call you with the good news that the procedure was a success and you no longer have to use contraceptive precautions.

It is very important that even at this stage, one or the other vas deferens may rejoin later on and fertility will be restored in 1 out of 3000 cases. If you fail to supply follow up semen samples, you must accept that 1 in 500 chance that the procedure failed before all sperm disappeared from your semen i.e. at your own risk.

Voluntary Consent

It has been fully explained to me that there is no perfect method of sterilization and complications can arise. In the event that sterilization should fail, under no circumstances whatsoever will I hold Dr. Fawad Zafar legally liable for any subsequent pregnancies or complications. I fully understand that the purpose of sterilization of any person is to prevent further pregnancies and this is in no way contrary to our personal and moral beliefs.

The complications include, but are not limited to, spontaneous reconnection resulting in a possible pregnancy, infection, bleeding, hematoma in the scrotum, and the possibility of chronic testicular pain.

I have read and understand the above statements pertaining to the vasectomy. I have had time to think about the procedure, its expectations, and risks with the physician, and I consent to a bilateral vasectomy for the elective sterilization process.

I do hereby request and grant permission for sterilization to be performed on myself.

Patient's Name