Toronto Vasectomy Clinics
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Vasectomy Success Rates

Vasectomy success rates are greater than 99%, and are no different between the conventional and the No Needle, No Scalpel techniques. However, it is important to note that, as with all methods of birth control, vasectomy failure and unplanned pregnancy can occur. Vasectomy failure can be described as early or late. Before elaborating on these, it would be helpful to explain the concept of recanalization


 

Recanalization

Recanalization is the process of reuniting a divided channel of a bodily tube - in this case, the vas deferens.  During vasectomy the vas deferens is divided, however even after vasectomy, the testes continue to produce live sperm. Vasectomy failure can occur because over time, your body may re-establish the connection between the divided ends of the vas deferens, thereby allowing live sperm to once again enter the semen.

 

 

Early Failure

Recanalization is described as early if it occurs during the first 12 weeks after the vasectomy.  In this case, the 12 week semen analysis will detect the presence of live sperm. Because other contraception is still being used during this time, there is no increased risk of unplanned pregnancy due to early vasectomy failure - apart from the failure risk of the contraception method that you and your partner are using during this period. Early recanalization occurs in less than 1% of men who have had vasectomy.  Repeat vasectomy would be necessary in these men.

It is important to note that the presence of sperm in the semen sample at 12 weeks does not usually mean that there is early recanalization. In most men, it simply means that more time is needed to clear the last of the sperm, and further semen analysis will be done at a later date to confirm this. If live sperm in the semen is detected on multiple subsequent semen analyses, then the diagnosis of early recanalization would be considered. 

 

 

Late Failure

Recanalization is described as late if it occurs sometime after semen analysis has proven that the semen is free of sperm.  In the case of late recanalization, the vas deferens re-establishes a path for sperm flow after an initially successful vasectomy. Late recanalization can occur months or even years after vasectomy.  Because vasectomy success (no sperm in the 12 week semen sample) has been established and reported to the patient, other forms of back-up contraception have likely been discontinued, and unplanned pregnancy can occur.  Late failure occurs in approximately 1 in 2500 men who have undergone vasectomy.  It is important to note that the risk for unplanned pregnancy due to late failure is lower than the risk of failure due to any other method of birth control.

 

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Risks of Vasectomy

Although Vasectomy is a very safe procedure, as with any operation there are associated risks.  All of these will be discussed in detail during your consultation appointment. 
 


Bleeding

There is a small risk of bleeding due to vasectomy, about 0.5%, or 1 in 200 men. During the procedure, the doctor will control any bleeding directly. Rarely, bleeding may occur after vasectomy, forming a haematoma (bruise) under the skin. The majority of the time this will stop on its own and the body will absorb the haematoma naturally. In a very small number of men, another procedure may be required to drain the haematoma. We always ask whether you are on any medications that can cause bleeding, or if you have a history of bleeding easily, so we can take the appropriate steps to minimize the chance of bleeding.


 
 

Infection

The risk of infection after No Needle, No Scalpel Vasectomy is very low, approximately 0.4%, or 1 in 250 men. The vast majority of these infections can be treated with oral medications, although even more rarely, surgical drainage may be required.

 
 

Sperm Granuloma

In some men a small lump the size of a pea may be felt under the scrotal skin, at the site of the vasectomy. This is called a sperm granuloma, which is your body's reaction to the procedure, and is not in itself a complication. Most men are not aware that it is there, although it may be sensitive if it is squeezed directly with fingers. In the small number of men who develop post vasectomy pain syndrome, some find that their pain is localized to this lump. This can usually be treated initially with anti-inflammatories. If necessary, removal of the granuloma can correct these symptoms.


Chronic Pain

Many men do not have any need for painkillers after vasectomy, and of those who do, most require only a short course of over-the-counter ibuprofen or acetaminophen. However, about 1% to 2% of men have long term pain, called post-vasectomy pain syndrome. Non operative treatment strategies will improve these symptoms in the majority of men, but they are not always successful. Rarely, surgical procedures may be performed in an attempt to treat this condition. 


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Before Your Vasectomy

By properly preparing for your No Needle, No Scalpel Vasectomy, you can help us to provide you with a safe, smooth and worry-free experience.


 

1. Please read all of the 'FAQ's' and 'About Vasectomy' so that you understand what will take place. If you still have questions, write them down to ask the doctor when you visit. 

 

2. Be sure that you have carefully considered and discussed with your partner that vasectomy is a permanent form of birth control.

 

3. If you are taking a blood thinner, such as Aspirin® (ASA), Coumadin® (warfarin), Plavix® (clopidogrel) or other blood thinners, or you are taking anti-inflammatory medications such as Advil® (ibuprofen) or other anti-inflammatory medications, these must be stopped 7 days before the procedure. Since some of these medications are prescribed by your doctor, you must check with your doctor whether it is safe to stop the medications for this period of time. You may restart them 2 days following the procedure. 

 

4. The night before your procedure, please shave or clip the entire front of your scrotum carefully (clipping is preferable if you own a clipper). We ask that you do this the night before because the disinfecting solution we use on the skin can cause minor stinging if the skin is shaved immediately before the procedure.

 

Do NOT use chemical depilatory cream (i.e. Hair Dissolving Cream) on your Scrotum!

 

5. Shower as you normally would on the morning of the procedure to clean the area. Do not use any creams, powders, scented products or sprays on the area.


6. There is no need to fast prior to vasectomy. Eat as you would do normally.
 

7. Please purchase an athletic support, and wear this when you come for your procedure. This will support your scrotum after vasectomy and minimize discomfort. A rigid cup is not required. Supports can be purchased at athletic supply stores, but call in advance to make sure they have stock as not all stores carry this product.


8. When you arrive for your procedure, please ensure that you have Extra Strength Acetaminophen (Tylenol®).  You are encouraged to take 2 Extra Strength Acetaminophen before surgery to get it working early!
 

9. Please arrive at the Toronto Vasectomy Clinic at least 20 minutes prior to your appointment, to allow time for parking and to register. Rushing to be on time will make it hard for you to relax, which is key to a smooth and worry-free experience.

 

10. We will ask you to spend a short time with us after your procedure so that we can ensure that you are comfortable and feeling well.

 

11. Plan your way home! Arrange a ride home if you can. We do not use any sedating medications so you may legally drive yourself, however we STRONGLY advise that you arrange a ride, as some men may feel faint a little while after their procedure. Alternatively, you could take a taxi or public transit.


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After Your Vasectomy

The following will help you to recover from your No Needle, No Scalpel Vasectomy.


1. Avoid driving yourself home post vasectomy. Ideally arrange a ride in advance, or plan to use a taxi or public transit.

2. Do not return to work or perform any significant physical activity. Spend the rest of the day reclining and resting at home.

3. You may eat and drink normally.

4. We recommend taking acetaminophen (Tylenol®) immediately after your procedure, and then regularly for 24 hours. Should you need more pain control, you may take ibuprofen (Advil®) in addition to the acetaminophen. Avoid Aspirin® (ASA) for two days, as well as any blood thinners or anti-inflammatories you have stopped taking the week before. Icing the area is generally not required.

5. Wear the athletic support at all times for the next two days (except in the shower).

6. You may remove the dressing and shower 24 hours after your procedure. Do not bathe, swim, or otherwise immerse yourself in water for at least one week.

7. The following day you may drive, return to work if you have a desk job, and perform non-strenuous regular activities. After two days you may return to more strenuous work. Avoid strenuous exercise, sports, running and cycling for at least one week. Continue to wear the athletic support for a week during significant activity. Increase your activity carefully and listen to your body.

8. Refrain from having sex or ejaculating for five days following the procedure. Upon your first few ejaculations you may see a small amount of blood in the ejaculate, this is normal.

9. A small amount of dark bruising of the scrotum is normal. However, if you note that your pain is not improving, is becoming worse after a few days, or if you have fevers, increasing redness, swelling or drainage at the site, please contact the Toronto Vasectomy Clinics. 

On the day of your procedure you will be given the surgeon's cellphone number for any postoperative concerns.

10. After vasectomy the sperm left within the vas deferens needs some time to completely clear out. During this time you must use another form of birth control to prevent unwanted pregnancy. After a minimum of 12 weeks AND 20 ejaculations, you will provide a semen sample to the lab (a lab requisition and container will be given to you at the time of the vasectomy). The doctor will receive these results and discuss them with you in clinic. You must not stop using your regular birth control until you return to clinic and are told by our physicians that your analysis shows that your semen is free of sperm. We do not discuss laboratory results by phone.

The following instructions are IMPORTANT!

Prior to collecting your semen sample, refrain from sexual activity resulting in ejaculation for a minimum of two days but not longer than seven days.

Ensure that you drop off your semen sample to the laboratory within two hours of providing the sample.  To ensure the most accurate semen testing results, please provide a masturbatory semen sample ejaculated directly into the container provided.

All the seminal fluid must be collected in the sterile container as the greatest concentration of sperm is found in the first portion of the ejaculate. Do not use a condom to transfer the sample into the container. 

Maintain the sample at or near body temperature prior to delivery to the laboratory. 

Label the sample container with your full name, and your date of birth and health card number.  Also record the time and date of collection on the container and the number of days of abstinence.  Please also bring the requisition form to the lab.  Please schedule an appointment for two weeks after delivering your sample.

The following labs have multiple locations. Please contact the labs directly to find the location nearest to you.

Gamma-Dynacare 1-800-668-2714

LifeLabs 1-877-849-3637

You may go to any other Ontario lab that offers post vasectomy semenalysis. The requisition form you received from us today may be used in all Ontario laboratories that offer this service.  

Please note that there is a $25 fee for replacing lost requisition forms


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General Questions about Vasectomy


 

How much does a Vasectomy cost?

No Needle, No Scalpel vasectomy and all related pre- and post-procedural care is fully covered by OHIP at any institution or private clinic in Ontario; you do not pay any fees at our clinic, and you should not be asked to pay for a vasectomy anywhere in Ontario, regardless of the technique used. Click below to review the Ministry of Health policies regarding insured services:

http://www.health.gov.on.ca/en/public/programs/ohip/cfma.aspx

http://www.health.gov.on.ca/en/public/publications/ohip/protecting_access.aspx

Should you request them, a nominal fee will be charged for non-OHIP services such as doctor's notes, chart copies and insurance forms.

At the Toronto Vasectomy Clinic we do not charge block fees.

Please note that if you do not show up for your appointment, or cancel with either less than 48 hours notice, or less than 2 business days, you will be charged a $100 cancellation fee.

 

 

What do I bring?

For your initial appointment, please bring your health card and a list of your current medications.  The doctor will discuss the procedure in detail, and answer any questions you may have. 

 

 

How Do I Prepare?

Your vasectomy will be booked after you have met the doctors for your initial consultation, at which they will explain to you what you need to do to prepare. Please refer to the FAQ's: Before Your Vasectomy for detailed instructions.

 

 

How much does a Vasectomy hurt?

During your No Needle, No Scalpel vasectomy, you may experience the sensation of mild pressure, but most men do not feel any pain. Any unusual discomfort can be treated with more local anaesthetic (freezing). About 1% of men who receive local anaesthetic with the MadaJet® also require a small needle to inject additional freezing. This needle injection is performed in an area that has already been partially frozen, so the experience of the needle is diminished. 

After a vasectomy, about half of men do not require any pain medication. Of those who do, a few doses of acetaminophen (Tylenol®), or ibuprofen (Advil®), generally alleviate any discomfort. Stronger medication is almost never required. 

 

 

What if I have concerns after my Vasectomy?

At the time of your vasectomy, your surgeon will review with you your post vasectomy care instructions, which also appear under FAQ's: After Your Vasectomy. You will also receive a written instruction sheet, along with the cellphone number of the surgeon. You may contact the surgeon for any post operative concerns that you may have.

 

 

When can I return to my activities?

Most men are able to return to driving and desk work the following day. For those whose work requires heavy lifting or strenuous activity, please see the detailed information provided in the FAQ's: After Your Vasectomy.

 

 

When Can I have Sex after Vasectomy?

You may have sex five days after your vasectomy. You should be very gentle initially, and proceed according to your level of comfort. You may notice a small amount of blood in your first few ejaculations; do not be alarmed, as this is not uncommon. 

Vasectomy does NOT affect:

• sensation during sex and orgasm
• the amount or appearance of the semen
• sexual libido or sex drive
• your ability to have or maintain an erection
• your ejaculation
• your levels of male hormones (testosterone)

 

 

When can we stop using our regular birth control?

You must continue other forms of contraception until we tell you that laboratory testing has confirmed that your semen is free of sperm.

After your vasectomy, you must wait at least twelve weeks AND have at least twenty ejaculations, then you will need to submit a semen sample to your local lab (see FAQ's: After Your Vasectomy for details). You will then make an appointment to follow up with us in the clinic. Only after we tell you that the lab has confirmed that your semen is free of sperm, can you then dispense with other forms of contraception. 

 

 

Does Vasectomy increase my risk of cancer or other disease?

Several large studies have addressed this question, and no increased risk of prostate or testicular cancer has been associated with vasectomy. 

Most recently, a widely publicized study from July 2014 reported an association between vasectomy and prostate cancer. The American Urology Association reviewed this study and performed a large analysis combining the data from this report along with all the previous studies that addressed this question. They found that the total evidence showed no relationship between vasectomy and prostate cancer. In 2015 the AUA updated their 2012 guidelines to reflect this process.

The AUA also reviewed the evidence for an association between vasectomy and several other chronic diseases. No evidence was found for vasectomy being a risk factor for other diseases.

This information can be found at the AUA site under "Guideline Statement 3: Discussion" 

http://www.auanet.org/guidelines/vasectomy-(2012-reviewed-for-currency-2015)#x3374

 

 

Do I need to worry about the metal clips?

As described in the "About Vasectomy" page, clips are placed on the sheath surrounding each vas deferens, after it has been divided; this is the fascial interposition method. These clips are made of titanium, which is an inert, non-reactive, and non-magnetic metal. Titanium is commonly used to make clips and surgical implants. These surgical clips do not cause increased pain or complications when used in vasectomy.  They will not set off metal detector alarms, nor would will they affect MRI (Magnetic Resonance Imaging) testing.

 

 

Does a reversible Vasectomy exist?

Although there are operations to reverse vasectomy, these do not always restore fertility. As such, vasectomy should be considered a permanent form of birth control. Alternatives to vasectomy are currently in the experimental phase of development, and are not available for men at this time.

 

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