Ken’s experience: Still fertile, maybe you have a third vas?

Here is my story. It may be just beginning.

I am 39 years old and have three children. My wife has had a difficult time birthing them and three is plenty. My wife was long convinced that vasectomy was the way to go. After doing a little research and hearing from co-workers about it, it seemed like it was the best way to go at least in comparing that to the female alternative.

I asked my regular doctor for a referral and he gave one. I did not find that doctor in my PPO so I selected another. I was not too concerned as it was billed as such a routine procedure. On March 7, 2003, we went in and had a little videotape thing to watch. We then had a brief consultation and the procedure commenced.

It was relatively quick. I have a modified scalpel procedure, single midline incision. There was more pain at times than I had described to me by others that had it and by the doctor and other web information. I was scheduled to return in 10 days.

Three days later, the swelling on the left side wast about equal to the size of the testicle and appeared to be not diminishing, the right was quite smaller. I called the office and they had me come in on Tuesday. The urologist did not seem surprised at all, but since the pain was bad and the ibuprofen was not working he prescribed naproxen 30 days (plus refill). The refill part bothered me. The naproxen helped a lot I think. I had some night with a hard time getting to sleep though. The doctor recommended heat. I curled up with a heating pad and it helped instantly… except the swelling ballooned. After a couple of days of that, I stopped the heat… have not had the nerve to try it again.

So, the right side swelling continued to go down. The left side much more slowly. Suddenly at like 10 days, the right side just seemed to clear up. The left side seemed to show some progress. Gradually over the next weeks, the left side shrank… well, maybe not so gradually but seemingly in steps. After the naproxen was out 35 days or so from the day of the vasectomy, I quit it, not trying the refill. The very next day I had most of a day of pain. Not excruciating, but bad enough. The next morning it was gone.

Please note at this point I was very inactive. Other than walking around at work and climbing some stairs no real strenuous activity… this included no sexual relations.

Since the point of this was no babies, I was now preparing for the semen analysis. They recommended 20 ejaculations. I actually kept track and tallied 27 ejaculations. I had the test at 8 weeks. (yes, do the math, that was nearly an ejaculation every day – I was on a mission).

The test was on a Wednesday. I called on Friday to ask when I could expect results. They said the doctor was out and would call me Monday. Monday passed. I called Tuesday. Oh, they have the results, the doctor will call. Wednesday comes and now I am wondering. Finally, he leaves me a voicemail. The results were positive. Not only sperm but a lot of it. He said they expect no more than 1 million at 4 weeks(?). I had 26mil/ml and 56 mils in total! He said in five years he had never seen it. He recommended a second test. If that was positive, then a second vasectomy under general anesthetic.

I had a lot of questions and I asked them via email. he answered most, but in generalities. He doesn’t really seem evasive. He suggested there may be a third vas. He would look for it and if he didn’t find one cut them again. He said recovery (which I considered a month) would likely be about the same. I am thinking it would be worse due to more probing.

I have sought a second opinion. Turns out the guy that was originally recommended to me was in my PPO all along, but I did not know it. At the visit, he kept stopping himself from calling the other guy incompetent. The original doctor really did nothing that made me question his ability other than the vasectomy not working. He said that he does like 8-10 a week for five years. That seems like a good amount to me.

Okay. A new doctor recommended a similar thing. Could be third vas. Suggests vasectomy under general anesthesia. He said, another possibility is that with the single incision method perhaps he cut the first vas released it, then pulled it back out and cut it again! I am thinking then why do I have swelling on the right too?! He suggested that third vas or not, they would re-cut both sides. They use a no-scalpel procedure and at the hospital an intern will do it. I can see that no-scalpel seems like it should mean less damage, with two holes, no real chance of cutting same one twice. How do they probe for the possible third and wouldn’t an intern be as inexperienced as my original doctor or worse?

When I first got the results I had quite a discussion with my wife. While I thought we communicated in the past, we missed something on this subject. SHE was the one that never wanted to use condoms. She can’t use the pill now as she is breastfeeding still. She said that the risk of pregnancy was a big inhibitor for her. I wanted to increase the frequency of relations. What I did not know was that her problem with condoms was as much that they hurt as the efficacy. I had NEVER heard that. There are like dozens or hundreds of types of condoms, surely something wouldn’t hurt?

I have had lots of bad feelings about this. While I am not in excruciating pain, there is the risk that it will never go away. I am thinking that the second vasectomy will just increase the chance that will happen. I think… hey, this is not some horrible disease, I have no right to feel so sorry for myself… then I think .. but it was totally elective. In some respects unnecessary, yet so risky. I think of this several times a day.

Okay, so, I am about 9.5 weeks into this. I have been pretty much pain-free for a while, but then suddenly today just lying in bed waking up it feels like a bee stink in my right testicle. Then lesser pains strike at decreasing frequency for a number of hours (8?). Why is this on the right when most swelling and pain was on the left side! I do have more days than not, a sensation on both sides, a kind of discomfort. I related it to the feeling I recall as a child of a bruised muscle.

So, here I am. Perhaps 1/2 or 2/3 vasectomized. Not where I wanted to be but compelled to go forward – all the more aware of the serious risks I face. Still, I cannot see how I can find a physician that I can have high confidence due to this being rare enough and simply not very well researched.

My only real hope right now is that the semen analysis was botched. Seems unlikely, but some methods of it could have that amount of error.

Knowing what I know now would I do this again? I might have had to – that or get a divorce. But my wife knowing what we know now… I think we might have tried harder coming up with other methods of birth control first. It’s hard to say. Until you go through it and it works out badly you just think… hey, I’m one of the 399 guys out of 400 that have few problems.

11th June 2003 update

Well, I got a second semen analysis. This one was negative. Now of course the question, which one was right? Hence I have a third one pending.

My options looked very, very grim prior to this negative test. It seemed to me that problems are rare enough that getting someone with experience at correcting them would be tough. Any procedure sounded likely to at least double my risks of more problems. Anyway, now with a negative test I at least have hope of not needing to worry over all those issues.

What remains is the odd part. Pain has recurred a few occasions now three months out. It is usually pretty fleeting or kind of dull and does not occur every day. In that I am far luckier than some, it is clear. I feel kind of stupid complaining because other guys have had it so much worse.

12th June 2003 update

I got my third test results. Negative. I am sperm free. Phew. Can’t recall how much I said about this, but it is strange. Another example of how the medical community varies a LOT in this subject. My instructions were to do the semen sample after 20 ejaculations. I kept track because I wanted a valid test. I did the test after 27. The test came back at 26 million/ml. The doctor was surprised. He’d never seen that.

I did some research and discovered that there could be a small amount and some tests, done wrong would amplify the amount… basically because they only count in a ‘sample’ of the sample. If they don’t mix the sample or multiply wrong.. there you go, a low count leads to a very high count. I’m speculating, but it’s at least theoretically possible.

Lesson: don’t get too concerned about one bad test.

So I was told 20 ejaculations. I was talking to one guy that said they told him 5. Other people have been told tests in 2 weeks or tests in one month. One guy I talked to was not sperm free for 6 months.

Well, I am out of the woods on that for now, but the pain is still there. The last three ejaculations hurt. I seem to feel pain for about three days than not much for a week or more. The response from two doctors is… ‘that happens.’ They say it’s the sperm granulomas. I read online that this will ‘resolve’ in months.

Well, I think I am out of the woods at least in terms of not needing a second vasectomy for birth control purposes. I suspect that the pain will resolve. And I still feel kind of bad for complaining as I know some have had a worse outcome.

I have really mixed feelings on this topic now, but it does appear to be less risky than tubal ligation. I’ll update on the pain as it progresses, still having some at 3 months plus.

Submitted by Ken