Some people reach this point in their lives after having many children. Or one child. Or even no kids at all. Some are in their 30s or beyond, and some have made up their minds even earlier.
Though their circumstances vary widely, millions of men and women have asked themselves these same two questions that go hand in hand: Do we have all the kids we want and need? If so, which one of us is getting “fixed”?
This him-or-her question should be decided with great care. For couples weighing whether they're ready to permanently prevent pregnancy, here are some important questions to ask.
Who’s Making These Decisions - and Why
Men have one option when they want to permanently turn off their baby-creating hardware - also called sterilization -- and women can choose from several. For men, the option is a vasectomy. A doctor cuts and seals off the two tubes that allow sperm to travel from the testicles to the outside world.
Women can have a tubal ligation, also called a “tubal” or “getting your tubes tied.” Her Fallopian tubes are sealed off, keeping her eggs from meeting any sperm. Or she can have a procedure in which a doctor inserts tiny devices into the tubes through the uterus, thus blocking them.
Women take the leap nearly three times as often as men, says Sonya Borrero, MD, MS, an assistant professor at the University of Pittsburgh. She researches reproductive issues and counsels female patients on their contraceptive choices. According to the CDC, about 16% of reproductive-age women had opted for tubal sterilization in 2002, compared to 6% whose partner had had a vasectomy.
“Some women feel that it’s their body and they want to have control of their fertility and they aren’t open to the negotiating process. They say ‘I want to make sure I don’t have any more kids,’” Borrero says.
However, men may have many reasons to shoulder the decision, says Grace Shih, MD, MAS, an assistant clinical professor at the University of California, San Francisco. She does research on the role of men in reproductive decisions, and also performs vasectomies.
“If a woman has had difficult pregnancies, that’s where men may feel like they have more responsibility. Or if women have difficulty using hormonal contraception, men may feel like this is their chance to contribute,” she says.
Him or Her? How to Make Sure
Though this decision can bring relief and freedom, it can also lead to regret and conflict for couples.
Discussing the following issues with your partner -- and yourself -- can ensure you’re making the right choice. These questions may be uncomfortable to ponder -- but they may help you be clear about what's right for you.
Would I Ever Want Kids Again?
If you were ever single again, might you want to have more kids with a future spouse? Even worse, if you were to suffer the loss of a child, would you want another, Borrero asks.
If you foresee reasons why you’d regret this decision, don’t do it, she says. You should consider all of these to be permanent. A vasectomy isn’t nearly as costly and invasive as the surgery to reverse it. And the odds that you’d be able to father a child again aren’t good enough to count it as a fall-back option down the road, Shih says.
What Could Go Wrong?
In a 2011 journal article, Shih pointed to earlier research finding that women were 20 times more likely to have a serious problem related to a tubal than men face from a vasectomy. In addition, men tend to recover more quickly from a vasectomy, she says.
A tubal ligation requires anesthesia and deep incisions into her abdomen, both of which are concerns, Borrero says.
However, if a woman is going to have her tubes tied during a planned C-section delivery, the added risk of the tubal is less of a concern. The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.
When Does It Start Working?
If you’re looking for instant results, a tubal holds the edge: It works immediately. After a vasectomy, a man can still get a woman pregnant for several months, until lingering sperm are flushed from his plumbing. So it’s crucial for couples to use a backup method until your doctor says you're in the clear. And men need to provide a semen sample after a vasectomy, Shih says.
The Essure and Adiana devices, which are inserted into the Fallopian tubes, also require a checkup to ensure that they’re installed properly and the woman can’t get pregnant, Borrero says. If you choose these options, be sure you’re going to do the follow-up work. During the first three months after insertion of the device, another form of birth control must be used.
How Stable Are We?
“I don’t think you should ever have this procedure if your relationship is unstable, you’re going through a stressful phase, or you’re thinking of splitting up,” says Eli Karam, PhD, an assistant professor in the marriage and family therapy program at the University of Louisville, Kentucky.
This is a major decision that you should make only when you have a clear view on your long-term plans.
What Hopes and Fears Do I Have?
If you’re assuming that the procedure will lead to more sex, run this past your partner, Karam says. Some people expect lots of stress-free romps once they no longer have to fear an unwanted pregnancy -- but their partners aren’t sharing this daydream.
On the other hand, some women may fear that their husbands will stray after a vasectomy since they’ll face fewer risks, he says. Discuss all your hopes and concerns before the procedure.
How Much Does It Cost?
If you’re thinking about your bank account, “In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy,” Shih says.
If you have health insurance, check on whether it will cover the procedure and what costs may still be your responsibility.
Just Who Am I Making Happy Here?
Finally, if you’re the one having the procedure, be sure you’re doing it because you want it, not because your partner has cajoled you or bargained with you, Karam says. You’re more likely to be happy with the decision if you made it.