Akanksha Mehta, MD, on counseling patients on fertility after vasectomy

In an interview with Urology Times®, Akanksha Mehta, MD, MS, discussed why the updated 2026 American Urological Association Vasectomy Guideline^1,2 places greater emphasis on fertility restoration and how clinicians can better counsel patients considering permanent contraception. Mehta is a professor of urology at Emory School of Medicine in Atlanta, Georgia.

The expanded discussion on fertility restoration reflects the growing number of men who are seeking options after vasectomy, according to Mehta. Although vasectomy remains a highly effective and intended permanent form of contraception, she noted that approximately 8% to 10% of men ultimately pursue vasectomy reversal. With an increasing number of younger men undergoing the procedure, including some who have not yet completed family building, the guideline committee recognized the importance of proactively addressing future fertility considerations during the initial consultation.

Mehta emphasized that patients should be informed about the full range of available options. These include vasectomy reversal, sperm retrieval for use with in vitro fertilization (IVF), and sperm banking or cryopreservation before vasectomy. However, she stressed that the availability of these strategies does not alter the core recommendation that vasectomy should be viewed as permanent contraception. Any path to future fertility after vasectomy typically requires additional procedures, financial cost, time, and planning.

The updated guidance also aims to help clinicians navigate fertility restoration discussions when patients return years later seeking pregnancy. Mehta explained that treatment selection should be individualized based on factors such as the patient’s social circumstances, partner age, comorbidities, and time elapsed since vasectomy. In some cases, vasectomy reversal may offer the best chance of success, whereas in others, sperm retrieval with IVF may be more appropriate. For men who previously cryopreserved sperm, those specimens may also provide a pathway to parenthood.

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