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Done Having Kids: His and Her Options

What to consider about tubal ligation, vasectomy, and other options.
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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.

Essure 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 this option, 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.

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