wound created by the no-scalpel method usually does not require stitches. nsv is the most commonly performed type of minimally invasive vasectomy, and both describe the method of vasectomy that leads to access of the vas deferens. open-ended vasectomy open-ended vasectomy: in this procedure the testicular end of the vas deferens is not sealed, which allows continued streaming of sperm into the scrotum. this method may avoid testicular pain resulting from increased back-pressure in the epididymis. studies suggest that this method may reduce long-term complications such as post-vasectomy pain syndrome. vas irrigation: injections of sterile water or euflavine (which kills sperm) are put into the distal portion of the vas at the time of surgery which then brings about a near-immediate sterile ("azoospermatic") condition. the use of euflavine does however, tend to decrease time (or, number of ejaculations) to azoospermia vs. the water irrigation by itself. this additional step in the vasectomy procedure, (and similarly, fascial interposition), has shown positive results but is not as prominently in use, and few surgeons offer it as part of their vasectomy procedure. other techniques the following vasectomy methods have purportedly had a better chance of later reversal but have seen less use by virtue of known higher failure rates (i.e., recanalization). an earlier clip device, the vasclip, is no longer on the market, due to unacceptably high failure rates. the vasclip method, though considered reversible, has had a higher cost and resulted in lower success rates. also, because the vasa deferentia are not cut or tied with this method, it could technically be classified as other than a vasectomy. vasectomy reversal (and the success thereof) was conjectured to be higher as it only required removing the vas-clip device. this method achieved limited use, and scant reversal data are available. vas occlusion techniques main article: vas-occlusive contraception injected plugs: there are two types of injected plugs which can be used to block the vasa deferentia. medical-grade polyurethane (mpu) or medical-grade silicone rubber (msr) starts as a liquid polymer that is injected into the vas deferens after which the liquid is clamped in place until is solidifies (usually in a few minutes). intra-vas device: the vasa deferentia can also be occluded by an intra-vas device (ivd). a small cut is made in the lower abdomen after which a soft silicone or urethane plug is inserted into each vas tube thereby blocking (occluding) sperm. this method allows for the vas to remain intact. ivd technique is done in an out-patient setting with local anesthetic, similar to a traditional vasectomy. ivd reversal can be performed under the same conditions making it much less costly than vasovasostomy which can require general anesthesia and longer surgery time. both vas occlusion techniques require the same basic patient setup: local anesthesia, puncturing of the scrotal sac for access of the vas, and then plug or injected plug occlusion. the success of the aforementioned vas occlusion techniques is not clear and data are still limited. studies have shown, however, that the time to achieve sterility is longer than the more prominent techniques mentioned in the beginning of this article. the satisfaction rate of patients undergoing ivd techniques has a high rate of satisfaction with regard to the surgery experience itself. recovery incision stitches and a shaved scrotum14 days after vasectomy surgery sexual intercourse can usually be resumed in about a week (depending on recovery); however, pregnancy is still possible as long as the sperm count is above zero. another method of contraception must be relied upon until a sperm count is performed either two months after the vasectomy or after 10–20 ejaculations have occurred. after a vasectomy, contraceptive precautions must be continued until azoospermia is confirmed. usually two semen analyses at three and four months are necessary to confirm azoospermia. the british andrological society has recommended that a single semen analysis confirming azoospermia after sixteen weeks is sufficient. post-vasectomy, testicles will continue to produce sperm cells. as before vasectomy, unused sperm are reabsorbed by the body. conceiving after vasectomy in order to allow the possibility of reproduction via artificial insemination after vasectomy, some opt for cryopreservation of sperm before sterilization. dr allan pacey, senior lecturer in andrology at sheffield university and secretary of the british fertility society, notes that those he sees for a vasectomy reversal which has not worked express wishing they had known they could have stored sperm. pacey notes, "the problem is you're asking a man to foresee a future where he might not necessarily be with his current partner—and that may be quite hard to do when she's sitting next to you." the cost of cryo-preservation (sperm banking) may also be substantially less than alternative vaso-vasectomy procedures, compared to the costs of in-vitro fertilization (ivf) which usually run from $12,000 to $25,000. sperm can be aspirated from the testicles or the epididymis, and while there is not enough for successful artificial insemination, there is enough to fertilize an ovum by intracytoplasmic sperm injection. this avoids the problem of antisperm antibodies and may result in a faster pregnancy. ivf may be less costly per cycle than reversal in some health-care systems, but a single ivf cycle is often insufficient for conception. disadvantages include the need for procedures on the woman, and the standard potential side-effects of ivf for both the mother and the child. vasectomy reversal main article: vasectomy reversal although those considering vasectomies should not think of them as reversible, and most people and their partners are satisfied with the operation, life circumstances and outlooks can change, and there is a surgical procedure to reverse vasectomies using vasovasostomy (a form of microsurgery first performed by earl owen in 1971). vasovasostomy is effective at achieving pregnancy in a variable percentage of cases, and total out-of-pocket costs in the united states are often upwards of $10,000. the typical success rate of pregnancy following a vasectomy reversal is around 55% if performed within 10 years, and drops to around 25% if performed after 10 years. after reversal, sperm counts and motility are usually much lower than pre-vasectomy levels. there is evidence that those who had a vasectomy may produce more abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility. the higher rates of aneuploidy and diploidy in the sperm cells of those who have undergone vasectomy reversal may lead to a higher rate of birth defects. approximately 2% of men who have undergone vasectomy will undergo a reversal within 10 years of the procedure. some reasons that people seek vasectomy reversals include wanting a family with a new partner following a relationship breakdown or divorce, their original partner dying and subsequently going on to repartner and to want biological children with them, the unexpected death of a child, or a long-standing couple changing their minds some time later, often prompted by situations such as improved finances or existing children approaching the age of school or leaving home. patients often comment that they never anticipated the possibility of a relationship breakdown or death, or how that might affect their situation at the time of having their vasectomy. a small number of vasectomy reversals are also performed in attempts to relieve post-vasectomy pain syndrome. prevalence internationally, vasectomy rates are vastly different. while female sterilisation is the most widely used method worldwide, with 223 million women relying on it, only 28 million women rely on their partner's vasectomy. in the world's 69 least developed countries less than 0.1% of males use vasectomies on average. of 54 african countries, only ten report measurable vasectomy use and only swaziland, botswana, and south africa exceed 0.1% prevalence. country vasectomy usage notes canada 22% "of all women rely on vasectomy" uk 17% - 21% only range given new zealand 17% - 21% only range given south korea 17% - 21% only range given australia ~10% belgium ~10% denmark ~10% spain ~10% switzerland ~10% nepal 7.8% brazil 5.1% colombia 3.4% swaziland 0.3% botswana 0.4% south africa 0.7% in north america and europe vasectomy usage is on the order of 10% with some countries reaching 20%. despite its high efficacy, in the united states, vasectomy is utilized less than half the rate of the alternative female tubal ligation. according to the research, vasectomy in the us is least utilized among black and latino populations, the groups that have the highest rates of female sterilization. new zealand, in contrast, has higher levels of vasectomy than tubal ligation. 18% of all males, and 25% of all married males, have had a vasectomy. the age cohort with the highest level of vasectomy was 40–49, where 57% of males had taken it up. canada, the uk, bhutan and the netherlands all have similar levels of uptake. history the first human vasectomies were performed in the late 19th century. the procedure was initially used mainly as a treatment for prostate enlargement and as a eugenic method for sterilizing "degenerates". vasectomy as a method of voluntary birth control began during the second world war. the first recorded vasectomy was performed on a dog in 1823. the first human vasectomies were performed to treat benign prostatic hyperplasia, or enlargement of the prostate. castration had sometimes been used as a treatment for this condition in the 1880s, but, given the serious side effects, doctors sought alternative treatments. the first to suggest vasectomy as an alternative to castration may have been james ewing mears (in 1890), or jean casimir félix guyon. the first human vasectomy is thought to have been performed by reginald harrison. by 1900, harrison reported that he had performed more than 100 vasectomies with no adverse outcomes. in the late 1890s, vasectomy also came to be proposed as a eugenic measure for the sterilization of men considered unfit to reproduce. the first case report of vasectomy in the united states was in 1897, by a. j. ochsner, a surgeon in chicago, in a paper titled, "surgical treatment of habitual criminals". he believed vasectomy to be a simple, effective means for stemming the tide of racial degeneration widely believed to be occurring. in 1902, harry c. sharp, the surgeon at the indiana reformatory, reported that he had sterilized 42 inmates in an effort to both reduce criminal behavior in those individuals and prevent the birth of future criminals. eugen steinach (1861–1944), an austrian physician, believed that a unilateral vasectomy (severing only one of the two vasa deferentia) in older individuals could restore general vigor and sexual potency, shrink enlarged prostates, and cure various ailments by somehow boosting the hormonal output of the vasectomized testicle. this surgery, which became very popular in the 1920s, was undertaken by many wealthy individuals, including sigmund freud and w. b. yeats. since these operations lacked rigorous controlled trials, any rejuvenating effect was likely due to the placebo effect, and with the later development of synthetic injectable hormones, this operation fell out of vogue. vasectomy began to be regarded as a method of consensual birth control during the second world war. the first vasectomy program on a national scale was launched in 1954 in india. the procedure is seldom performed on dogs, with castration remaining the preferred reproductive control option for canines. it is regularly performed on bulls. society and culture availability and legality vasectomy costs are (or may be) covered in different countries, as a method of both contraception or population control, with some offering it as a part of a national health insurance. the procedure was generally considered illegal in france until 2001, due to provisions in the napoleonic code forbidding "self-mutilation". no french law specifically mentioned vasectomy until a 2001 law on contraception and infanticide permitted the procedure. the u.s. affordable care act (signed into law in 2010) does not cover vasectomies, although eight states require state-health insurance plans to cover the cost. these include: illinois, maryland, new jersey, new mexico, new york, oregon, vermont and washington. in 2014, the iranian parliament voted for a bill that would ban the procedure. tourism main article: medical tourism medical tourism, where a patient travels to a less-developed location where a procedure is cheaper to save money and combine convalescence with a vacation, is infrequently used for vasectomy due to its low cost, but is more likely to be used for vasectomy reversal. many hospitals list vasectomy as being available. medical tourism has been