Quick intro:

I'm 27, childfree and planning to stay that way, but of course you never know how your attitude may change, so I've been weighing my options for semi-permanent contraception. In the context of vasectomy discussions, I've seen lots of guys here commenting that they are holding out for Vasalgel. After looking into it carefully, I became rather skeptical though. I will summarize my thoughts here to start a discussion and help each other out.

First, for completeness sake, a quick summary of the alternatives:

  • Condoms You can get past the mood-killing factor, but I don't care what you might say, the feeling never comes close to bareback. And you still get around 2% pregnancy rate even assuming PERFECT use (suuure you always store them correctly), which is fucking huge. Only good for protecting against STDs before you confirm she is healthy and faithful.

  • The Pill Pregnancy rate close to 0, which is cool, but ultimately she is the one who controls it and can 'accidentally' forget. Plus if you care at all about the girl, fucking up with her hormones is not exactly 100% safe and cool (and even if you don't care, loss of sex drive is a common side effect), and often you'll have to convince her to take it (looking at you, Japanese women).

  • IUD Same as above minus the health effects, but plus the fishing line up your business. Rather uncommon in young women anyway.

Now onto the good stuff. Vasectomies are awesome but for two big issues:

  • Only partial reversibility Actually you will most likely get the swimmers back if you do the reversal, but they might not be as potent, especially after 10 years. In any case, you will still be able to father children, but likely through in vitro fertilization (IVF) with only a slightly smaller chance than usual especially if less than 15 years have passed since the snip. Plus IVF is not exactly fun for the mother with all the injections; not really an issue for the surrogacy route though. To sum up: fathering children will get more complicated and expensive.

  • A small chance to develop significant chronic pain (1-4%), usually from pressure buildup. Holy shit this one is scary. Fortunately if you get unlucky it is often treatable by reversal or other types of surgery.

Then here comes Vasalgel / RISUG.

None of the above problems and it's just around the corner – maybe 2018! ...at least that's the current version, as they have been postponing the beginning of the clinical trials for a couple of years already. Also, note how it is just the beginning. And after that they "hope to get it approved as soon as possible". Yeah, right. The RISUG human trials in India have been "ongoing" for over 10 years, with lots of animal studies published over the last 30 or so. Also, Vasalgel has a slightly different formula than RISUG so don't count on one helping the other overmuch. I am optimistic that it will hit the market eventually. However, hoping to see it there soon is just fucking illusional. Personally I think they only say that because they wouldn't get as many donations if they stated "maybe in 5 years". They are definitely not transparent in their timeline estimates and you can be sure there is a reason for that.

So what is a guy to do? Here is my plan, feel free to criticize.

Basic plan assuming no children wanted:

  1. Freeze one sperm sample. One. Don't really need this, as you can get your sperm out through reversal or needle aspiration, but it might have slightly higher quality than your own in say 20 years. Plus it's insurance against cancer and whatnot.

  2. Get a no-scalpel vasectomy. Become best friends with a bag of frozen peas. In the case of too much untreatable chronic pain, get it reversed.

  3. If Vasalgel does hit the market and becomes an established, safe method (personal optimistic estimate: 7-10 years, when vasectomy reversal rates are lower but still acceptable): get your tubes restored and blocked with Vasalgel instead.

Assuming a change of mind about children:

  • Get it all reversed. Hope for decent sperm motility. Try the old-fashioned way for a maximum of 1-2 years (simple chance aside, sperm quality improves over time after the reversal). If unsuccessful, but sperm is present and decent quality, change to intrauterine insemination treatment.

  • If still unsuccessful or wanting surrogacy or twins, change to in vitro fertilization with intra-cytoplasmic sperm injection. No sperm in the ejaculate? Congratulations! You get to use your frozen sample. Or get it from your balls, it's just a needle.

  • Adopt like a motherfucker and don't let any loser tell you it's beta.

  • Become a step-...DON'T.

I ignored the cost factor. If you don't have it for fertility treatments/adoption, you don't have it for a kid either.

TL;DR: Just get snipped and change to Vasalgel when and if it becomes available. It's not that bad.