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Wednesday, Nov 25, 2009
This newfound interest in men's reproductive choices by the government is only one indication that Americans are no longer ignoring the fact that men want to play an active role when it comes to deciding whether or not to have children. For decades, guys who wanted to take the reins and handle the responsibility of birth control had only two options: condoms and vasectomies. Today, a handful of drug companies are closer than ever to developing hormone-based male contraceptives. "There is a major interest in finding a male contraceptive," says Henry Gabelnick, director of CONRAD, an organization that is teaming up with the World Health Organization to study injectables for men combined with testosterone. "My guess is it's going to be four or five years before there is enough data to have a product on the market, if not later. But, ultimately, [the market] will change." Other forms of male contraceptives that work by interfering with the development of sperm or their functioning will likely take longer to develop. In November, a study in the journal Science made big headlines when it found that male monkeys injected with a protein had an immune reaction (developing high antibody levels and preventing the sperm from fertilizing the egg) and could not impregnate females.
"The fact that men have reproductive opinions is now being acknowledged to a greater extent," says Patricia Lunneborg, retired professor of psychology at the University of Washington and author of "The Chosen Lives of Childfree Men." And it's about time, say some men. "The man's opinion should carry as much weight as the woman's," says Jerry Steinberg, "founding non-father" of No Kidding! an international 10,000-member organization for people without children. "It takes two to make a baby, and it should take two to make the decision."
What will be the repercussions of a growing public discourse on male reproductive choice? Will it translate into more intentionally childless men in the future? Could it mean more men, like Moran, opting for vasectomies? Perhaps. "There is more information out there so men can make informed decisions," says the author of "Child-Free Zone," David Moore, 38, who had a vasectomy in October. "We were already totally committed to being child-free, but a friend visited with their young child and drove my wife and I mental," he says. "I also thought it would be a good idea to get my wife off the pill." Keuling's fianci, Vincent Ciaccio, 27, a health specialist in New York, is one of those men affected by this slowly changing climate. "Until I was 18, I thought if you were biologically able, you had kids," says Ciaccio, co-leader of his local chapter of No Kidding! "Men need to know that they have the right to not want to be a father, and they have the right to make that choice a permanent one."
Vasectomies -- which cost between $300 and $1,500 and are often covered by insurance -- have become routine 10-minute office procedures since a no-scalpel technique was introduced in the United States in the 1980s. The surgery is so routine that, according to recent reports from England, British nurses may soon be allowed to perform them without a doctor present. But just how much choice a young, unmarried or childless -- or all of the above -- man really has when it comes to accessing a vasectomy is debatable. As Moran found out when he was 23, if you don't have any children, your request for a vasectomy may not be taken seriously. Three doctors turned down Steinberg before he found one who would sterilize him at 34. It can be so difficult for child-free men to find an agreeable urologist that the message boards on the No Kidding! site include a section where members who've been sterilized can provide referral info for willing doctors.
Why do men who don't want to have children face roadblocks when it comes to choosing to make their choice permanent? "Just like with abortion, sometimes reproductive choices are looked at as being outside the realm of standard medicine," says Cornell University urologist Peter Schlegel, president of the Society for Male Reproduction and Urology. "Opinions are allowed to run rampant and personal views are applied by practitioners." It doesn't help that umbrella organizations like the American Society for Reproductive Medicine and the American Urological Association have no ethical guidelines on vasectomies -- such as who should get them and in what scenarios -- leaving doctors an open window to make the call.
It's a common practice, for example, for some doctors to make arbitrary age cutoffs for vasectomies. "If someone were to call me and say, 'I'm 28, single and I don't want children,' I would not waste their time and money to come in and see me," says Dr. Michael Warren, a urologist at the University of Texas Medical Branch in Galveston. His office only schedules a vasectomy consult if the candidate is over 30 with two kids or under 30 with more than two kids. The reason for his policy, he says, is that in his 33 years of practice he's seen too many men (whether they have children or not at the time of the surgery) later change their mind. "I have no problem with somebody wanting to live that way, but I know they might not always," he says.
Dr. Richard Vanlangendonck, a urologist at Ochsner Clinic Foundation in New Orleans, agrees that considering age when clearing a candidate is common sense. "When you're 22, you don't know what your life is going to be like three years from now," he says. "When you're 35 or 40 you'll have a better idea."
But consistent scientific data to back up doctors' policies is lacking. A Danish study conducted in 1987 found that regret is two to three times more frequent among men sterilized before age 30 than in men sterilized after 30. A more recent study done at the Cleveland Clinic Foundation found that vasectomy reversal occurred 12.5 times more often in men who underwent vasectomy in their 20s than in men who were older. Yet an Australian study found that men who were intentionally childless were not overrepresented among men seeking to surgically reverse their vasectomies. (The urologists that Salon spoke with who specialize in vasectomy reversals confirmed this trend, or lack thereof, in their own practices.) In fact, a study that compared 44 childless men and 51 fathers who got vasectomies at the Planned Parenthood Association of Maryland during a four-year period concluded that vasectomy is physically and psychologically safe for both groups.
