What do you do when you feel that your family is complete? This is a decision most couples eventually make. What steps should they take to avoid an unplanned pregnancy in the future? If they are really sure that they want no more children, then it is reasonable to choose a permanent solution to this possibility.

The usual solution is that of sterilization of either the male or female. Obviously, because of the permanent nature of sterilization, it is not a decision to be taken lightly and should only be made after much discussion between the partners and their doctor. Both partners need to be absolutely certain that there is no possibility that they will want children in the future.

The male sterilization process is called vasectomy and is the equivalent to tubal ligation in the female. It is considered to be one of the most reliable methods of birth control and requires only minor surgery. The downside is that it is almost always irreversible.

Tubal ligation, the female equivalent to vasectomy, is a process where the fallopian tubes are either cut or sealed off so that the eggs cannot reach the womb, thus preventing pregnancy. This, too, is intended to result in permanent inability to become pregnant and should therefore be carefully considered before going ahead.

Generally speaking, men will normally only consider a vasectomy when they have already fathered children and feel that their family is complete. Often, this doesnt happen until they reach middle age. Doctors normally insist that the man is entirely sure about the consequences of such a decision and also of the permanency of this surgery.

Realistically, this decision should be made jointly between the man and his partner. They need to discuss the advantages and disadvantages of the procedure and make this decision after careful consideration. However, the ultimate decision rests entirely with the man.

There are cases of successful reversal of a vasectomy but, in most cases, it is impossible. The surgery for reversal is also very expensive.

A vasectomy can be carried out in the doctors surgery as it is done under a localized anaesthetic. It is a relatively basic procedure where a small cut is made in two places about 1 inch (2.5 cm) apart and the intervening section is removed. The ends are then folded back and tied with a non-dissolving material such as silk. The wound is then stitched. This procedure is done on both sides and only takes about a half an hour.

The wound generally takes a few days to heal and the stitches are then taken out. It may be a little bit sore when the anaesthetic wears off but that it quite normal. It may be advisable to avoid intercourse until the stitches are removed as it can be quite painful.

One matter of importance is the length of time between this surgery and the time when the man actually becomes infertile. Because some sperm are stored in the seminal vesicles, they are still capable of fertilizing the female ova for several months after the vasectomy is performed. This is because they have already passed up the vans deferens, the tube that is cut, before the operation took place. These sperm are usually used up after around three months but can last for up to six months, causing the possibility of pregnancy. The length of time is relative to frequency of intercourse and therefore to the number of ejaculations the man experiences after the procedure.

Normally, a specimen of semen is examined at eight and twelve weeks after the vasectomy to determine whether it is safe to have unprotected sexual intercourse. Other forms of contraception, such as condoms, should be used to avoid unwanted pregnancy during the time that the sperm are still present.