CreditTill Lauer

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March Madness is upon us, and for urologists throughout the country that means one thing: It’s vasectomy season.

Let me explain.

Every year, men schedule their vasectomies in conjunction with the N.C.A.A. men’s basketball tournament, so they can watch the games while recovering on the couch with a frozen bag of peas.

In fact, at the Mayo Clinic in Rochester, Minn., so many men sign up for vasectomies during March Madness that appointments reach “max capacity,” said Dr. Tobias S. Kohler, a urologist and men’s health expert at the medical center who has observed this phenomenon ever since he was an attending physician a decade ago.

But even though a study last year found a peak in the number of vasectomies during March — and also at the end of the year during the holidays — most men in this country don’t opt for sterilization: They rely on their female partners to prevent pregnancy.

In the United States, female sterilization is twice as prevalent as vasectomy, according to 2015 estimates from the United Nations — despite the fact that vasectomy is equally effective, less invasive and carries a lower risk of complications.

Why? It’s a blend of cost, misconceptions and fears about the procedure, and cultural expectations about what truly defines a man.

Chris Lopez, 34, a father of three boys in Suffolk, Va., said even though he and his wife are not planning to have more children, he’s against the idea of a vasectomy.

“If I couldn’t produce kids for some medical reason or biological reason, I know for a fact it would make me feel not good about myself,” he said.

For Mr. Lopez, the ability to rear children is tied to his beliefs about masculinity. A man is many things, he said: strong, brave, a good dancer — but also, he’s supposed to be able to “have kids if that’s what he wants.”

Then there are the practical considerations, he added. Looking ahead 20 years, will he and his wife still be married? Will she even be alive?

“Maybe I meet a younger woman or something like that and she wants to have kids, and then I can’t give that to her,” Mr. Lopez said.

His wife, Sarah Kennedy-Lopez, 38, said she laughed when she and her husband first discussed these hypothetical scenarios, but even so, she understands where he’s coming from.

“Not all couples do make it,” she said, adding, “life does go on should a spouse die.”

Their children — a 7-year-old and 4-year-old twins — were conceived via in vitro fertilization, and her chances of getting pregnant without assistance are so low that neither of them uses birth control. So she isn’t pressing the issue.

“A couple times I have said to him, ‘Well, you know you could get a vasectomy and take care of that, so there would be no worries,’ and he says, ‘No, no, no — I’m not doing that. You can go and get your tubes tied,’” she said. “But I wouldn’t want to do that either, especially because I feel like I went through enough in conceiving our children in the first place.”

Studies have shown that men who receive vasectomies in the United States are typically white, non-Hispanic and live in the North Central and Western regions of the country. They also tend to have private insurance.

Vasectomy is covered either partially or in full under most insurance plans, but the procedure may require a referral from a primary care provider. Without insurance, the price is usually about $1,000. Vasectomy reversals, however, are not covered by insurance, and the procedure is cumbersome and expensive.

By contrast, the Affordable Care Act required insurance companies to cover 18 types of contraception used by women, including sterilization surgery, and no co-payment is required.

Aside from cost, getting a vasectomy often requires multiple visits to the doctor — first to establish consent, then to have the surgery and later to figure out when the sperm has been purged from the ejaculate. The entire process can take three months or more.

Dr. Anuj Khattar, a fellow with Physicians for Reproductive Health who practices in the Seattle area, estimated that after the initial consultation, 20 to 30 percent of his patients end up either changing their minds or simply not showing up for the procedure.

“I think part of the fears around vasectomy is that it’s so permanent,” Dr. Khattar said, adding that some men worry about “losing some of their virility and their ability to enjoy sex.”

But “physiologically, it doesn’t affect any of those functions,” he said. “There’s just a lot of misinformation.”

Ryan Cragun, a professor of sociology at the University of Tampa and father of one, said that despite his desire to get a vasectomy, he too had last-minute doubts: “Oh my gosh, I’m basically sterilizing myself,” he recalled thinking.

Even though it is estimated that about half a million men receive vasectomies in the United States each year, Dr. Cragun said it isn’t something men tend to talk openly about.

Post-vasectomy, he reports his sex life has improved, especially now that his wife is no longer taking birth control.

“Her libido is up, there’s no condom involved — it’s better. That’s a win-win in every regard,” he said.

In some countries, including Britain, South Korea, Canada, Ireland, Spain and Australia, the prevalence of vasectomy exceeds that of female sterilization, according to the United Nations. But worldwide, just like in the United States, female sterilization is far more common, and couples who use contraception choose methods designed to be used by women.

Caila Smith, 25, a mother in Huntington, Ind., said she was encouraged to get her tubes tied by some of her health care providers after she became pregnant with twins a second time.

She didn’t like the side effects of the birth control pill or Depo-Provera injections, both of which she had tried in the past, so she opted for tubal ligation after her children were born, in part because it was covered in full by insurance and she was told she could get the procedure done during her cesarean section.

After enduring a painful recovery, she learned that her fiancé could have gotten a vasectomy at minimal cost and that she now has a higher risk of ectopic pregnancy, something that wasn’t clear to her beforehand.

“They gave me a form and I guess I just kind of skimmed through it, you know, without digging too deep into what could happen,” she said. “If I knew then what I knew now, I feel like I would have pushed for him to get a vasectomy.”

Unlike vasectomy, which is a quick outpatient procedure to cut and seal the tubes that carry sperm and block the transfer of sperm to the ejaculate, tubal ligation is far more invasive and often conducted under general anesthesia. The surgery, which involves cutting or blocking the fallopian tubes, carries higher rates of complications, including damage to surrounding organs, said Dr. Holly Bullock, an assistant professor in the department of obstetrics and gynecology at the University of Arizona College of Medicine in Tucson.

The procedure does have its benefits, however.

“It is immediately effective and can be completely her decision that does not rely upon a partner’s follow-through to get the procedure and the follow-up post-vasectomy semen analysis to prove that it was effective,” Dr. Bullock said.

Tubal ligation may even reduce the risk of ovarian cancer, particularly among women who have BRCA1 or BRCA2 gene mutations, according to the American Cancer Society. And removing both fallopian tubes entirely, a procedure called salpingectomy, is thought to reduce the risk even more, Dr. Bullock said. That’s because doctors now believe that some ovarian cancers originate in the cells of the tubes.

But, she added, she recommends vasectomy to patients who are exploring permanent options.

Marco Cabrera, 38, a father of two in Traverse City, Mich., who had a vasectomy in 2016, said, “I feel like this is one place where men need to quote-unquote man up,” adding that he knew men who had refused to get vasectomies, insisting that their wives undergo sterilization instead.

“I’m just really unimpressed with some of the men I meet,” he said.

Despite having had complications after the surgery, “I still think the vasectomy was worth it,” he said. “I don’t have to worry anymore. I know I’ve done my part.”

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