Welcome back to our Why Not Him? series, where we challenge outdated assumptions around permanent birth control and ask a simple question:
If a couple is finished having children, why is the burden still so often placed on women?
I’m Matthew Zerden, MD, a board-certified OB-GYN with subspecialty training in Complex Family Planning, I have spent years counseling patients on contraception, sterilization, and reproductive choices. That experience offers a unique perspective: when couples compare the real-world risks, recovery, and cost of permanent birth control, the answer is often more straightforward than many realize.
A Unique Perspective on Both Sides of the Decision
As Dr. Matthew Zerden, I bring a perspective that’s uncommon in this space. I’m a board-certified OB-GYN with subspecialty training in complex family planning and a background in research on female surgical sterilization. I’ve spent years counseling women on contraception—including IUDs and tubal procedures.
Today, I also perform hundreds of vasectomies each year at His Choice Durham Chapel Hill and in our clinics throughout the state.
When couples consider permanent contraception, two options usually come up:
- Tubal ligation (“getting tubes tied”)
- Vasectomy
Both can be highly effective. But the experience of each procedure is very different.
Effectiveness
Both options are excellent forms of permanent birth control.
- Tubal ligation: approximately 0.5% failure rate
- Vasectomy: approximately 0.15% failure rate after confirmation testing
In other words, both work very well—but vasectomy is among the most effective options available and is MORE effective than a tubal ligation.
Procedure Differences
Tubal Ligation
Tubal ligation typically involves:
- Abdominal surgery or laparoscopy
- Sedation or general anesthesia
- Operating room or hospital setting
- Surgical staff and facility fees
- More recovery time afterward
Vasectomy
A vasectomy at His Choice Durham Chapel Hill is done in the following manner:
- Performed in-office
- Done with local anesthesia only
- Completed in about 20–30 minutes
- Minimally invasive
- Designed for quick return home the same day
Risk Profile
Tubal Ligation Carries Surgical Risks Such As:
- Bleeding & Infection
- Injury to bowel, bladder, or nearby organs
- Anesthesia-related risks
- If pregnancy occurs afterward, increased risk of ectopic pregnancy
Vasectomy Risks Are Typically Lower and Include:
- Bleeding & Infection (typically less severe than tubal ligation)
- Temporary swelling
- Bruising
- Mild discomfort for a few days
No procedure is risk-free, but the overall severity is far lower with vasectomy.
Recovery Time
Recovery matters—especially for busy parents balancing work, childcare, and life.
- Tubal ligation: several days to weeks depending on surgical approach
- Vasectomy: many men resume desk work quickly, normal routines within days, and most activities within 4-7 days
Cost Comparison
Costs vary depending on insurance and location, but many couples are surprised by the difference.
- Tubal ligation: can reach $6,000+ when hospital, anesthesia, and facility costs are included
- Vasectomy: often far less expensive, see our pricing
The Smarter Option for couples:
For couples making a shared decision, one option often offers:
- Lower risk
- Lower cost
- Faster recovery
- Less disruption to family life
That leads to a reasonable question:
If you’re both done having kids… why not him?
Reframing the Conversation
Instead of asking:
“What procedure should she go through?”
Ask:
“Which option makes the most sense for us?”
For many couples, the answer becomes clear.
Follow our Why Not Him? series as we continue exploring smarter, fairer, and simpler approaches to permanent birth control.
See our video series on vasectomy.
