The cutting edge

Mitch and Allie met two years ago, and when things started getting serious, they began talking about kids - neither wanted to have any. They were young to have this realization - Mitch is 25, Allie is 23 - but the engaged couple from South Jersey said they had both known for years they weren't parent material.

So they went an unconventional route - a few weeks after getting engaged this summer, Mitch got a vasectomy. When Allie told friends over dinner, she said, "Everyone just looked at us like, 'You're kidding.' "

The 10-minute procedure is a form of male sterilization much more common among dads in their 40s than childless men in their 20s like Mitch. "I never really wanted kids, ever," says Mitch, who works 10- to 12-hour days running a company he started three years ago. (Because the surgery is a sensitive matter - and not everyone in their family knows about their decision - the couple requested anonymity. Mitch and Allie are pseudonyms.) "I never felt like I would have enough time to take care of them. Some people I know who have kids hire nannies to take care of them. I'd never want to do that."

"I said, 'I don't want children,' " Allie says. "He didn't either. It never came into my head that I was put on this Earth to be a mother."

Young men like Mitch - childless, and looking to stay that way - make up a small but growing minority of vasectomy patients, according to doctors who perform the procedure. They also present a problem for urologists (specialists in the male reproductive system): How young is too young? Can a man who's 23 really be sure he won't want to start a family when he's 39? Some doctors decline to perform the procedure on men younger than 30 or those who don't already have children. Others try to talk them into postponing the decision.

"If he's single, in his 20s, that's the group I try to convince it's not the best time for it," said Abington Memorial Hospital's chief of urology, Robert Charles, who says he has seen a small but discernible rise in the number of young men seeking vasectomies.

Even with this type of reluctance on the part of doctors, some young men are committed to having the procedure done.

"You'll get people who are completely clear, this is not something they want to do. They are absolutely positive they don't want to have kids," says Bruce Sloane, a urologist with a private practice in Center City, who does about 50 vasectomies a year. Like many urologists, Sloane uses the initial consultation to determine how much the patient has thought about the procedure.

Occasionally, Sloane says, some young men will "flinch." "He'll say, 'Maybe I do want to [have children], someday," says Sloane. "On the other hand, some guys say, 'Doc, I'm dead sure on this.' I think that's legit."

Young, childless couples forgo parenting because they want to retain their freedom, says Laura Scott, who is writing a book and making a documentary film on child-free couples. Scott, who is childless by choice herself, surveyed more than 170 childless adults and interviewed 30 couples for the project.

"I think people in this generation, in their 20s, they're quite aware of the actual cost of raising a child," says Scott, of Roanoke, Va. "I think 30 years ago, you assumed parenthood for yourself, and everybody else around you did, too. In the last 30 to 40 years, parenthood has moved from an assumption to a decision."

And more and more are deciding not to be parents.

The percentage of people who said children were very important to a successful marriage dropped from 65 percent to 41 percent between 1990 and 2007, according to the Pew Research Center. In 2002, 6.2 percent of women ages 15 to 44 said they didn't expect to have children, up from 4.9 percent in 1982.

Many who forgo child-rearing want to pursue a fulfilling career that might not provide for a family.

"They understand that you can't have it all," Scott says. "A lot of the guys I talked to didn't make a lot of money - they were artists, teachers, musicians. One guy told me, 'I want to have the freedom to take a job even though it won't support a family of four.' "

For these men, the safest bet for warding off unwanted visits from the stork is vasectomy - an outpatient procedure in which the surgeon disconnects the vas deferens, a noodlelike conduit that carries sperm to the male sex organs. Recovery involves a day of rest, some ibuprofen, and yes, ice. Some men schedule their recuperations to coincide with sporting events like the NFL playoffs or NCAA tournament.

While disconnecting the vas is relatively easy, putting it back together is another matter. A vasectomy reversal is a complicated and costly procedure that doesn't always work. Most insurers won't cover reversal, and if a patient waits more than 10 years, the success rate for reversal diminishes greatly, says Andrew Axilrod, a clinical assistant professor of urology at the University of Pennsylvania and director of male sexual health at UPHS. Patients can save their sperm before a procedure for possible in vitro fertilization in the future, but few do. It costs about $500 to bank and $200 to store. Insurance doesn't cover that, either.

"I tell patients the reversal's going to cost them at least five figures, and what happens if they meet the woman of their dreams who tells them the only reason she's with him is to have kids?" Axilrod says. "Those guys are screwed."

Still, the procedure remains popular - more than 500,000 are performed every year in the United States - because it's easier than other forms of permanent sterilization. Tubal ligation - when a woman gets her "tubes tied" - is a more invasive procedure. New studies raise questions about long-term use of birth-control pills. Condoms carry a slight risk of failure, and many men don't like using them.

Concerns about the environmental cost of overpopulation drove many men to the urologist in the 1970s, Scott says. Today, lifestyle reasons and a desire to take control of reproduction - an area that had once been the sole purview of women - is a main cause.

"That '70s time period was when a lot of men were getting snipped for environmental reasons," Scott says. "Now young men are wanting to take responsibility for their reproductive choices, and this is something new."

As for Mitch and Allie, they haven't told their parents about their decision yet. Allie says they want grandkids, but she doesn't want to make her decisions based on what other people want of her.

"We have some friends with children and they're like, 'Isn't that really selfish?' " Allie says. "But I think it shouldn't be up to everybody else to decide what we're going to do. It's our decision."