I perform vasectomies in Texas. I've had a huge increase in patients post-Roe — and a lot of them are young and childless.

• Urologist Luke Machen performs vasectomies in Texas, where abortions are banned.
• Machen's requests began to increase with the Supreme Court leak that showed Roe v. Wade might be overturned.

This as-told-to essay is based on a conversation with Luke Machen, a urologist based in Austin, Texas, where abortions are banned. This piece has been edited for length and clarity.

Since the overturning of Roe v. Wade earlier this year, there's been an uptick in the number of vasectomy requests at my clinic. I usually perform 45 to 50 vasectomies a month. In the two days immediately following the overturning of Roe, we received 150 vasectomy appointment requests.

Originally from Baton Rouge, Louisiana, I'm a urologist at Austin Fertility and have been in practice there for three years. I have additional training in reproductive urology and andrology, which is a branch of medicine that deals with diseases and conditions specific to male health. I'm 35, married, and have two young children — a 2-year-old and an 8-month-old.

While Austinites may be slightly less blue than they think they are, Austin is certainly a blue enclave in a red state.

Our practice has been around for more than 30 years

A few years ago, the clinic decided to track how many requests for vasectomies we receive each day and how many vasectomies we actually perform. We were averaging five or six electronic appointment requests for vasectomy consultations per day before the overturning of Roe.

Typically, our patients were 36- to 37-year-olds who had around two children. Our practice does about 90 to 100 vasectomies a month. The consultations are dispersed between myself and another urologist who has the same training as me.

Historically, most of our vasectomy patients come in because they're done having children

In fact, the three most common reasons patients schedule an appointment are: they just had a scare; they meant to get a vasectomy a year ago and now they have baby No. 3; or their partner doesn't respond well to birth control and they're looking for other options.

I'll probably do one or two procedures a month on patients in their 50s. Oftentimes, it'll be because they have a new partner who's a little younger and they want to be safe. On the other hand, I have patients in their early 20s who are adamant that they don't want any children in the future.

Our increase in requests started with the Supreme Court leak in May that showed Roe v. Wade might be overturned

We went from probably six requests a day to 20 to 30 requests. And then, after the actual decision, we increased to 75 a day.

We've remained well above that five or six mark, but in those first few days following the decision, we had 150 electronic requests for vasectomy consultations. In June, we had 59 consultations for vasectomies with 18 of those coming right after the decision. That continued into July, when we had double our usual consultation rate.

In terms of the people who are getting vasectomies post-Roe, I don't have any specific data yet. I will say, anecdotally, that we're seeing a lot more people who have zero children and they're skewing a little bit younger, in their 20s and early 30s.

I've been asking most of my patients if the Roe ruling had any effect on their decision, and many have said yes

It's about seven or eight out of every 10 patients. It's something we're actively studying. Most of those patients say they've been thinking about having this procedure for a year or two, and the decision was just a big push to get it done.

I don't think I've talked to anybody who says, "This wasn't on my radar at all, but now I want to get it done." Most of them say, "I've been thinking about this for a long time and this was the push I needed."

As for their political affiliations, I don't know officially. We have a TV on the ceiling that patients can watch while I'm doing the procedure. If there's a certain news story on, they'll comment on it, so it's mostly indirect.

No one is saying, "I'm a Republican, I'm a Democrat." It's normally what I infer from a conversation. Based on that, though, I wouldn't say one side is coming in more for vasectomies than the other.

A vasectomy is literally blocking off the vas deferens

One way of thinking about it is we're basically just shutting down the road from the sperm factory to the sperm warehouse. It doesn't affect your testicular function or your sexual function. It doesn't affect your erections in any way either. It's all internal. Your testicles look the same. Your penis looks the same. You can't tell the difference, and neither can your partner.

How we do the actual procedure is a common question, too. I do one side at a time. I make a very small puncture in the upper side of the scrotum, and that's where the needle is inserted to numb things up.

There's a very real mental component to the procedure

I tell my patients that you could be a Navy SEAL, but the anxiety is just different when it's a procedure on your scrotum. Being nervous is very normal.

I routinely offer patients valium beforehand if they can provide a driver. Typically, I tell patients that the shot is the worst part.

Vasectomies are much less invasive than it is for someone to get their tubes tied

Dental work may be the closest comparison because it involves a shot of numbing medicine in a sensitive area. The shot starts working pretty much instantaneously. It's not uncommon to feel some pulling and weirdness for a minute or two, but by the time we're working on the vas deferens, you really shouldn't be feeling anything at all.

A vasectomy takes around 15 minutes and it's typically done in a doctor's office, whereas to get your tubes tied, there's typically general anesthesia and you're operating near vital organs.

For the most part, medically speaking, the only reason to get a vasectomy is for reproductive reasons

They're to prevent your partner from getting pregnant, and they're 99.75% effective. That's the number that I quote to patients. I also tell them that there are two different failure types.

One, I call an "early failure." This is when, for whatever reason, the procedure just doesn't work. However, we're able to detect this ahead of time. One of the key steps is an appointment after the vasectomy where we check the semen sample to make sure the vasectomy worked. This is how we would detect that early failure rate which is about one in 500.

The second failure I call a "late failure." This is when you have a successful procedure, but a pregnancy still occurs down the road. The rate that I quote for this is about one in 2,000.

I have a couple of theories about why this happens. The leading theory is recanalization. We're hardwired to reproduce, and just somehow, the ends find a way to recanalize. But, the honest answer is that we don't know why. The other thing I suspect is that these patients just didn't get that post-surgery check-up or test to prove that it worked.

I tell my patients that the vasectomy is meant to be permanent sterilization

While I love doing reversals, they're not 100%. It's a very cool operation — you're using a microscope and a very small sutures to re-approximate the two ends — and in ideal circumstances, the success rates can be upward of 95%.

But, if you wait a really long time to get a reversal done, the success rates drop closer to 50%. A "long time" is probably 15 or more years.

Recently, I had a young guy and his partner come in. They didn't want to get pregnant for three to five years, and they just were kind of evaluating all of their options. They wanted to have kids eventually, and they wanted to do the responsible thing.

I typically recommend against a vasectomy for a patient like that. But, I also say, "You're an adult, and ultimately, this is your decision." Statistically, half a million vasectomies are done each year in the United States.

Every year, a ballpark 5% will eventually opt to get a reversal.

I think vasectomies are fertility medicine

This is a procedure that I like to do and I think I'm good at. There's also a large chunk of my practice that sees couples that want to have children but are struggling.

For too long, I feel like all the blame and responsibility has been shoved onto the partner who can get pregnant. I think some of this is increased awareness by men about what they can do. I think more men stepping up is definitely a positive thing.