OK, sports fans. It's that time of the year – March Madness. Basketball games abound, the wagers are flying, rivalries are raging.
For men in the know, all that can mean only one thing:
"There's actually a huge uptick during March Madness," said Puneet Masson, Penn Medicine's director of male fertility care and an assistant professor of urology. "I would say I see triple the numbers. People book this months in advance."
"We call it Vas Madness."
And it's not just Penn. Other health providers around the country also say March Madness means a rise in vasectomies for sports-minded patients.
It makes sense. When all you really want to do is sit around and watch sports, what better time is there for elective surgery that pretty limits you to sitting around and watching sports?
Masson, at Penn nearly four years, said this was not part of the specialty they told him about in medical school, but each of the last few years, he has seen it grow. Vasectomies, he said, are also big right before Thanksgiving – a major sports weekend – and just before Super Bowl Sunday.
"Last year, I did a Super Bowl party," Masson said. "Six guys."
Forewarned is forearmed.
"I tell them it's going to be boring," the urologist said. "I tell them, 'You're just going to be chilling on the couch with a bag of frozen peas on your groin.' "
Talk about heaven.
Some doctors say the trend started eight years ago, when a urology clinic in Oregon ran an ad promoting the benefits of scheduling a vasectomy in March.
"You go in for a little snip-snip and come out with doctor's orders to sit back and watch nonstop basketball," the voice-over promised. "If you miss out on this, you'll end up recovering during a weekend marathon of Desperate Housewives."
Copycat ads followed. Now a sports radio show in Washington, D.C., has an annual Vasectomy Madness contest, whose prize is a free vasectomy.
Here's how it works: Three men come on the air to make their cases for getting snipped. The announcers ruthlessly roast them, and then listeners vote for their favorite.
Procrastination can be so common with the "Big V" that it takes a panel of sports jocks offering a free procedure for some guys to finally let a doctor take a scalpel to their nether regions.
That may be one reason vasectomy rates are low: About 5 percent of women rely on their partner's vasectomy for contraception, unchanged from a decade ago. The Centers for Disease Control and Prevention's National Survey of Family Growth compares that with 20 percent of women who have had a sterilization procedure, even though women's surgery is more invasive and more expensive.
"Men are culturally the providers. It's hard for them to seek care," said Paul Turek, a California urologist. "They don't know how to be a patient."
Turek has clinics in San Francisco and Beverly Hills. He sees an increase in vasectomy visits during March Madness, and he says he has also noticed more men coming in together.
"One group came in from a tech company in a limousine," he said.
Last year, five college buddies scheduled a group vasectomy in March. They live all over the U.S. now, and one had an idea to reunite in San Francisco and undergo the outpatient procedure together.
"I gave them a deal," Turek said. "I closed the doors. We had sports TV on. They were having fun."
As each guy returned to the waiting room, he was greeted with fist bumps and high-fives. Then the men went back to their hotel to bet on the games and yell at the television together.
There is another theory about why vasectomies aren't more popular: the cost. The Affordable Care Act requires insurers to cover contraceptives without charging out-of-pocket costs. But vasectomies were not included in the rule.
The procedure usually costs about $500, but some doctors charge up to $1,000.
Vasectomy was overlooked in Obamacare because, under the law, birth control was considered a women's health service.
Last year, 12,000 people signed a petition asking regulators to cover vasectomy without cost sharing. Doctors' groups even drafted language to this effect to add to the regulations.
But when the Trump administration took over, it told the groups to stop trying, according to Aaron Hamlin, executive director of the Male Contraception Initiative.
Jack Mydlo, urology chair at Temple University's Lewis Katz School of Medicine, said he had not noticed a run on vasectomies this time of year. But he said the timing makes sense.
"Spring is in the air, friskiness is in the air," Mydlo said, "but if you have two or three kids, you might want the friskiness but not the babies."
Masson said other countries observe World Vasectomy Day, which encourages men to take responsibility for reproduction, and he gives credit to his patients who do so. In the spirit of good cheer, he said he gives out "goodie bags" including lubricant to aid in the steps necessary for the men to be assured they are no longer at risk of causing a pregnancy after the procedure.
Unlike some other practices, Masson said, his office does not advertise this time of year, and still sees plenty more business. But he'd like to offer his patients souvenir T-shirts that might say, "Trust me. I had a vasectomy."
"People would wear them to the bar," he says. Or this on a T-shirt: "I got snipped at Penn."
Masson said his bosses nixed that idea. His basketball team, Villanova, also is out of the running. But Masson is keeping hope alive for 2018.
"Maybe next year," he said, "they'll let me do the T-shirts."