POST-VASECTOMY PREGNANCY:
Dear Sumner:
John is a 43 year old patient of mine who had a vasectomy about 9 months ago (not by you). He had his semen checked at about 4 months after the procedure, and no sperm was found. Contraception was then discontinued. It came as quite a surprise to John and his wife when she missed her period last month, particularly when a pregnancy test done a few days ago was positive. I immediately ordered another semen check, with no sperm being found once again. This couple has been married for 25 years and has 3 children, ranging in ages from 10 to 18. They are currently trying to decide whether to have an abortion. Needless to say, this pregnancy has caused considerable strain in their marriage. His wife categorically denies any extramarital activity. They have always seemed like an exemplary couple and have done a wonderful job raising their kids. I would be very distressed if this marriage broke up because of this pregnancy. I would appreciate if you would see John and try to help sort things out.
Dear Mel:
Post vasectomy pregnancies are very rare and usually occur within the first few weeks of vasectomy because the couple has incorrectly assumed that there is no need for contraception once the vasectomy has taken place. However, there may still be residual sperm present within the ductal system at that time. In 1972, I reported on a more uncommon phenomenon: the transient reappearance of sperm after vasectomy (JAMA: 219:1753, 1972). I had a good talk with both John and his wife re this study. They both seemed VERY relieved after our visit together and decided not to interrupt the pregnancy.
