Patients who see an operation as the safest form of contraception should be warned, writes Dr. Thomas Stuttaford, that complete protection is an illusion.
Many years ago, before the days of DNA testing to settle paternity disputes, a colleague came to see me about his wife's pregnancy. The jubilation of forthcoming fatherhood was absent, replaced by doubts, suspicion and fears. The trouble was that eminent urologists had previously assured him that he had a derisory sperm count and was certainly infertile. His wife had always seemed as steady as Caesar's, but he now wondered if the threat of life-long childlessness had so enhanced the charms of some fellow delegate met at a distant conference that she had strayed. I wondered too, but a search of the literature found more than enough quoted cases in which men with low sperm counts had had children to calm his fears. His daughter is now grown-up and looks reassuringly like her father.
If pregnancy despite a [url=https://www.volumepillsreview69.com]low sperm count[/url] can occasionally cause domestic disharmony, the emotions felt when one occurs after vasectomy and subsequent negative sperm checks are even more intense and engender a greater suspicion of infidelity.
In the journal of the Medical Defense Union (the insurance company that protects doctors against patients' claims) Joseph Smith, a consultant urologist, has recently reviewed the possibility of pregnancy after vasectomy. He suggests that all patients sign a Department of Health consent form explaining that there is still a very small chance of a return to fertility. The Lancet has also recently published case histories of six men seen by Mr. Smith's team. In these men negative [url=https://www.semenaxreview-info2.com]sperm counts[/url] were followed by pregnancy and DNA testing proved paternity. One man had eight negative sperm counts after vasectomy, but still his wife conceived.
It is estimated that one in 2,000 vasectomies fails, usually through the formation of a new channel at the site of the operation, but possibly occasionally because sperm have lingered in the seminal vesicles. Mr Smith emphasizes that conception is more likely when a low sperm count follows the vasectomy than when it is part of a general pattern of infertility. Vasectomy is often requested because a man's sperm have already proved highly fertile; in those cases in which the sperm numbers have always been low individual sperm may also be of poor quality.
Sperm quality is important. Ideally they should be present in large numbers, at least 20 million per ml, with more than 60 per cent of normal shape and size. More than half must still be frisky three hours after ejaculation. Just as not all greyhounds are born chasers, ready to run straight for their quarry, nor will all sperm swim purposefully towards the ovum. This ability to swim in the correct direction, like a good greyhound running from the slips, and not to mill around aimlessly, is known as its linear sperm velocity. Its importance has become recognised only recently with the advent of computer-assisted aids.
There have been arguments about the desirability and safety of vasectomy over 25 years, but the attacks have been directed at the possibility of side effects, not on doubts as to the operation's effectiveness as a contraceptive measure. No form of contraception, however, carries a 100 per cent guarantee against failure. The MDU's plea is that patients should be told that a small risk of conception remains. Mr Smith has found in his practice that this risk is so small that few if any patients opt to use additional methods afterwards.
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