I have been married to my husband for 10 years and we have two beautiful kids. After our second one six years ago my doctor told me that it would not be a good idea for me to have any more children, so my husband had a vasectomy.
I continued to take birth control pills (BCPs) for other reasons besides contraception. Recently, we've been having sex without a condom, but then my husband pulls out and puts on a condom before he ejaculates.
The past two or three months I've been having periods at the time of the month when I should have them, but they are lighter than normal. I'm scared I might be pregnant. What do you think are the chances? Do I need to be concerned?
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Although late failures following vasectomies can occur they are very, very rare. There is nothing about your history that suggests that you are at increased risk for pregnancy. You are doing just great! Your use of pills, in addition to being protected by your husband’s vasectomy makes the risk of pregnancy extra ordinarily low.
Finally, you are also using withdrawal and then a condom. You should be running our nation’s family planning program and if you were, we would go from 48% of all pregnancies being unintended to zero pregnancies being unintended and abortions in our country would fall dramatically! What makes you such a careful contraceptor? |
The following information is from the 19th edition of Contraceptive Technology:
EFFECTIVENESS
Vasectomy is highly effective and one of the most reliable contraceptive methods.[i][i],[ii][ii],[iii][iii],[iv][iv],[v][v] The first-year failure rate in the United States is estimated to be 0.15% (see Table 27-1), with a range of 0% to 0.5% (see Table 27-16). In general, vasectomy failure rates are believed to be similar to those for female sterilization and lower than those for reversible methods.
It is very difficult to interpret the published literature on vasectomy efficacy because follow-up is usually short-term; many studies are retrospective, anecdotal and of low quality; a wide variety of occlusion methods are used; and there is no standard definition of what constitutes failure.[vi][vi] In addition, few studies present failure rates based on pregnancies after vasectomy; most report failures as failure to reach azoospermia (i.e., no sperm in the ejaculate). The relationship between sperm counts after vasectomy and the risk of pregnancy is not well understood, nor can it be readily measured. When pregnancy rates are reported, there are two complicating factors. Since vasectomy is not immediately effective, pregnancies may be related to failure to use another contraceptive until sperm are cleared from the reproductive tract. One quarter to one half of pregnancies after vasectomy may occur during this time.iii,iv,[vii][vii] In addition, pregnancies may not always be attributable to the men who underwent the vasectomy. True failure of the technique can result from spontaneous recanalization of the vas, division or occlusion of the wrong structure during surgery, and (rarely) a congenital duplication of the vas that went unnoticed during the procedure. It is clear, nevertheless, that pregnancy can occur long after the vasectomy procedure.
Her email reply on 1-12: “The human body behaves so oddly at times! I’ve read on the internet about women who are pregnant but continue to have periods for a few months anyway. What can you tell me about that? I’ve also read all kinds of stories from women who say they got pregnant by their husbands after vasectomies, and that’s the reason for my concern. I’m afraid for my health if I were to have another baby, but I cannot refrain from being with husband.”
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Pregnancy can occur in women whose partner’s have had a vasectomy, but it is rare. Recanalization can occur leading to pregnancy, but it is very rare.
Periods are also rare in women who are pregnant. They can happen but certainly are rare. |
Her email on 5-29: Hi Dr. Bob, I’m still on the pill and take it at the same time each day and of course, my husband still has the vasectomy from 7 years ago. Right now I’m having my period (tonight is dose 4 of single-hormone pills) and we decided to have sex without the condom today. Sometimes I think I ovulate when I take the placebo pills or after taking dose one of the hormone pills, so that would have been at least two days ago. Did I make a big mistake today? Two married people having sex shouldn’t have to be this much worry!”
My final thoughts on 6-3: You and your husband are amazing. You are so well protected and I don’t want you to worry as much as you are worrying now.
Why don’t you go to an urologist and have him look at a masturbation specimen from your husband. If there are not sperm, you could stop using any contraception at all.
Her email reply on 5-31: “You are so kind to this worried lady. Thanks Dr. Bob!”
Now, July 26, 2010, I want to know what methods you are using. Are vasectomy, pills, condoms and withdrawal all being called upon? No pregnancies can occur, assuming this is the case. What has happened to your periods? How old are you now? What was the reason the doctor said you should stop at 2 children?
Key Words: vasectomy, health reasons, birth control pills, condoms, withdrawal, ejaculation, periods, pregnant, concerned, rare, effectiveness
Posted 1-20-2009, Updated 1-27-2009, Updated 1-30-2009, Updated 5-29-2009, June 7, 2009, Updated 6-15-2009, Updated 7-26-2010
[i][i] EngenderHealth. Male Sterilization. In Contraceptive Sterilization: Global Issues and Trends. New York NY: EngenderHealth. Chapter 7, pp. 161-177. 2002. Available at http://www.engenderhealth.org/res/offc/steril/factbook/index.html.
[ii][ii] Wang D. Contraceptive failure in China. Contraception 2002;66:173-178.
[iii][iii] Nazerali H, Thapa S, Hays M, Pathak LR, Pandey KR, Sokal DC. Vasectomy effectiveness in Nepal: a retrospective study. Contraception 2003;67:397-401.
[iv][iv] Jamieson DJ, Costello C, Trussell J, Hillis SD, Marchbanks PA, Peterson HB; US Collaborative Review of Sterilization Working Group. The risk of pregnancy after vasectomy. Obstet Gynecol 2004;103:848-850.
[v][v] Hieu DT, Luong TT, Anh PT, Ngoc DH, Duong LQ. The acceptability, efficacy and safety of quinacrine non-surgical sterilization (QS), tubectomy and vasectomy in 5 provinces in the Red Rive Delta, Vietnam: a follow-up of 15,190 cases. Int J Gynaecol Obstet 2003;83:S77-85.
[vi][vi] Labrecque M, Dufresne C, Barone MA, St-Hilaire K. Vasectomy surgical techniques: a systematic review. Biomed Central Medicine 2004; 2:21. Available at http://www.biomedcentral.com/1741-7015/2/21
[vii][vii] Deneux-Tharaux C, Kahn E, Nazerali H, Sokal DC. Pregnancy rates after vasectomy: a survey of US urologists. Contraception 2004;69:401-406.
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