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Vasectomy and Pregnancy
My boyfriend has had a vasectomy. I have taken a pregnancy test and it is positive. On 4/12/14 I had an ultrasound done at Family Planning Associates and was given the pills for a medical abortion. I have not been with anyone other than my boyfriend since my last menstrual period (which was on 3/9/14). He had his vasectomy 4 years ago and he said in 2012 his sperm count was less than 1 million sperm per milliliter of semen. Is that the same as zero sperm count? He has scheduled another sperm count for this week. I am certain I did not sleep with someone else. Paternity is moot at this point since we decided not to keep the pregnancy, but if we had, I would submit to a DNA test no problem. What I am afraid of is that this will negatively affect our relationship since he will probably suspect I cheated. My questions are below.  Please help. Thank you in advance for your help and professionalism.

1) My biggest concern: If his sperm count this week is zero, will his doctor tell him there's no way he caused the pregnancy?  What if his sperm count is less than 1 million sperm per milliliter of semen (I'm not sure if this is the same as 0)?  

2) Is a count of less than 1 million sperm per milliliter of semen the same as zero? Or does less than 1 million sperm per milliliter of semen still mean there are some (if very few) sperm present?

3) Is it possible for sperm to be intermittently or occasionally present after a vasectomy?  Meaning that because of possible re-canalization, some sperm might get through? Is it possible for the tubes to rejoin temporarily? Or is it that once they rejoin (if they do), they always remain rejoined until further surgery?

4) Are sperm counts absolute? I have heard from women who were told their husbands had 0 sperm count and they got pregnant after.
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563773 tn?1374250139
Hello,
Thanks for posting your query.

I can understand your concern for the pregnancy that has occurred after your boyfriend has had vasectomy.

Although vasectomy is considered quite safe method of contraception but it is not full proof and does not provide 100% protection against pregnancy. More than 99 per cent of vasectomies are effective at preventing pregnancy. Very rarely, the 2 cut ends of the vas deferens can join together and form an open channel for sperm again and this can result in pregnancy.

Now mostly recanalisation can be early and late recanalization. Early recanalization is most likely to happen in the first few weeks following vasectomy before having been given the all clear and late recanalization is where the all clear has been given, and the vasectomy spontaneously reverses itself many months or years later. This recanalisation can occur due to formation or scar tissue or sperm granuloma.

One thing I would like to explain that sperm continue to be made in the testes after a vasectomy. After time, however, production of sperm is often reduced but even reduced number of sperms can cause pregnancy although it is a very rare occurrence.

Now answering your questions one by one:

1) Decraesed number of sperms is called oligospermia and it is of mild, moderate or severe types. Severe types is when there are 0 to 5 million sperm/mL.  When there are no measurable level of sperm in semen then it is called azopsermia. Then it can be considered that it is zero sperm count. Hence less than 1 million sperms in semen does not mean zero sperm count.

2) This answers your second question also.

3) Azoospermia can be due to pretesticular, post testicular and testicular causes and vasectomy falls under the post testicular causes. It simply means that the production of sperms has not stopped altogether. It is just that there are no measurable amounts of sperms in semen due to obstruction in the form of vasectomy. Once recanalisation occurs then it has to be removed surgically. Then a surgical procedure called fascial interposition is done. In this a short piece of the vas deferens is cut and removed, and the remaining two ends are tied. Fascial interposition involves pulling the sheath covering the vas deferens over one severed end, then sewing it shut to create a natural tissue barrier. This is quite reliable for vasectomy.

4) Pre- and post-testicular azoospermia are frequently correctible, while testicular azoospermia is usually permanent. Hence if there is any vasectomy reversal or a canal has reformed after vasectomy then if your boyfriend is having oligospermia or azoospermia then also pregnancy can occur although considered very rare and an exception.

Hope that this information helps and hope that you get better soon.

Wishing you good health.

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Avatar universal
Thank you SO much for your help!!!  A couple of additional concerns:
1) It sounds like his last sperm count was 2012 when he was told he had "less than 1 million sperm per milliliter of semen."  Is a vasectomy considered successful with this count?  Or does the count have to be 0 for a vasectomy to be considered successful?  Since his was not 0, I wonder why they did not follow up, especially since his last count was 2012 and I think he had the vasectomy done in 2009?
2) I know the answer varies from doctor to doctor and depends on many factors about the patient, but in general, if he were your patient and had a vasectomy (2009) and had oligospermia (in 2012) and still has oligospermia now, what would you tell him the chances of him being the father are (impossible, slim, etc.)?  What would you tell him the chances are if he previously had oligospermia (in 2012), but now has azoospermia?
THANK YOU!!!!
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Avatar universal
Dr. Kaur, when you get a chance, could you please take a look at my additional questions.  Thank you!!
Thank you SO much for your help!!!  A couple of additional concerns:
1) It sounds like his last sperm count was 2012 when he was told he had "less than 1 million sperm per milliliter of semen."  Is a vasectomy considered successful with this count?  Or does the count have to be 0 for a vasectomy to be considered successful?  Since his was not 0, I wonder why they did not follow up, especially since his last count was 2012 and I think he had the vasectomy done in 2009?
2) I know the answer varies from doctor to doctor and depends on many factors about the patient, but in general, if he were your patient and had a vasectomy (2009) and had oligospermia (in 2012) and still has oligospermia now, what would you tell him the chances of him being the father are (impossible, slim, etc.)?  What would you tell him the chances are if he previously had oligospermia (in 2012), but now has azoospermia?
THANK YOU!!!!
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563773 tn?1374250139
Hello,
Thanks for writing back to me.

It usually takes several months after a vasectomy for all remaining sperm to be ejaculated or reabsorbed. If your boyfriend had vasectomy in 2009 and in 2012 he did not have zero sperm count then we cannot totally call it a vasectomy failure. Even counts less than one million sperm is very less likely to cause pregnancy until and unless recanalisation has occurred.
  
If he had oligospermia  ( in 2012 and 2014) then chances of pregnancy are very less and if he has azoospermia ( in 2012 and 2014) then chances of pregnancy are nil; provided no recanalisation has occurred which would have reversed the obstruction causing oligospermia and azoospermia .

I sincerely hope that helps. Take care and regards.




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Avatar universal
A related discussion, pregnancy after no scalpel vasectomy was started.
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