To vasectomy or not to vasectomy...

[Marquand]

I'm currently pregnant with DC3. I'm 43, and DP is 46, so in both our minds this is definitely the last one.

I would like DP to have a vasectomy - I really don't want to use the pill in future, and I'm not too keen on condoms either.

He said a straight out NO when I asked him. I really don't think it's an unreasonable request.

What do you think?

I think that a lot of partners worry about the risks of birth but at least IME a lot of that worry is focused on the immediate time on/after the birth rather than on the risk of permanent injury.

That not my experience. All the men in my friendship circles are fully aware of the risks of pregnancy and labour and concerned by them.

BTW not saying 'your turn to take the risk' but for those concerned with vasectomy risks and advocating use of a coil. Have you Googled the risks associated with that?

Yes I have. As I considered it recently. That doesn't mean one partner can insist the other has a procedure done

It would be waste of nhs funds!

NHS recommendation is using contraception until you are fully in menopause and periods have stopped. The average age for that is 51.

I don't know how much vasectomy costs as compared with 8 years of other forms of contraception for the OP, but I imagine it is pretty similar.

The cost of a vasectomy is certainly cheaper than medical care for another pregnancy. (Especially as mothers in their 40's are much more likely to have complicated pregnancies and deliveries.)

Do you know that according to BPAS more women in their 40's have terminations than teenagers?

Those guidelines are based on women using the pill continuously so that they can easily switch over to hrt.

Having a vasectomy for less than 2 years of possible fertile time left v's using some form of contraception or even the withdrawal method since the chances of a natural pregnancy are so slim at the age of 44/45

Not to mention the extra cost to nhs if complications occur after the vasectomy

I'm all for vasectomies but this case seems ott

If the op doesn't want to take the pill then why not try the mini pill for the short fertile period that remains. It's not forever it's less than 2 years

Or go private and spare the nhs!

What? You are actually saying women might as well stop using contraception at 45?

Is that what you believe?

Vasectomy in the private sector starts at about £400 (Marie Stopes). A mirena coil costs about £90 but I don't know how NHS would price the appointment time for fitting. But as each coil lasts 5 years, you're still looking at 15-20 years of contraception by LARC for the cost of one vasectomy.

It's not what I believe it's a scientific fact that there is a 3-4 % chance of conceiving naturally at 45. In practise it's very rare to see anyone over these age limits have a hearth baby naturally

Women are encouraged to stay on the pill as this helps with the switch over to hrt

If you didn't use any contraception after the age of 45 the odds are that you would not conceive naturally and if you did you would miscarry in the first trimester due to chromosomal defects

It's science and facts and the law of nature.

Of course there may be one of two in every social group who have conceived naturally but it's very rare. That's why people say I've heard of someone's cousin etc but may not personally know any people over this age group who have gone on to have a successful pregnancy.

It's so rare for it to occur I've never seen in at my hospital and I'm sure most doctors won't have either. That's why I can't believe a doctor would recommend a vasectomy when there is almost no fertile window left

Read the facts

You could get sterilised instead?

I doubt a gp would refer her. Unless she was having a c section and got sterilised at the same time it would be deemed an unnecessary operation

Discussions like these are why I wish more stats were taught in school.

The OP got pregnant at 43.
Fertility does not drop off a cliff edge. It declines gradually. As she is ovulating at 43, the chances that she will still be ovulating at 44, 45 or 46 are high.

Think about it like age of dying. What are the chances that I, in my 30's, will live to be over 100? Let's say it's 10%. What is the chance that someone who is 99 will live to be over 100? Much higher, since we have a lot more data - they've already lived to 99. I haven't.

Does that make sense? Many women are not ovulating any more at 43. But the OP is. So she is much, much more likely than average to still be ovulating right up into her late forties or fiftyish.

Aa a separate issue, I am doubtful of the 3-4% stat for the average 45 year old woman, and if it is true, what it specifically means. It can be interpreted various different ways. I would like to look up studies on Google Scholar to confirm it and I'll try to get some time to do so later on.

That 3-4% chance is per cycle, and yes it's much lower than for younger women.

But it's not the same as zero.

If pregnancy would be disastrous for you then you need to use contraception for as long as you are menstruating. And the NHS provides it.

The over 45 birth rate in UK has increased by 200% in recent years (ONS, 2015 statistics). Miscarriages would not be counted in that, so the number of conceptions must have increased more.

The birth rate has only Increased with the help of ivf. Why do people write so much crap on here

Why do people write so much crap on here

I give up.

I don't understand what you are saying

You are saying there is a 3-4% chance of a woman aged 45 conceiving naturally and having a healthy baby.
So there is a ??% chance of conceiving and miscarrying or having a not healthy baby? Is that right?
But you don't think women over 45 should worry about that and might as well go contraception free?

If you are that worried - use two methods at a time. There are pros to lots of things for example condoms are fab in stopping stuff get on the car seats, settee, carpets etc.

Seriously, contraception wouldn't be provided free on the NHS if it didn't have a value. Relying on my fertility declining naturally as a method of contraception is, for me, up there with having sex standing up.

I understand some people feel very strongly about vasectomies. It's still our choice and for us to weigh up relative risks of different options. It's just all the alternatives carry risks, mostly carried by the woman.

Trying to close down the argument by saying vasectomy =bad and look at all the alternatives really isn't helping.

The best choice for us as a couple is probably different to the best choice for someone else. Doesn't make either choice wrong.

What I do know, based on when my mum hit the menopause, is that I expect to need contraception for another 15 years. Because I do intend to have sex between now and then and I will not rely on me being infertile (or increased chance of miscarriage! ) or the withdrawal method. Ffs.

3-4% fertility for women over 45 means that in a year, 100 women over 45 will get pregnant. That isn't good enough for me.

Two things:

1. I know it's already been said but I think AlasAlas saying "You comment on every vasectomy thread. It's not right to make it a personal crusade." is pretty damn rude to TheFuzz. I think it's important that he does share his experience, I don't understand why he shouldn't comment on every vasectomy thread and don't see why you consider it 'a crusade'. That's his real lived experience, it sounds bloody awful and he has my every sympathy.

2. Some people seem very quick to play down the 1 in 10 chance of pain. I know full well that I wouldn't be particularly comfortable with that level of risk going into an operation, when other options were available. Especially when just upthread there's quotes of stats for getting pregnant at a certain age being 3-4% where someone commented that risk isn't acceptable to them. Even though it's less than half the risk of pain post vasectomy. There seems to be quite a blasé attitude to balls by some posters. Glad that a lot of others don't seem to hold this view.

Haven't read the ft but, op, how are you expecting to give birth? If there is any possibility of a cesarean (emcs or elcs) Is get it plastered all over your notes that you'd like to be sterilised while they're in there.
Mine was an elcs from the outset (emcs, elcs previously) and I made sure the subject came up in every single conversation with the mw and consultant.
No way would dh ever have agreed to a vasectomy.

DH had a vasectomy a week ago, he is black and purple with bruising and cannot sit down/stand up/walk comfortably. This morning we found out the wound is also infected. Awesome.

But he doesn't regret it at all!

Having said all this, it is still his body, it's really up to your dh. It may be the sensible option to you but you can't force him.

I an not truvialising the experience of some posters. I have seen the NHS page giving 1 in 10 experience long term pain. Fuzz has my deepest sympathy.

I would expect though that of the 1 in 10, only a fraction have that experience with others experiencing different levels of pain and some presumably having treatment. I don't know the details and that is the information we will be looking for.

BTW a 3-4% chance of pregnancy is also a baby, child, human being. That's pretty life changing all round.

The 1:10 is for long term testicular pain, ie PVPS.

The other pretty shitty but treatable complications (like granulomas) are in addition to that.

I realise it means longterm pain. What I am trying to understand is how affects people differently. I would be surprised if everyone was affected in the same way and to the same extent.

NRFT but can't you get an essure (a non invasive form of sterilistation) if he won't have a vasectomy OP? i am getting one on the NHS next month, it takes no longer than putting a coil in, basically little springs are put in your tubes to make them close up. Its really a lot less invasive than a normal sterilisation procedure under general anaesthetic but works just as well.

tilder, I did a bit of googling and reading of research papers. There are various figures but I think that the number of vasectomies resulting in pain which is debilitating or affecting quality of life is between 1 and 5%. So not an insignificant number at all.

One of the definitions of PVPS is pain severe enough to seek medical attention. The pain is often made worse by sex.