Mid 40s contraception dilemma. Both still fertile. Impasse reached - frozen!

[Greenlandrover]

We are both 46. I have two young children from previous LTR.
He has none.
We lost a baby last year, early miscarriage.

I'd never (knowingly) had a m/c before and it knocked me for six. I'm still not over it. Consequently the idea of another m/c is alarming to say the least. It happened whilst I was on patch contraceptive.

Admittedly I wasn't 100% with the patch at remembering to change it so that doubtless contributed to the pregnancy.

But my boyfriend said his previous LTR became pregnant whilst on the pill and he seems quite confident she wasn't neglectful taking it, so he's had two women pregnant on contraception which makes me further dubious - I really don't want to risk another m/c.

He's asked his doctor about vasectomy, and I've researched sterilisation as I'm very worried about having to take hormonal contraception again. I've looked at everything including all the ones that are left inside long term.

He says he will have a vasectomy if I don't want to use hormonal contraception, and as he's sure he doesn't want children, that sounds ideal. However, he has had a heart attack not too long ago, and is now stented and on permanent heart meds, so it seems unfair to put him through another medical procedure - however straightforward a snip is, I know - but we both seemed to have reached an impasse with who makes the contraception decision.

Does he snip (me clipping is out as it's too invasive, bigger risks, and still with the possibility of pregnancy, and an ectopic one at that), or do I go back on hormonal contraception? We are both saying to eachother the same thing, 'If you don't want to do it, I will'. We just can't make the decision!

I'm due a heart consultation next week as I have a slight issue (short PR wave, no biggie) and I'll ask my doctor's advice too, but it's ultimately that either myself or my boyfriend have to say, right, I'll do it!

I've now told him I'll go back onto hormonal contraception but the more I think about it the more it scares me. But I can't bring myself to say to him, AI know you've had Heath issues recently and you shouldn't have to go through anther procedure, but you have said you don't want children, and I definitely don't want to risk another m/c, so surely vasectomy is the right decision?

Then again, I had my pregnancies age 38 and 40 and then the m/c at 45, and a maternal family history of pregnancies in mid to late Forties on my Mum's side, so I'm always aware I may still be fairly fertile (as he is, clearly!) and no hormonal contraception is infallible..

Your views or advice would be so warmly received, thankyou. I'm at an impasse and can't move.

There is so much contraceptive options from the jab to implants that would avoid any surgical risk to both of you, the snip isn't always the pain free easy method that we are lead to believe a friend from work truly regrets sending her hubby for the snip due to pain he is suffering 3 months later

There is surgical risk and surgical risk. Female sterilisation is a big surgical procedure with subsequent impact on your hormone state. I would let your DP have a vasectomy, it is a minor out patient procedure, like going to the dentist.

It isn't a big surgical procedure and doesn't have an impact on hormones. I wish people would stop advising what they know nothing about.

UrethraFranklin1 how do you know, I know nothing about it?

My statement was not a direct quote as it was 15 years ago, but it was a paraphrase of what the Consultant said to myself and my DW, when we went to discuss. Of course you may be more qualified than the consultant, but certainly I took his advise at face value. As the altenative was spending the next 10-15 becoming qualified enough to contradict him (if indeed contradiction was appropriate).

Vasectomy is surgery with a 10% risk of the serious complications (see NHS pages) and not remotely comparable to a dental procedure.

But if your DH is happy with that level of risk (after all, that means 90% are fine in 3 weeks or so, many within a day or few), the fail rate for vasectomy is lower than that for traditional female sterilisation. Essure however claims to be as safe or safer than vasectomy. And although not risk free, it does seem to be lower risk of complication that vasectomy.

The risks of the serious complications of vasectomy are often under-estimated, whereas those is female sterilisation are sometimes overstated.

Hysterectomy is major surgery with possibly major effect on hormones.

Not tubal ligation though.

Though both procedures leave you sterile.

I was sterilised 2 years ago - best decision i ever made.
Op performed in day surgery at Hospital, pain for few days - nothing that paracetamol didn't sort & back to work after a couple of days

No impact to hormones.

I had my tubes tied over 30 years ago. Keyhole surgery with 3 incisions around the navel so the scars were never obvious. I couldn't take the pill, was advised to limit my children to 2 and have never looked back. Such a pleasure to enjoy sex spontaneously without all that faffing about.

15 years is a long time ago, and your comments are categorically wrong. Tubal ligation is minor day surgery with NO hormonal impact.

UrethraFranklin1 apologies just checked with DW, apparently Consultant was talking about something else re:hormonal impact (contraception options). But he did lean heavily on the man having the op, as it was a signifcantly easier op in relative terms.

Things may have changed but mine was easy, in and out in less than an hour, watched the whole thing, no after effects.

I recently had a tooth removed, stunted wisdom tooth (not the real term) and I know which I would be happier to have done again.

I think the fact that your husband has a coronary artery stent will have a big impact. He will be on some anti clotting medication and will have to stop this before surgery ( with risk of occluding his stents) or not and risk haematoma/ local bleed following vasectomy.

That sounds like it makes that option not sensible at all.