Counselling did help this couple towards an acceptance of their situation, but years of suffering might have been avoided if they had been encouraged to make a joint decision regarding their future together when the wife had recovered from her third delivery. However, it must be recognized that it is easy to be wise after the event, and with hindsight the patient may find it easy to blame the doctor for inadequate discussion. At times of stress people do not really hear those things that they do not wish to hear, as the following case demonstrates.

A married couple attended the subfertility clinic over a period of several years. As time passed the anguish of the woman and the grief of the husband became increasingly distressing. The man was in his 50s, tall, distinguished and successful. He had agreed to a vasectomy in his first marriage because his wife suffered from a severe depressive illness which recurred after each childbirth. He had felt that she had suffered so much that he should have the operation. His wife died some 10 years after the vasectomy and after a time he had remarried a much younger woman. They both wished for children, and he underwent reversal of vasectomy.

This man was totally unprepared for the very poor semen analyses after reversal. He felt that he had not understood that the operation should be regarded as irreversible when the vasectomy was discussed. He did volunteer that he had been under considerable stress at the time, and he felt now that it would have been more appropriate if his wife had been sterilized as she could not have had another pregnancy safely. At the time he had felt she had suffered enough.


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