Letters

Sterilise in haste, repent at leisure and great expense

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7266.962/a (Published 14 October 2000) Cite this as: BMJ 2000;321:962
  1. Edward Tuddenham, professor of haemostasis (edward.tuddenham{at}csc.mrc.ac.uk)
  1. Imperial College School of Medicine, Hammersmith Hospital, London W12 0NN

    EDITOR—Roberts's editorial on good practice in sterilisation well summarises the technical issues involved in surgical sterilisation but passes lightly over the social, psychological, and ethical issues attached to this highly personal topic.1 I do not know if the Royal College of Obstetricians and Gynaecologists' publication—the main source for the editorial—does any better,2 but I wish to discuss here a point that has been raised in the literature on assisted conception.

    A considerable proportion (over 10%) of requests for fertility treatment now come from men and women who underwent surgical sterilisation to please a previous partner and have subsequently remarried (including, ironically, the first successful case of in vitro fertilisation).3 Such treatment is expensive and traumatic and usually fails, in the case of vasectomy because of high titres of antisperm antibodies and the low success rate of intracytoplasmic sperm injection and in vitro fertilisation generally.4

    The only counselling that is given before sterilisation in most clinics is the information that the operation will be difficult to reverse. There may be no request to interview the partner or to discuss the matter further. An andrologist I know, who makes his living performing surgical reversals and difficult sperm recovery procedures, tells me that demand for sterilisation of the partner is often a symptom of rejection, which is followed quite soon by departure of the spouse. I am acquainted with several people to whom this has happened.

    In cases in which the demand comes from the partner who is not the subject of the operation, informed consent is a misnomer but rather resembles taking a cat to the vet. The cost of failed in vitro fertilisation procedures in this country is about £100m annually; most of these procedures are paid for privately and of course keep the cash registers of the in vitro fertilisation industry ringing merrily. Of that £100m, at least £10m must relate to earlier surgical sterilisation procedures. Clearly this could be avoided if semen was stored before vasectomy3 or couples are urged through proper counselling to really think through the implications of mutilating the future fertility chances of either partner.

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