When Tubal Ligations and Vasectomies Fail

By Corinne Garcia | June 21st, 2011 at 12:00 am

Mari Dominquez, of Bozeman, Montana, stared at the results of her pregnancy test in total disbelief. How could she be pregnant? Mari’s husband, Joe Patton, had a vasectomy four years prior.

Back when Joe “got snipped,” the couple felt like they’d made it over a major parenting hurdle. With both kids in school, they no longer had the daycare bills, and the baby stage – sleepless nights and endless diapers – was a thing of the past.

But, surprise! Mari had a positive pregnancy test glaring in her face.

Mari and Joe joined the ranks of the very small percentage of vasectomies that fail, and little Josie, now three years old, is living proof that getting snipped doesn’t always work. “I didn’t know whether to laugh or cry,” Mari recalls. “Joe didn’t seem as shocked. I think to him it was some external affirmation of his virility,” she laughs.

And who could blame him? The odds of getting pregnant after a vasectomy are pretty low. An estimated 11 percent of the population uses vasectomy as their primary method of birth control, and the Royal College of Obstetricians & Gynecologists report a 1 in 2000 (.05 percent) chance of a pregnancy resulting from vasectomy failure. This statistic is based on the men who’ve been given clearance to get back in the game after having their sperm count tested.

Though the percentage of failed vasectomies is low, Dr. David Kaufman of Central Park Urology in New York City, who has performed thousands of vasectomies, isn’t convinced that they ever fail. “It’s hard for me to imagine that if a man has a vasectomy done right and continues to use contraceptives until he has a semen analysis that documents a zero sperm count, that it can’t not work,” he says. In other words, assuming the procedure is done correctly and the patient obeys follow-up instructions, there should be no surprise babies.

Dr. Kaufman says that pregnancy may occur if the patient hasn’t “cleaned out the pipes,” as live sperm is detected in about 10 percent of routine post-vasectomy sperm counts. “Some men have higher amounts of storage than others,” Dr. Kaufman explains. “It can take up to 50 or 60 ejaculations to clear out the pipes : they have to ejaculate like a monkey!” Some men even ask him to write a note to their wives explaining the need for lots of sex.

Another reason for failure? “The milkman effect is always something you have to consider truly,” Dr. Kaufman says. Joe had a zero sperm count after his vasectomy, and at first, Mari’s doctor asked if the baby was indeed Joe’s. It is.

But there is also something called a re-canalization, described by Ken Goldberg, M.D. of Texas Urology and founder of the malehealthcenter.com, as a rare occurrence in which “the ends of the vas deferens reopen.” Although this is reported in less than 1 percent of vasectomy patients, Dr. Goldberg says this re-growth can be prevented even more if the doctor makes sure to leave a large enough gap between the cut ends. “If the doctor removes a reasonable segment, the better off you are,” he says. “The more tube you take out, the wider the gap that the sperm would have to bridge.” And Dr. Goldberg also recommends a follow up. “Make sure you come back, and make sure you’re cleared a year after, and there’s no sperm present,” he says.

“I don’t blame the doctor for the failure,” Mari says. “I honestly think it was a fluke. We just happened to be in that percentage.”

Vasectomies aren’t the only surgical sterilization that can fail. After having seven kids, Beth and Robert Wilson of Richmond, Virginia decided tubal ligation was the best way to ensure they didn’t have any more. They were wrong.

“My period was the one thing in my life that was consistent,” Beth recalls, explaining that after she had her tubes tied, she was sure she wasn’t pregnant after missing a period. When she finally took a test, she was in shock when the doctor called telling her it was positive.

“I was totally speechless,” she says. “I thought, ‘I can’t go through this again.’ It had taken so long to come to the decision.” But, like Mari and Joe, the couple rolled with it, and they now have 21-year-old Merry, the youngest of eight children.

And they’re not alone. An estimated 15 percent of the population use tubal ligation as their primary method of birth control, according to the Surgery Encyclopedia. Failure occurs in about 5 per 1,000 women after one year and 18 per 1,000 women after 10 years, according to Comprehensive Gynecology.

So how does it fail? Beth’s doctor explained that most likely not enough scar tissue formed to block the fallopian tubes, and that over time more would form. It was a case of too little, too late. Other documented reasons tubal ligations fail, although rare, include the tubes growing back together, a botched surgery, or the rare case of a woman being pregnant before the surgery.

“It’s not common, but it does happen,” says Dr. Colette Kirchhoff, MD of Family Practice in Bozeman, Montana, explaining that, although rare, some result in a tubal pregnancy.

Whatever the reasons, Mari and Joe and the Wilsons were unexpectedly flung back into baby land. Both couples had to reclaim their baby gear and their baby mentality, and start over again.

“I never would have pictured myself with three kids,” Mari says, explaining that she still thinks about how much easier things would be if they just had two. Both in their late 40s, the couple often joke about how old they’ll be when Josie hits certain milestones. “But there’s an element of it where I feel like maybe this was meant to happen.”

And Beth can’t imagine life without Merry. “We just told her when she was older that she was really meant to be. She’s extra special and intended to be on this earth,” Beth explains.

So if a couple is absolutely positive that they want no more children, what is the safest route – birth control or sterilization surgeries?

“I don’t know,” reports Dr. Kaufman. “It depends on the person. Older women will hit menopause and may want to use birth control to bide time for another year or two.”

But Dr. Kirchhoff explains that birth control fails more often because it leaves more room for human error. “People forget to take their pill or don’t take it on time, and that decreases the efficiency,” she says.

If you choose to go through with surgery, it’s important to follow up with your doctor. After a vasectomy, the patient should return for a zero sperm count, using other birth control in the meantime. After a tubal ligation, a woman may opt for a hysterosalpingogram (HSG) test to ensure the surgery was effective.

And for whatever reason, some pregnancies might just occur anyway, regardless of precautions. “When we sent an email to let our families know about this third pregnancy,” Mari laughs, “we said that Joe had ‘super-seeded’ his vasectomy.”

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