He had a vasectomy, but they're now expecting their fourth child

Medgclay Salano Inzai and his wife Beryl Salano who is heavily pregnant. [Alex Chagema, Standard]

Medgclay Salano Inzai underwent a vasectomy in July 2022 following lengthy discussions with his wife, Beryl Salano. At the time, Beryl had borne him three children, all through caesarean section (CS). The possibility of another CS caused them a lot of concern.

Vasectomy is a medical procedure in which the vas deferens - the tubes through which sperms flow - are severed to stop their movement. Ideally, it is presumed to be a permanent, irreversible procedure for birth control in men. To his consternation, though, Beryl got pregnant despite the vasectomy. She is due to deliver this month.

Beryl maintains that they were faithful to one another and infidelity was out of the question.

"I am a mother of three, going for four this month. I have been married for 12 years. My husband and I are very close, more of friends. At some point, he felt I was using too many family planning pills because they had started to affect my periods and blood pressure," Beryl says as she explains what led to the decision to opt for vasectomy.

Mention of 'family planning' brings to mind pictures of women taking birth control pills, or undergoing tubal ligation to stop having more children. In the typical African male-dominated society, where machismo goes for everything, it is rare to find men who are willing to go for vasectomy out of consideration for their wives.

According to the Economic Survey 2023, the number of men undergoing vasectomy rose to 557 in 2022, up from 248 in 2021. In 2020, 334 men underwent sterilisation.

Men feel safe knowing they can still sire other children if they divorce or lose a child. Often, the women get the short end of the stick. Salano is among those who embraced vasectomy in 2022.

"A family is built by both man and woman. It is, therefore, wrong to make it look like family planning is an all-women affair. Vasectomy is not castration. I made a conscious decision to go for a vasectomy and I do not regret it. Other men should go for it too, it is safe," says Salano.

Indeed, the fear of becoming sexually dysfunctional is the reason most men give vasectomy a wide berth.

"Men shouldn't worry. When my husband told me he was going for vasectomy, I had my misgivings. I was worried it could negatively affect our sex life, but I was wrong because things got better," Beryl admits.

A woman getting pregnant months after her husband underwent vasectomy would have raised issues of infidelity on the part of the woman. Indeed, Beryl is aware of this but says the level of trust between them cannot lead to such an outcome in their relationship.

According to Dr Stephen Lukasewycz, a Urologist, vasectomy is a very effective form of birth control and only a small percentage of patients report failure.

He says that having sex too soon after the procedure might lead to pregnancy since it takes several months for semen to be sperm-free after vasectomy.

Beryl says the realisation she was pregnant shocked her. She was sure she could not be impregnated by her husband, and she had not strayed outside her marriage. "My husband is a health practitioner who works with men. He is part of a group that has been educating men on the need to go for vasectomy as a way of taking the pressure off their wives in terms of taking pills for birth control," she adds.

"We love and are faithful to each other. We are believers hence, infidelity is a nonissue. When my husband went for a vasectomy, he was informed of all possible outcomes, and being a medical practitioner, he understands such procedures are not 100 per cent guaranteed to succeed," Beryl says.

Dora Aura, a clinical officer, says it is possible for a woman to get pregnant even when her husband has undergone a vasectomy.

"A part of the vas deferens could have been severed, but semen has lined up in the tube up to the urethra. If you engage in sex almost immediately after the procedure, there is a likelihood of causing a pregnancy. We advise our male clients to use precautions during the first 21 ejaculations after vasectomy. They should conduct a semen analysis after three months," she explains.

According to Beryl, she first noticed her tummy was growing big and took to exercising to cut it down. However, despite the physical exercises, the tummy kept growing and that is when she started suspecting that she was pregnant.

"When the doctor finally confirmed I was pregnant, I went into denial. I was worried about how the public would view me because I had delivered my third born last year and the baby is barely seven months old," she says.

According to her husband, they followed the doctor's advice after the vasectomy.

"I was told to use protection for three months since there is always the possibility some semen could remain in the vas deferens after vasectomy. We had safe sex for three months but soon noticed my wife missed her periods.

"She put it down to a normal delay but when it did not come for three months, we went for a test that confirmed she was pregnant, and that shocked us. We went to our doctor who informed us there was a chance such a thing could happen. After she delivers, I will undergo a test to confirm my sperm count," Salano says.

The Indian Journal of Urology advises couples to undergo "an analysis of semen specimen after a vasectomy to confirm success before the use of alternative contraceptives is abandoned".

The journal states that the most important factor accounting for failure of vasectomy is the length of the vas deferens. "At least 15 mm of vas deferens should be excised to maximize the success of the procedure".

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