Among 200 couples referred for counselling with a view to donor insemination (DI) were 21 whose request arose from an earlier vasectomy. This had been judged irreversible, apart from one case where the man had been sterilised for genetic reasons and therefore had not sought reversal. An overall incidence of 10.5% indicates that vasectomy may lead to fertility problems in the event of remarriage, which has become more common with an increasing divorce rate. All 21 husbands but only 3 wives had been previously married; 3 former wives had died, otherwise all previous marriages had ended in divorce. Most husbands were considerably older than their second wives, epecially as compared with the majority of men in the larger series who were still in a first marriage. Their relative maturity may have helped them to respond more sensitively to their wives' maternal needs when they already had children of their own. During a follow-up interval of up to 8 years, 2 couples had separated after a brief relationship but 9 of the other 12 contacted had become parents by DI. The 3 remaining couples included a wife who at the latest report was 5 months pregnant, and 2 who were still pursuing treatment. Despite the low failure rate in this small series we should bear in mind that DI is not an ideal solution to the problem of male infertility, nor always even acceptable. Pre-operative banking of semen as a form of insurance against unforeseen circumstances may appeal to some men who have decided on vasectomy, although this facility is neither widely available nor commonly used where it is available. © 1993.
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