A strange tale of oral sex, a knife fight and the most unlikely of pregnancies recently brought to light by the blogosphere has doctors touting the triumphant persistence of sperm.
In 1988, a 15-year-old girl living in the small southern African nation of Lesotho came to local doctors with all the symptoms of a woman in labor. But the doctors were quickly puzzled because, upon examination, she didn't have a vagina.
"Inspection of the vulva showed no vagina, only a shallow skin dimple," so doctors delivered a healthy baby boy via Caesarean, the authors wrote in a case report published in the British Journal of Obstetrics and Gynaecology.
Her birth defect -- called Mullerian agenesis or Mayer-Rokitansky-Küster-Hauser syndrome -- didn't necessarily surprise doctors, but her pregnancy did. Even the 15-year-old girl could not believe she was pregnant.
Yet by looking at her records the hospital staff realized the young woman was in the hospital 278 days earlier with a knife wound to her stomach. The average pregnancy lasts 280 days. After interviews, they gathered that "Just before she was stabbed in the abdomen she had practiced fellatio with her new boyfriend and was caught in the act by her former lover. The fight with knives ensued."
The girl arrived at the hospital with an empty stomach -- and therefore with little stomach acid around -- and doctors found two holes from a stab wound that opened her stomach up to her abdominal cavity. The case report said doctors washed her stomach out with a salt solution and stitched her up.
"A plausible explanation for this pregnancy is that spermatozoa gained access to the reproductive organs via the injured gastrointestinal tract," the authors wrote.
"Here's an unbelievable set of coincidences," said Dr. Richard Paulson, head of the University of Southern California Fertility Program in Los Angeles. "But it's totally plausible."
Although doctors know that sperm needs a low acid (high pH) environment to survive, and would likely die eventually in the low pH of stomach acid, doctors also said that sperm comes in a protective fluid: ejaculate, a nourishing medium meant to protect the sperm.
Besides, "out of hundreds of millions of sperm if you knock out 90 percent of them, you're still going to have tens of millions of sperm," said Dr. Peter Schlegel, chairman of urology at New York Presbyterian Hospital/Weill Cornell Medical Center in New York.
"Sperm are pretty hardy," said Paulson, who pointed out that sperm must make it out of the acidic environment of the vagina before reaching more friendly territory at the cervix and in the uterus. Once in the abdominal wall, Paulson estimated that the sperm could survive for days.
"It's a long way from the stomach into the lower abdomen, it's a heck of a trip, but they made it," said Paulson. "You just need sperm somewhere in the area of an egg."
Paulson said in the early days of fertility treatments in the 1980s, doctors injected sperm in the lower abdomen hoping for the coincidental encounter with an egg. The procedure, called DIPI or direct intraperitoneal insemination, has largely been replaced by more effective methods.