I think this dude needs to use the following words, to himself, his therapist, and his wife: "If my father had done what my wife is asking me to, I would not exist, and this issue is hitting me at a very basic existential level". I mean, what I'm hearing around the edges of this is that he almost seems to be taking it as though his wife says he shouldn't exist. Which I don't think is a correct framing, but it's what I'm getting from him.

Exactly this. I think that his circumstances make this especially emotionally loaded for him.

WITH THAT SAID, it’s much harder for women to get doctors to approve sterilization (spent many years playing THAT game, and basically had to get a separate tubal ligation to “prove” I was serious about wanting and needing a hysterectomy), and the invasiveness/recovery isn’t apples-to-apples.

(I still recommend that she do it, given the consequences if she gets pregnant. Wondering if she had Hyperemesis Gravidarum like I did.)