In this episode, Scully and Doggett investigate several women who had no way of naturally conceiving but who claim to have been abducted and impregnated with alien babies.
"Per Manum" featured a substantial appearance by Duchovny who had elected not to return to the show as a full-time main character following the ending of season seven.
FBI special agents John Doggett (Robert Patrick) and Dana Scully (Gillian Anderson) meet Duffy Haskell (Jay Acovone), who tells them about his wife—a multiple-abductee who he believes was killed by her doctors upon giving birth to an alien child.
Duffy refers the agents to Zeus Genetics in Maryland, and shows them an ultrasound scan that seems to vindicate his story.
In a flashback, Fox Mulder (David Duchovny) tells Scully that her abduction has rendered her infertile, as her ova were harvested for genetic experiments.
At Zeus Genetics, Scully overhears a pregnant woman, Mary Hendershot (Saxon Trainor), who is telling her doctor that she no longer wants to be under his care.
In order to avoid being seen, Scully hides in a storeroom, finding it full of preserved fetuses that resemble the alien child born earlier, but she is discovered by a Dr. Lev.
The women are driven away, but Mary enters labor and it becomes clear to Scully that Rohrer is not acting with good intentions.
After settling his contract dispute with Fox, Duchovny quit full-time participation in the show after the seventh season.
[3] In order to explain Mulder's absence, Duchovny's character was abducted by aliens in the seventh season finale, "Requiem".
[9] Spotnitz has described "Per Manum" as being "a real paranoia episode", concerning "the way you perceive connections between people, what are they saying, and is it suspicious or not".
[9] Adam Baldwin, who makes his first appearance as recurring character Knowle Rohrer, originally auditioned for the part of John Doggett, losing out to Robert Patrick.
[19] Despite this, VanDerWerff noted that the episode "has some issues", largely due to the convoluted nature of the mythology at this point in the show's run, as well as the fact that Duchovny looked "a little bored" at times.
[20] Robert Shearman and Lars Pearson, in their book Wanting to Believe: A Critical Guide to The X-Files, Millennium & The Lone Gunmen, rated the episode five stars out of five, calling it a "return to form" for the series.
[21] Tom Kessenich, in his book Examinations: An Unauthorized Look at Seasons 6-9 of 'The X-Files', noted that the episode typifies the basic themes of the series—"dark, foreboding terror, overriding sense of paranoia" and "the fear of the unknown" among others.
[22] Writing for The Vindicator, Eric Mink felt that the episode was "intense, unsettling, sometimes gross, and suspenseful to the point of nerve-racking [sic]", feeling that its plot would "resonate instantly and ominously with viewers".