A Contemporary Estimate of Vasectomy Failure in the United States: Analysis of US Claims Data.

Abstract

To characterize trends in vasectomy utilization, delivery, and failure in a large administrative database.We utilized the MerativeTM MarketScan® (2007-2021) Commercial Database to identify vasectomized men. Vasectomy failure (VF) was defined as documented pregnancy =6 months post-procedure. Additional outcomes include the need for repeat vasectomy within one year and birth rates. Logistic and Cox proportional hazard regression were used to analyze factors associated with failure.In a cohort of 489,277 vasectomized men, the mean (SD) age was 38 (6) years, with most procedures performed by urologists (n = 344,319). Overall post-vasectomy pregnancy rate six months post-procedure was 1.97 cases per 1000 persons per year, representing a pregnancy rate of 0.58%. Annual declines-particularly in recent years-in post-vasectomy pregnancy (ptrend=0.03) and birth (ptrend=0.04) rates were observed. Older age and recent vasectomy years were associated with reduced odds of VF, while the absence of a post-vasectomy semen analysis (PVSA) was associated with increased VF (aOR:1.14; 95% CI: 1.03-1.25; p<0.001). Importantly, vasectomies performed by non-urologists (aOR:1.56; 95% CI:1.40-1.74; p<0.0001), as well as vasectomies occurring in office-based settings (aOR:1.25; 95% CI:1.08 -1.44; p<0.01) were associated with higher odds of repeat procedures.Vasectomy failure is rare. Older age and vasectomies performed in later years correlate with decreased odds of failure, whereas the lack of PVSA increases odds of failure. A higher pregnancy rate shortly after the procedure underscores the need to improve patient counseling.

View details for DOI 10.1097/JU.0000000000004405

View details for PubMedID 39740108