Analysis of international practice patterns regarding postvasectomy fertility options

Area of Science:

• Urology
• Reproductive Medicine
• Surgical Practice Audit

Background:

• Management of postvasectomy fertility options varies among urologists.
• Differences in practice patterns may exist between the USA and UK.
• The impact of andrology fellowship training on practice standards is not fully understood.

Purpose of the Study:

• To compare the management of postvasectomy fertility options by urologists with and without andrology fellowship training.
• To evaluate and contrast the practice features of urologists in the USA versus the UK regarding vasectomy reversal (VR).

Main Methods:

• An audit of American Urological Association-affiliated urologists was conducted on their VR management practices.
• Practice standards were assessed against 10 best practice parameters.
• Fisher exact test was used to compare management strategies between trained and untrained urologists and between US and UK practices.

Main Results:

• UK urologists performed VR more frequently than US urologists (83.6% vs 50.4%).
• US urologists provided more detailed information on fertility options and used microsurgical techniques more often, but less frequently counseled couples together and referred for IVF-ICSI.
• Non-fellowship-trained urologists, in both countries, were less likely to counsel couples on all options, discuss IVF-ICSI, provide outcome data, or use microsurgical techniques.

Conclusions:

• Significant disparities in VR practice standards exist between US and UK urologists.
• Andrology fellowship training is associated with improved adherence to "best practice" guidelines.
• Increased volume of VR procedures performed correlates with higher concordance with best practice standards.