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

We characterize trends in vasectomy utilization, delivery, and failure in a large administrative database.

We used the Merative 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 1 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 of the procedures performed by urologists (n = 344,319). Overall postvasectomy pregnancy rate 6 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 postvasectomy pregnancy (p_trend = 0.03) and birth (p_trend = 0.04) rates were observed. Older age and recent vasectomy years were associated with reduced odds of VF, while the absence of a postvasectomy semen analysis was associated with increased VF (adjusted odds ratio [aOR]: 1.14; 95% CI: 1.03-1.25; P < .001). Importantly, vasectomies performed by nonurologists (aOR: 1.56; 95% CI: 1.40-1.74; P < .0001) and vasectomies occurring in office-based settings (aOR: 1.25; 95% CI: 1.08-1.44; P < .01) were associated with higher odds of repeat procedures.

VF is a rare phenomenon. Older age and vasectomies performed in later years correlate with decreased odds of failure, whereas the lack of postvasectomy semen analysis increases odds of failure. A higher pregnancy rate shortly after the procedure underscores the need to improve patient counseling.