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

Purpose: To characterize trends in vasectomy utilization, delivery, and failure in a large administrative database. Materials and Methods: We utilized 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 one year and birth rates. Logistic and Cox proportional hazard regression were used to analyze factors associated with failure. Results: 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. Conclusion: 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.