Background

The vasectomy rate among privately insured men ages 18 to 64 in the US increased by 0.11%—a 26% change—from 2014 to 2021 (see Figure).¹ This finding suggests the long-term decline in the vasectomy rate among privately insured men is likely over.^2,4 The authors hypothesized that this decline ended in 2014.¹ The difference in the vasectomy rate from 2014 to 2021 was greatest in men with 3 or more children (0.49%), with 2 children (0.3%), with a wife not of advanced maternal age (0.28%), and ages 35 to 44 (0.24%). The percent change was greatest in men with no children (61%), with a wife of advanced maternal age (41%), who were single (4%), and ages 18 to 24 (37%). Both the differences and percent changes were greater in rural geographies compared to urban geographies in every region except the Northeast.¹ Therefore, men who may be good candidates for vasectomies, such as those who are in their late thirties or early forties and are done having children, were responsible for most of the growth in the vasectomy rate from 2014 to 2021. However, demographics of men in whom vasectomies may be less common, such as those who are single and in their teenage years or early twenties, may be growing more quickly. Urologists and other practitioners who perform vasectomies should be mindful of these changes, especially those who practice in rural geographies.

Figure. National vasectomy rate among privately insured men aged 18 to 64 in the US between 2014 and 2021.

Will the Overturning of Roe v. Wade Increase the Vasectomy Rate?

The authors proposed several explanations for the increase in the vasectomy rate, including that men may have responded to national, state, or local debates on abortion by electing to receive a vasectomy.¹ A growing body of literature suggests vasectomies increased after the overturning of Roe v. Wade on June 24, 2022.^5,7 Bole et al published the first peer-reviewed data on this topic, comparing medical and billing records at a large Midwestern health system from July-August 2021 to July-August 2022.⁵ They found vasectomy consultations increased by 22.4%, and median procedural volume per month increased by 118 (P = .03).² Next, Kassab et al compared medical records from 2 high-impact university hospitals from June 15-21, 2022, to June 22-28, 2022.⁶ They found office visits for vasectomy consultations increased by factors of 2.4 at hospital 1 and 6 at hospital 2.⁶ Finally, Zhang et al conducted a retrospective cohort study in a nationally representative database of approximately 87 million patients from 55 health care organizations.⁷ They found vasectomy incidence increased by 0.194%—a 20% change—in the 7 months after the overturning compared to the 7 months prior, and that the trend in vasectomy incidence, which was increasing prior to the overturning, became greater (P < .05).

Implications

The vasectomy rate among privately insured men ages 18 to 64 increased between 2014 and 2021. Permanent contraceptive utilization in men and access to abortion for women may be related, so the overturning of Roe v. Wade may increase the vasectomy rate more in 2022 and beyond. Researchers should assess the causality of the relationship between vasectomy and abortion as survey and health insurance claims data become available; the variation in states’ legislation after the overturning offers a quasi-experimental design to do so. Researchers should also continue to monitor trends in the vasectomy rate among privately insured, publicly insured, and uninsured men, to ensure demand continues to be met.

Acknowledgments

Not every individual who is eligible for a vasectomy may identify as a man. We acknowledge that the term “men” does not reflect every gender identity.

The overturning of Roe v. Wade refers to the issuance of Dobbs v. Jackson Women’s Health Organization, 597 US ___ (2022).

Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose.

Author Contributions: OR, MH, and ZH proposed the study. MH and ZH drafted the manuscript. OR, MH, and ZH read and approved the final manuscript.