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

To 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 postprocedure. Additional outcomes include the need for repeat vasectomy within 1 year and birth rates. Logistic regression 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 postprocedure 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 (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 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 rare. 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.