The status of vasectomy in the United States: Economic influences and long-term follow-up in men with no children

Background: Vasectomy is surgical occlusion of the vas deferens as a form of male contraception. Vasectomy is the most common non-diagnostic procedure performed by urologists in the United States. While uncommon, a childless man requesting a vasectomy can be an ethically challenging scenario for urologists. We hypothesized that men who had undergone vasectomy prior to having children would have higher rates of vasectomy reversal and family planning attitudes inconsistent with being sterile compared to men undergoing vasectomy after fathering children. We also studied the relationship between national economic conditions and men electing vasectomy.;Methods: We performed an analysis of the 2002, 2006-2010, and 2011-2013 waves of the National Survey for Family Growth (NSFG), a nationally representative survey of family planning in the United States. We compared demographic information and family planning attitudes among men who had undergone vasectomy and compared characteristics of those with vs. without children. We also performed a survival analysis of the National Survey for Family Growth 2002, 2006-2010, and 2011-2013 datasets with additional economic information obtained from the National Bureau of Economic Research and the Bureau of Labor Statistics.;Results: Of the 20,146 men surveyed, 696 (3.5%) reported undergoing a vasectomy. Of the men reporting vasectomy, 3.5% (95% CI 2.4-5.1) underwent the procedure without having had children. Compared to men with children, men without children were older at the time of vasectomy, were less likely to have ever been married, and were more likely to be agnostic or atheist. Whereas 1.3% (0.7-2.5%) of men with children underwent vasectomy reversal during the follow-up, 0% of men without children underwent reversal, p=0.441. When asked how many children they intended to have, men without children expected 0 children, whereas vasectomized men with children expected 0.01 (95% CI: 0.0-0.2), p=0.007.;For the economic analysis, of the 20,146 men who participated in the NSFG, 7,424 men had at least one child, which using NSFG weighting methodology, is equivalent to a national population of 27,329,505 men. Of these men, 12.1 % (95% CI 10.6 -- 13.7) underwent vasectomy after having a child. Using multivariate Cox proportional hazards regression, we found that compared to men in their teens, men ≥ 25 years old were almost twice as likely to undergo vasectomy after having a child [hazard ratio (HR) 1.88 (95% CI 1.29 -- 2.75)]. Compared to men with 1 child, men with two children were 2.61 (95% CI 1.64 -- 4.16) times more likely to undergo vasectomy and men with at least three children were 3.57 (95% CI 2.37 -- 5.37) times more likely have the procedure. Compared to non-Hispanic White men, Black (HR 0.16 95% CI 0.11 -- 0.25), Hispanic (HR 0.23 95% 0.16 -- 0.34), and other minorities (HR 0.35 95% 0.16 -- 0.77) were significantly less likely to undergo vasectomy. Men who had children born during an economic trough were more likely to undergo vasectomy, (HR 1.23 95% 1.01 -- 1.52).;Conclusion: Men who undergo vasectomy without having children constitute a small but distinct population of men. During short term follow-up post vasectomy, men who have not fathered children do not express higher rates of post-vasectomy regret. In addition to demographic factors such as age and race, the economic environment influences a man's likelihood of undergoing vasectomy such that men who have children born during an economic trough are more likely to subsequently undergo a vasectomy.