1 in 5 Men Desire Future Fertility After a Vasectomy
Urology – September 30, 2013 – Vol. 30 – No. 10
Predictive factors for vasectomy include income, number of biologic children, access to care, education level, religion, and race.
Article Reviewed: Vasectomy Demographics and Postvasectomy Desire for Future Children: Results From a Contemporary National Survey. Sharma V, Le BV, et al: Fertil Steril; 2013;99 (June): 1880-1885.
Background: Nearly half a million men choose vasectomy each year. Having a clear understanding of which men undergo a vasectomy can help improve counseling and possibly provide guidance to increase acceptance in those not currently seeking vasectomy. Additionally, because the rate of desire for subsequent fertility is often calculated from men presenting for vasectomy reversal consultations, this may underestimate the numbers.
Objective: To determine the demographic factors of men choosing vasectomy and to define the number of men subsequently desiring fertility post-vasectomy.
Design: Analysis of National Survey of Family Growth (NSFG).
Methods: The NSFG was conducted from June 2006 to June 2010 and sampled 10,403 men aged 15 to 45 years. Participants were questioned by female interviewers and compensated $40. Using Centers for Disease Control and Prevention methodology, the 110 diverse sampling units were adjusted based on census data to estimate national results.
Results: 8992 men aged ≥18 years were surveyed and 368 had a vasectomy during this time frame. This corresponds to a prevalence of 6.6%, markedly lower than the tubal ligation prevalence of 16.4% in women for the same age ranges. White men were more likely to have undergone vasectomy, with a prevalence of 9.1%. Black men and Hispanics had a prevalence of 2.4% and 2.1%, respectively. Other factors increasing the prevalence of vasectomy included income, education level, access to health care, and U.S. born (compared to immigrants). In total, 84% of the men had at least 2 children and 21% of men who were adoptive fathers had a vasectomy. The overall strongest predictor was number of biologic children. Overall, 19% of men who had undergone vasectomy desired future children and this was more likely when men belonged to a religion. Only 2% of men had undergone a vasectomy reversal.
Conclusions: Predictive factors for vasectomy include number of biologic children, race, and access to care. Nearly 1 in 5 of these men desired subsequent fertility.
Reviewer’s Comments: These data match my general perception of the typical male presenting to my office for vasectomy consultation. It is interesting to see that black men and Hispanic men do not pursue vasectomy as often and this may be an area for growth if cultural concerns can be addressed. Most interesting in this manuscript is the fact that 1 in 5 men desire subsequent fertility. I am curious if some of the men described as adoptive fathers were in this group. I believe counseling on the option of vasectomy reversal or in vitro fertilization is important during the vasectomy visit so men realize there are options, but the cost of these procedures should also be discussed. It would also be interesting to see if the same demographics are seen in countries with universal health care and limited access issues.(Reviewer–Gregory Lowe, MD).