Association of the 2012 American Urological Association Vasectomy Guidelines with National Trends in Vasectomy Followup in the United States.

Abstract

The American Urological Association Vasectomy Guidelines published in 2012 defined vasectomy success as either azoospermia or rare nonmotile sperm (≤100,000 nonmotile sperm/ml). We sought to characterize nationwide practice patterns surrounding vasectomy followup before and after publication of the guidelines. Data were collected using the MarketScan® database. We identified men 18 to 64 years old undergoing vasectomy between 2007 and 2015 with at least 12 months of followup to track post-vasectomy semen analysis claims. Demographic data including age, vasectomy provider type and regionality were also queried. We compared the likelihood of men obtaining multiple post-vasectomy semen analyses before vs after the guidelines release with multivariate logistic regression. Linear regression was used examine time to first post-vasectomy semen analysis association with observed post-vasectomy semen analysis frequency trends. We identified a total of 87,201 patients who underwent vasectomy between 2007 and 2015 and had at least 1 post-vasectomy semen analysis claim. Men undergoing vasectomy in the post-guideline years of 2013 to 2015 were at lower risk for requiring any repeat post-vasectomy semen analysis (OR 0.68, 95% CI 0.66-0.71) and less likely to have had ≥3 post-vasectomy semen analyses (OR 0.82, 95% CI 0.77-0.88) than those in the pre-guideline (2007 to 2012) cohort. Mean time to first post-vasectomy semen analysis was shorter in men who submitted multiple analyses (p <0.001). Within a nationally representative patient cohort, men required fewer repeat post-vasectomy semen analyses after publication of the 2012 guidelines. Further research on patient and provider characteristics affecting variations in vasectomy followup patterns and guideline adherence is needed.