Risk factors for non-compliance in post vasectomy follow up

Abstract

Vasectomy is regarded as the most effective method of birth control, with over half a million performed annually in the United States. Poor compliance with providing a post vasectomy semen analysis (PVSA) has previously been reported in both the Family Medicine and Urologic literature, with rates ranging from 34-46%. Reasons for poor compliance with PVSA are not well described. Only one prior study was identified that examined socioeconomic factors predictive of non-compliance. We sought to further characterize this population by examining the pre operative characteristics of patients of a large volume vasectomy surgeon that were predictive of failure to provide a PVSA. A retrospective, single institution chart review Records were reviewed from April 2015 to April 2018, which identified 1137 patients who underwent vasectomy by a single surgeon. Patients who underwent vasectomy for non-fertility related reasons were excluded. Other exclusion criteria included requiring in vitro fertilization to conceive prior to the procedure. Patient characteristics analyzed include age, race, marital status, insurance type, and number of children. Univariate and multivariate logistic regression were performed to compare our two cohorts and to assess for factors predictive of post vasectomy compliance. 1,137 patients underwent vasectomy. The average age was 37.5 years. 89.5% and 88.7% of the patients were White/Caucasian and married, respectively. 27.5% of patients did not follow up for PVSA at any interval. Age was similar between patients who did and did not submit a PVSA (37.8 vs 37.3 years). However race, martial status, and insurance did differ, as patients in the no PVSA cohort were more likely to be African American (8.3% vs 3.7%), single (15.3% vs 9.7%) and have Title 19/Medicaid (2.9% vs 1.2%) insurance coverage (all p values <0.05). On multivariate analysis, single relationship status was independently predictive of failing to present for post vasectomy semen analysis (RR 1.86, p = 0.02). Age (RR 1.02, p = 0.08) and increasing number of children (RR 1.11, p =0.09) approached significance. A significant percentage of patients do not provide a PVSA confirming sterility, with single relationship status being most predictive of noncompliance when controlling for all other preoperative variables. As with all vasectomy patients, counseling these patients that they are not sterile until proven with a PVSA is paramount.