More Younger Adults Opting for Sterilization in Post-Dobbs Era, Studies Find

SAN ANTONIO -- Research presented here provides more evidence that the overturning of Roe v. Wade has resulted in an increase in permanent contraception procedures, particularly among younger men and women.

In one study that relied on a large national database, researchers found a significant increase in patients under the age of 30 years pursuing permanent contraception following the Dobbs v. Jackson Women's Health Organization decision in June 2022, reported Jessica Schardein, MD, of the University of Utah in Salt Lake City.

And a smaller, multi-institution study found that the number of vasectomy consults and procedures increased, particularly among younger and childless men, in the aftermath of the Dobbs decision, according to Kara Watts, MD, of Montefiore Medical Center and Albert Einstein College of Medicine in New York City.

Both studies were presented at the annual meeting of the American Urological Association.

Database Findings

The study presented by Schardein used data from Epic Cosmos -- which includes over 200 million patients from more than 27,000 clinics and 1,000 hospitals -- to conduct a retrospective review of U.S. adults undergoing vasectomy or tubal sterilization before (June to December 2021; late 2021) and after (June to December 2022; late 2022) the Dobbs ruling.

Investigators found a significant increase in the rate of patients under the age of 30 undergoing vasectomies (incidence rate ratio [IRR] 1.59, 95% CI 1.48-1.70) and tubal ligation (IRR 1.29, 95% CI 1.24-1.35). When stratified by marriage status, there was a significant increase in vasectomies among single men (IRR 1.13, 95% CI 1.08-1.18), but no change in the rate of tubal ligation among single women.

The researchers also assessed permanent contraception rates according to the legal status of abortion in states.

Relative to states considered to be "non-hostile" to abortion, the rate of tubal sterilizations was higher after Roe was overturned in states where abortion became essentially illegal (pre-Dobbs IRR 1.76, 95% CI 1.70-1.83; post-Dobbs IRR 1.85, 95% CI 1.79-1.92), and the interaction between the legal climate and post-Dobbs increase was significant, Schardein said.

The vasectomy rate was consistently higher in the illegal states and those considered "hostile" to abortion, both in the pre-Dobbs and post-Dobbs periods, but there was no interaction between the legal climate and any increase in vasectomy.

"Reproductive health matters," said Schardein. "Reproductive autonomy is important for people of all genders and may be influenced by legal climate. Understanding this relationship between state-level abortion laws and trends in permanent contraception is crucial to determine how to best allocate resources for education and services to ensure reproductive rights for all patients."

Multicenter Analysis

In the second study, the researchers quantified the change in vasectomy consults and procedures between the pre-Dobbs (18 months before) and post-Dobbs era (6 months after) using data from a nationally representative cohort of eight institutions.

Over the study period from January 2021 to December 2022 there were 4,326 initial vasectomy consults overall, with more subsequent vasectomies performed post-Dobbs than pre-Dobbs (158 per month vs 152 per month).

Data presented by Watts also showed the following changes post- versus pre-Dobbs:

• Age of men getting vasectomies was younger (median 37 vs 39 years, P<0.001)
• Percentage of married men without children getting a vasectomy increased (11% vs 5%, P<0.001)
• Proportion of single men without children getting a vasectomy increased (40% vs 23%, P<0.001)

The impact of these trends "is likely to be long-lasting," Watts said.

Co-investigator Jay Sandlow, MD, of the Medical College of Wisconsin in Milwaukee, observed that in his practice the rate at which vasectomies are performed is still increasing -- "although not to the same extent," and that his clinics are still booked months in advance for vasectomy consults.

Considering the urology specialty has an ongoing workforce shortage, Watts raised the question of who will be performing these vasectomies. "And in 10 years, are we going to see an uptick in vasovasostomies or decisional regret for having these procedures?"

Regarding the question of decisional regret, Sandlow pointed out that a study he co-authored in Urology showed that while the rate of regret among childless men who had a vasectomy was somewhat higher than among men with children, it was still well under 10% after more than 5 years post-vasectomy.