Yes, vasectomies may actually have risen since SCOTUS ruling

“People think of these laws as impacting women, and they most certainly do and certainly women bear the burden, but it’s impacting healthcare decisions for men too,” says Dr. Vij, who leads the Center for Male Fertility at Cleveland Clinic,” said Cleveland Clinic urologist Sarah C. Vij, MD.

The number of men seeking vasectomies appears to have risen following the U.S. Supreme Court’s overturning Roe v. Wade, according to new Cleveland Clinic findings that reinforce previous anecdotal reports.

In June 2022, the U.S. Supreme Court ruled in the case of Dobbs v. Jackson to overturn the 1973 Roe v. Wade ruling that had established a federally protected right to abortion in the United States. Soon after there were some reports, largely based on Google searches, suggesting increased interest in vasectomies among men. Now, Cleveland Clinic urologist Sarah C. Vij, MD, male reproductive fellow Raevti Bole, MD, and colleagues are the first to publish actual data showing both increased interest in vasectomy and also follow-through with the procedure since the Dobbs decision.

“People think of these laws as impacting women, and they most certainly do and certainly women bear the burden, but it’s impacting healthcare decisions for men too,” says Dr. Vij, who leads the Center for Male Fertility at Cleveland Clinic.

Comparing pre-and post-Dobbs data

In the study, published in the International Journal of Impotence Research, Dr. Vij and colleagues compared Cleveland Clinic records for all adults seeking consultation for vasectomy during July and August 2022 (“post-Dobbs”) with those during July-August 2021 (“pre-Dobbs”).

Post-Dobbs, 166 men initiated requests for a vasectomy consultation and 142 men actually attended the appointment, compared with just 123 and 116, respectively, pre-Dobbs. This corresponds to a 35% increase in vasectomy consultation requests and a 22% rise in vasectomy consultations.

Men expressing interest in vasectomy post-Dobbs were significantly younger, with a median age 35 years compared with 38 years pre-Dobbs (P = 0.01). There was also a significant increase in post-Dobbs men younger than 30 years seeking vasectomy, 24% versus 10% (P = 0.005).

White men comprised a higher proportion of men seeking vasectomy consultation post-Dobbs, 84% versus 71% earlier (P = 0.01). Slightly fewer men were married, 72% versus 79% pre-Dobbs, but that difference wasn’t significant (P = 0.29).

However, men seeking vasectomy post-Dobbs were significantly more likely to be childless, 17% versus 9% (P = 0.05). “Often when a childless man goes for a vasectomy it raises eyebrows. I’ve argued many times that it shouldn’t. But just to think, this type of political landscape is going to drive a 22-year-old guy who’s never had kids to get a vasectomy. Again, it just shows the impact,” Dr. Vij observes.

At three months post-consultation, 59% of pre-Dobbs men had undergone their vasectomies versus 66% of post-Dobbs men, not a significant difference (P = 0.21).

Separate analysis accounts for lag time

Since there is often a longer lag time between consultation and procedure and the procedure also tends to be seasonal, the investigators conducted a separate analysis of billing data for all patients who underwent vasectomies within the entire Cleveland Clinic health care system from 2018 through August 2022. Here, they found more than a doubling in median vasectomy procedural volume from pre- to post-Dobbs, rising from 104 to 218 per month (P = 0.03).

“Men sometimes get demonized in these discussions. In many ways, we’re proud of these patients who are trying to protect their partners,” Dr. Vij says.

The data on tubal ligation are less clear

Whether or not the Supreme Court’s decision has had an impact on tubal ligation among women is less clear, and no data on that topic have been published. Despite the fact that vasectomy is less invasive and safer than tubal ligation, it is still far less common as a permanent contraceptive approach, undergone by 6% of men compared to 16% of women who undergo tubal ligation.

But, Dr. Vij notes, tubal ligation data are more difficult to gather since women often undergo that procedure at the time of Cesarean sections. “I think that’s going to be very interesting to look at. But the timeline will be several years away.”

Medical considerations and state abortion laws

Also important to note is that Ohio had activated a “heartbeat bill” very soon after Roe v. Wade was overturned. At this writing, the law has still been blocked by a judge from taking effect based on a challenge from the Ohio American Civil Liberties Union. Further deliberations are pending.

Other investigators around the country are expected to present their institutions’ vasectomy data at the upcoming American Urological Association meeting in April, which should shed light as to whether this phenomenon varies by state abortion laws.

Meantime, Dr. Vij says, “the medical community needs to think about the impact that political changes with regard to reproductive care have on both women and men.”