Vasectomy rates rising in Northwest after Roe v. Wade overturned

Vasectomy rates have risen in the Pacific Northwest and elsewhere in the country since the U.S. Supreme Court overturned the legal right to abortion in 2022. At Oregon Health & Science University, Jason Hedges performs about 500 vasectomies a year. He’s also one of the relatively few surgeons who does reversal procedures as well. He says, like others in his field, he’s seen the interest rising and wait times for the procedure increase. Hedges joins us to discuss what’s involved and the changes he’s seen over the last several years.

Note: The following transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. A study this year found an increase in interest in vasectomies nationwide after the Dobbs decision that overturned Roe v. Wade and ended the right to abortion at the federal level. Doctors around the country have reported similar increases in the surgery. We were curious what’s happening in Oregon. So we’ve called up Jason Hedges. He’s a professor of urology at Oregon Health and Science University and he joins us now. It’s great to have you on the show.

Jason Hedges: My pleasure. Thank you for having me.

Miller: I wanna start with the voicemail because we asked our listeners about this trend and what it looks like in their own lives. Here is one of the responses that we got:

Rob [voicemail]: Hi, this is Rob from Portland. I actually had the procedure done myself, a decision my wife and I came to after Roe v. Wade was struck down. That wasn’t the entire basis, definitely something we’ve been thinking about a lot before, but definitely contributed to that decision and it just felt good to do my part to kind of lift that burden a little bit for my family as far as reproductive rights and choice.

Miller: Jason Hedges, have you seen an increase in the number of procedures that you do or that colleagues do since this decision?

Hedges: Yes, absolutely. I’ve seen, in my own practice at OHSU, a higher increase in the number of patients requesting a vasectomy and basically my waiting times have increased quite a bit in terms of the number of vasectomies that I’ve performed since the decision.

Miller: What is the waiting time? I’m curious what the increase in interest actually means?

Hedges: Well, for my practice, I do a pretty high volume of vasectomies. It’s a big focus of my specialty and typically I would be booked out four to six weeks, and I started seeing that I was booking out several months. And so it’s definitely seen an uptick. In talking to my colleagues across the country, as you mentioned in the segment, they’re seeing an increased demand requesting the procedure as well.

Miller: You say high volume. What does that mean? I mean, how many vasectomies might you perform in the course of a year?

Hedges: Over the last 13 years, I perform typically 300 to 500 vasectomies a year. And I would say over the last, at least more recently, I’m doing in the 500-plus a year.

Miller: Wow. Let’s have a listen to one more voicemail that came in.

Izzy [voicemail]: Hi, my name is Izzy from Portland, Oregon. Yeah, I got a vasectomy shortly after the Roe v. Wade change happened. It’s just something that had been on my mind for a while and that actually just expedited it tremendously, with how the laws were changing and how it, things felt very unequal. I wanted to actually just create my own personal level of equality by doing this action. Again, it was something that I had planned on doing for a very long time and the Roe v. Wade action changed, just expedited it. And I’m glad I did it. It was no big deal, more people should consider doing it.

Miller: What do you think is behind this increase that you’re seeing and colleagues around the country are seeing?

Hedges: I think as both the callers mentioned, there’s kind of this sparked awareness of reproductive rights and I think it kind of included the idea that men are thinking about it more in terms of their role and what they can do. I think that’s what we’ve seen across the country. I think what would be interesting to see or to analyze would be whether there’s a higher volume of vasectomy requests or procedures being performed in states where there’s a higher threat to abortion rights versus states where it’s still protected.

Miller: That was exactly a question I was going to ask you. So, but the fact that you’re saying that you’d be interested in seeing that, I guess it implies that that data may not exist yet. I mean, just to put it bluntly, if there would be a higher rate of increase of vasectomy requests, say in Oklahoma or Idaho or Kentucky or Texas than in Oregon or New York or Vermont or California.

Hedges: Yeah, I’m not aware of any published data on this yet. I know I have colleagues that focus on vasectomy and male reproductive procedures throughout, in all states. And they’ve all seen an uptick, but I haven’t seen any kind of good data to really look at this, but it’s definitely something that I would hypothesize may be happening.

Miller: You’ve previously published data about other trends in vasectomy rates, in particular, the connection between vasectomies and the economy. What have you found?

Hedges: Yeah. So, coauthors, including myself and colleagues from New York and Northwestern, Cornell, we looked a number of years ago and saw that when - kind of the summary is - when the economy is not doing well, vasectomies increase and when the economy is doing well, those of us that specialize in vasectomy reversal, those go up and we end up doing more of those. And that was kind of looked at over a few different recessions during a few different economic periods over the last 25 to 30 years in the United States.

Miller: Is it that simple, the connection between economic fears and not wanting another mouth to feed?

Hedges: I think simplistically that that’s true. Men elect to undergo a vasectomy for several different reasons. But I think that kind of thinking about the economic implications of having another child, are very true and important. And so it was an interesting observation that we found and I think it kind of makes sense or makes sense with what I see when I talk to my patients as well.

Miller: What’s the age range of your patients? And also just the average age?

Hedges: So historically, the average age of a patient who I perform a vasectomy on is usually in their thirties and forties. What I have noticed in my practice since Dobbs and even a little before that, I am seeing more men in their twenties request or ask for a vasectomy. I also have done a high number of men in their fifties and sixties and even seventies actually. But at least in my practice at OHSU in Portland, Oregon, I’m seeing a lot more men coming in for a vasectomy that are in their twenties, some have not had children, some are not in relationships. Classically a cohort of patients that historically, we wouldn’t see as many of, but I’ve definitely seen an increase in my own practice in that age group.

Miller: I’ve heard many times in many places about women who go to doctors who, often these stories are they’re in their twenties or thirties and they’ve decided definitely for themselves that they don’t want to have kids and they say, I want to get my tubes tied, and they’ve told so many stories about being second guessed by healthcare professionals who say, well, you might want them, you don’t know, you don’t know yourself, you might change, so you should really think about this. I’m curious if there is an equivalent for men seeking vasectomies, if you or others say, have you really thought about this?

Hedges: At least from the male side, I think there was definitely, decades ago that was more prevalent. There was a conservative thought that if a man was young, hadn’t had kids or even had a very young child that some providers were not as enthusiastic to offer it to them with the fear that they would change their mind or something would happen.

I feel definitely with my colleagues across the country that do what I do, that’s definitely not the case. As long as the patient understands that the idea of a vasectomy is a long term, permanent-like decision, we feel comfortable offering it to them. In part, someone like myself, who specializes in this field and we spend a lot of time basically offering… We know historically, about 6% of men who get a vasectomy will someday want to have a child. And that’s been a pretty prevalent number for many decades. And there are options, if they change their mind, none of them are guaranteed, of course, but there are options that have some high success rates in terms of vasectomy reversal and also sperm extraction procedures and doing in vitro. So there are options if people change their mind in most cases, but not all. But I think the more common feeling is as long as the patient kind of knows exactly what they’re getting into and they’re comfortable with that decision, I think many of us that do this often are comfortable offering it to patients that at one time were probably not offered in the past.

Miller: How do you measure the effectiveness of a vasectomy?

Hedges: So there are national guidelines on how to, we call it clearing a patient. And basically it’s a semen test that we look at, we look for the presence of sperm. And the recommendation is to check that sample eight to 16 weeks after the procedure has been completed. In my practice, 12 weeks is the number. And we know historically, about 15% of men who will do their first sample after 12 weeks will need to do a second sample to get cleared.

Miller: Meaning, because after 12 weeks, a not insignificant percentage of men still have sperm in their semen?

Hedges: Yeah, historically, the data shows about 15% of men will still have some sperm in their semen 12 weeks after the procedure. And so, even though the pipes are separated at the time of the procedure, any sperm that had already gotten past that point where the procedure is performed can live in the prostate and seminal vesicles for months and months and still cause pregnancy. So, it’s very important for a man to get cleared. Historically, men don’t do a good job getting their follow-up semen test, unfortunately.

And, anywhere from 37% to 50% of men never get that check test, unfortunately.

Miller: Why do you think that is?

Hedges: It’s a good question. I don’t know the exact answer. I think some men feel like, oh, I’m sure the provider did a good job and I’m sure I’m fine. I think that’s probably the number one. They forget, it’s three months out from the procedure. I can’t remember if it was two months ago or one month ago, I think I’m fine. I think there’s a little bit of that part that plays a role.

Miller: Is it true that there is an uptick in vasectomies in March to coincide with the NCAA basketball tournament?

Hedges: So in my practice, I do see a higher number of men starting to ask for a vasectomy or I start doing more procedures in March and April. Whether or not it’s directly because of March Madness in basketball, I’m not 100% sure of that. There’s, some groups that have used that tournament to kind of leverage the idea and to market, hey, now is a great time to get a vasectomy.

Miller: Because you have an excuse to sit on the couch and watch TV?

Hedges: Yeah. So it’s a good excuse to spend two to three days with ice packs watching TV, trying to take it easy. I call it the couch potato lifestyle. We do see historically, before Dobbs and kind of before COVID in my practice, there was somewhat of a trend where usually October, November, December, I’d see a higher request and all my procedure slots would be full, most likely because it’s kind of the end of the year and a lot of people, their deductibles on their insurance plans had been met, and then in Portland, Oregon, I would see a downturn in July and August. I think a lot of guys don’t wanna spend a weekend sitting on the couch if it’s nice weather in Oregon. That’s changed I’d say since COVID in my practice, but definitely since Dobbs. So we were busy throughout the whole summer and even in January and February before March madness.

Miller: Just going back, you had mentioned that one of your specialties is actually reversals. And that historically, and it seems like a pretty consistent finding, something like 6% of men who get vasectomies decide that they actually then want to have kids. How successful are reversals?

Hedges: So, vasectomy reversals can be extremely successful, especially if you go to someone that kind of performs them routinely. So, in our institute, vasectomy reversals are anywhere from 90% to 98% successful depending on kind of how far out the patient is from his vasectomy. So the farther out, if you’re 15 years or farther from your vasectomy, then there is a little bit higher risk that you need a certain connection for reversal that puts you in the 89% to 90% success rate.

Miller: Jason Hedges, thanks very much for your time. I appreciate it.

Hedges: My pleasure. Thank you, Dave.

Miller: Jason Hedges is a professor of Urology at OHSU.

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