Historically, permanent contraception has more heavily burdened female partners. Data from the 2002 National Survey of Family Growth suggests that 16% of women undergo tubal ligation as compared to only 6% of men undergoing vasectomy in the U.S [25]. Furthermore, vasectomy rates in the U.S. were previously noted to be decreasing across all geographic locations between 2007–2015 [26]. Prior to the Dobbs decision, vasectomy rates varied by geographic region, with the highest proportion being performed in the North Central (0.66%) and Western (0.61%) regions of the country, and lowest in the Northeast (0.41%) [26]. In order to meet patient need for reliable permanent contraception, various initiatives were considered to improve vasectomy utilization rates, including qualitative research into patient-related barriers to seeking vasectomy, enriched training opportunities for providers, and widespread utilization of the minimally invasive “no-scalpel” approach [27]. However, when the decision of Dobbs was announced, urologists recognized the substantial impact this might have on vasectomy volume.

Nationwide, vasectomy trends were noted to have increased by approximately 20% in the U.S. in the seven months post-Dobbs as compared to the seven months prior, as estimated by claims data [19]. This trend was persistent in subgroup analysis across different age, race and ethnic groups, except in men aged 40–60 years old, who had a downtrending rate in vasectomy consultation. However, this data set did not explore state-specific trends which is of particular interest given the large variation in abortion control amongst states. States with reported post-Dobbs vasectomy trends have been summarized in Table 1.

The first published data regarding vasectomy trends emerged from a quaternary care center in Ohio. On June 24 2022, hours after the Dobbs decision, the Ohio Senate moved to enact the Human Rights and Heartbeat Protection Act, which would ban abortion statewide after six weeks gestational age [28]. Single institutional data from Ohio after the introduction of this bill demonstrated a 22.4% increase in vasectomy consultations in the three months (July-August 2022) following the Dobbs decision as compared to the same time period the year prior (July–August 2021) [15]. These consultations were not merely patients seeking information, as this study also demonstrated an increase in procedural volume as well, with the number of vasectomies completed per month rising to 218/month from 124/month. Of note, due to the subsequent November 2023 ratification of Issue 1, abortion is legal in the state of Ohio at the time of this review.

Interestingly, analysis of vasectomy volume in states electing to preserve abortion rights demonstrated similar trends. For example, the state of Michigan moved to preserve abortion right shortly after the Dobbs decision through a temporary injunction which banned the enforcement of the 1931 abortion ban. Even so, Zhu et al. found a 150% rise in vasectomy consultation and 160% increase in vasectomy volume at their Michigan-based institution in the six months following the Dobbs decision [17]. On the other hand, studies from the state of California, which protected the right to abortion and expanded coverage for contraception including vasectomy with the Contraceptive Equity Act of 2022, found a rising vasectomy consultation rate that did not reach statistical significance [18, 29]. This discrepancy may be explained in part by the already higher rates of vasectomy on the west coast, or due to patient reassurance of preserved abortion rights given the generally liberal political climate of California [26].

Post- Dobbs variations in state-specific utilization of vasectomy were also pronounced in the military health system (MHS) cohort. Pierson et al. reported an overall increase in vasectomy utilization in patients in the MHS, with an accentuated spike in vasectomy utilization in Texas, a state with immediate triggering of laws banning abortion, as compared to Virginia, a state which took no legislative action against abortion in the immediate post-Dobbs era [16]. While altogether these studies suggest a nationwide rise in vasectomy use, with higher rates in more restrictive states, future studies are needed to directly correlate legal limitations of abortion with vasectomy utilization.