Optimizing vasectomy care pathways: patient preparation, follow-through, and evidence-based timing of post-vasectomy semen analysis.

purposeEvaluate our comprehensive vasectomy care pathway, find ways to improve patient experience, and optimize efficiency.

methodsWe performed a retrospective cohort study of men presenting for vasectomy consultation at a single academic center. Demographics, pre-consult research behavior, and reasons for vasectomy consideration including influence of the 2022 Supreme Court decision were collected via standardized survey. Clinical outcomes included progression to vasectomy, unplanned post-operative contact (UPC), post-vasectomy semen analysis (PVSA) completion, and PVSA positivity. Logistic regression was used to assess predictors of follow-through from consultation to procedure. PVSA positivity rates were evaluated across time cutoffs from 85 to 115 days.

resultsOf 364 men presenting for consultation, 263 (72%) proceeded with vasectomy. Patients reporting any pre-consult independent research were more likely to follow through compared to those reporting no preparation (86% vs 58%; OR 4.36, p = 0.002). Only 6% of patients reported the Supreme Court decision as influencing their decision. UPCs occurred in 13.3% of patients and were unaffected by nursing follow-up calls. 83% of patients completed PVSA, with positivity declining sharply when testing was performed after 100 days, from 8% to less than 3% (OR 4.57, p = 0.012).

conclusionPre-consult patient preparation is a strong predictor of vasectomy care pathway completion. Although observational, nursing follow-up phone calls did not appear to minimize UPC frequency in our cohort. Scheduling PVSA at or beyond 100 days post-procedure was associated with reduced positive semen analyses. Finally, the recent Supreme Court Dobbs decision had minimal influence on men. These findings support the development of targeted educational interventions to optimize pathway completion and minimize UPC.