The findings also highlighted the diversity of physicians performing the procedure in regard to background and outcomes.
The quality and quantity of information on vasectomy reversals (VR) on clinic websites varies significantly, potentially hindering patient understanding of the procedure and available options.
The findings, published in Urology, also highlighted the diversity of physicians performing the procedure in regard to background and outcomes.1
The investigators, led by Vivian Hua, MD, conducted an analysis of Internet search trends for “vasectomy” and “vasectomy reversal” from 2004 to 2022 using Google Trends in order to assess public interest in the procedure. Data showed that vasectomy reversal searches comprised 10% of the total searches for vasectomy throughout the given time frame.
The investigators then looked at information on VR provided from clinic websites. Clinics that showed demonstrable evidence of performing vasectomy reversal and met other inclusion criteria were included in the study, which yielded 190 clinics throughout 44 of 50 states. Each clinic was examined based on the information available on their website in regard to practice information (number and sex of physicians, location of practice), physician training (residency, infertility fellowship), procedure details (magnification, type of anastomosis, specific procedure performed, and type of anesthesia used), pricing, and outcomes (success rates and potential complications).
There were a total of 862 physicians identified from the 190 clinics included. Among those, 772 (89.6%) were male and 90 (10.4%) were female. The majority (96.1%) of reported physician residency training was in urologic surgery. Other training specialties included obstetrics/gynecology, general surgery, family medicine, and orthopedic surgery. Data also showed that a majority of urology-trained surgeons (58.3%) were not infertility fellowship trained.
Among the physicians who reported a magnification type used to perform microsurgery, 114 (60%) utilized a microscope, 3 (1.6%) used loupes, and 73 (38.4%) had no specified magnification technique. Only 119 (62.6%) physicians indicated that they performed vasoepididymostomies (VEs) if needed during the operation, 62 (37.3%) physicians did not specify whether they offered it, and 9 (4.7%) explicitly stated that they did not perform VEs even when indicated.
Of the 190 clinics analyzed, only 48 (25.4%) transparently reported out-of-pocket VR cost. The median reported out-of-pocket cost was $6500. There was no statistical difference between VR costs among surgeons that completed an infertility fellowship vs those that did not (P = 0.79).
Over half of the clinics (52%) reported VR success rates as high as 100%. Pregnancy outcomes were reported in 34% of clinics. Possible complications of the procedure were reported in 49 (25.8%) of the clinics, with non-urologists being more likely to report complications. There was no statistical difference between success rates for sperm in ejaculate or pregnancy (P = 0.47 and P = 0.31, respectively) among surgeons that completed an infertility fellowship versus those that did not.
These findings show significant variation among the information available on VR procedures at different clinics, with many clinics not reporting information such as surgical technique, success rates, or potential complications. Given that many patients often turn to the Internet as a means of education, the authors identified a need for more complete and transparent information available on patient-facing websites.
The authors wrote, “There may be a role for our professional societies in this area to provide evidence-based guidelines to support a high-quality baseline standard-of-care from which patients can begin their search for the right physician to meet their needs.”
1. Hua V, Bole R, Oh P, Parekh N, Vij SC, Lundy SD. The diversity of vasectomy reversal providers and their web-based advertising habits in the United States. Urology. Published online February 5, 2023. Accessed February 7, 2023. doi: 10.1016/j.urology.2023.01.036.