A nationwide analysis of hormonal contraception, sterilisation surgeries and reversal practices amongst Australian men and women from 2001 to 2021

Abstract

Family planning falls within the spectrum of care within our medical society. We sought to illustrate changes in contraceptive methods over time and evaluate tubal ligation and vasectomy reversal practices in Australia. Yearly data from 2000 to 2021 was extracted from 3 databases: Pharmaceutical Benefits Schedule, Medicare Benefit schedule and Australian Institute of Health and Welfare databases. Population adjusted rates of procedures and medical therapies were calculated using data from Australian Bureau of statistics. Use of Long acting reversible contraception (LARC) has increased by 34.1% from 2001 to 2021, with Mirena being the preferred contraception. The peak age group for tubal ligation during caesarean section was those >35-year-old (64.7%) whereas vasectomy more commonly performed in men aged 35–44. There was a 21.6% decrease in the number of vasectomies over time from 2000–2020. Female surgical sterilisation:vasectomy ratio shows tubal ligation was twice more common than vasectomy. Both macro/microsurgical anastomosis of the vas deferences were conducted: vasovasostomy (VV) and vasoepididymostomy (VE). There was a preponderance in the use of microsurgical approach for VV. Reversal mostly common occurred in those aged 40–44 at 29%. Overall, the rate of vasectomy is continuously falling over time whilst there is a steady incline in the use of LARC from 2020–2021. Both vasovasostomy and vasoepididymostomy reconstruction are practised. Although definitive conclusion from the literature lags, “real-world” trend indicate that micro-surgically conducted vasovasostomy might be the better surgical technique for desired patient outcomes.

Keywords

• vasectomy
• contraception
• reversal practices
• sterilisation procedures
• vasovasostomy
• vasoepididymostomy
• tubal ligation