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This was in the UK and in the end the NHS did cover it, although they contracted it out to a private provider

She did eventually sign off on it but only after I made it clear that I was the one who wanted permanent BC

Also my reaction

Went in to schedule a vasectomy and, with my wife literally sitting next to me, the doc said: "well something could happen to her and maybe in the future you'll have a wife who wants kids."

True. I've reverted to generating citations directly in Zotero and copying them into the LibreOffice footnotes. Then, if you put all the sources you used for a piece into one Zotero collection, you can still generate a complete bibliography at the end.

LibreOffice handles footnotes well enough