Clearance after vasectomy with a single semen sample containing < than 100 000 immotile sperm/mL: analysis of 1073 patients

Abstract

Study Type – Diagnostic (non‐consecutive) Level of Evidence 3b OBJECTIVE To evaluate the safety and efficacy of a new semen analysis protocol after vasectomy, where clearance is given to patients who provide a single semen sample with <100 000 immotile sperm/mL at ≥3 months after vasectomy. PATIENTS AND METHODS Between 1 July 2005 and 31 March 2008, 1073 men provided a first semen sample at ≥3 months after vasectomy. Semen was first evaluated on a wet‐slide preparation. Those samples with no (‘azoospermia’) or sporadic immotile spermatozoa could be cleared without further analysis. Samples with motile sperm were immediately labelled as potentially fertile, while those with a significant number of immotile sperm were re‐analysed using a Neubauer haemocytometer. All samples with <100 000 immotile sperm/mL were cleared. RESULTS Of men providing semen at 3 months after vasectomy, 96% could be cleared. No sperm were seen (‘azoospermia’) in 51.3% of samples, and 44.7% of samples contained <100 000 immotile sperm. No paternity has been reported in the cleared group after a follow‐up of at least 1 year. CONCLUSIONS A protocol stipulating that patients can be cleared after a single semen sample containing <100 000 immotile sperm/mL at ≥3 months after vasectomy is safe and dramatically reduces the number of men who cannot be cleared at 3 months after vasectomy.

2016 Laboratory guidelines for postvasectomy semen analysis: Association of Biomedical Andrologists, the British Andrology Society and the British Association of Urological Surgeons

“…In 2012, the American Urological Association (AUA) decided that 2 h between production and analysis was sufficient, stating that rather than precise motion quality, it is the presence or absence of motility that is important for a PVSA 31. This 2 h interval has been supported by Australian and Dutch workers18 (Royal Australasian College of Surgeons, 2009). However, the data to support this decision is minimal.…”

“…However, the majority of published literature suggests a minimum number of weeks before testing of between 12,6 11 16 17 1418 19 and 16 weeks 1 20. Decreased patient compliance has been noted with longer intervals 6 17 20…”

Vasectomy in Male Contraception and its Reversal

“…Men with persistent nonmotile sperm (<10 000/ml in a fresh specimen) should be considered clean [29]. Age and frequency of ejaculation probably influence the time to achieve azoospermia; some patients continue to have small numbers of nonmotile spermatozoa in their ejaculate for months or years after vasectomy.…”

Ischämische Hodennekrose nach Vasektomie

“…Auch hierüber muss der Patient aufgeklärt werden, da er erst bei Nachweis einer Azoospermie auf andere empfängnisverhütende Maß-nahmen verzichtet darf [24]. Allerdings scheint auch bei einer niedrigen Dichte immotiler Spermatozoen (<100.000/ml) im postoperativen Ejakulat bereis eine ausreichende Zeugungsunfähigkeit gegeben zu sein [14]. Die Technik des Duktusverschlusses (Ligatur oder Clip) hat keinen Einfluss auf die Erfolgsrate [25], die Enden sollten jedoch in verschiedenen Gewebeschichten zu liegen kommen [24].…”

“…3). In einer prospektiven Studie wurde bei 1073 Män-nern 3 Monate nach Vasektomie das Ejakulat analysiert: Dabei konnte in 96% der Fälle die Empfängnisverhütung "freigegeben" werden, da in 51,3% eine Azoospermie und in 44,7% lediglich <100.000/ml immotile Spermatozoen detektiert wurden; zu einer Schwangerschaft kam es im Beobachtungszeitraum nicht [14].…”