Delayed vasectomy success in men with a first postvasectomy semen analysis showing motile sperm

Purpose The 2012 American Urological Association (AUA) vasectomy guidelines recommend the finding of rare nonmotile sperm, representing 100,000 or fewer nonmotile sperm per ml, as a metric of post-vasectomy success. At our institution success was previously defined as 2 sequential azoospermic centrifuged semen pellets. The criteria change of including rare nonmotile sperm as a success end point may simplify post-vasectomy followup and decrease the number of post-vasectomy semen analyses required to assure occlusive success. Materials and Methods In the context of the new 2012 guidelines we retrospectively reviewed and analyzed the records of 972 of the 1,740 vasectomies (55.9%) performed between January 2000 and June 2012 after which at least 1 post-vasectomy semen analysis was done. Results A total of 1,919 post-vasectomy semen analyses were obtained from 972 patients with a mean ± SE age of 39.7 ± 0.2 years. Occlusive success was evident in 337 azoospermic men (36.4%), while 514 (52.9%) underwent 2 or more post-vasectomy semen analyses and 458 (47.1%) returned for a single post-vasectomy semen analysis but were lost to followup. Of these noncompliant patients 76.0% were azoospermic, 19.7% had rare nonmotile sperm, 1.5% had greater than 100,000 nonmotile sperm per ml and 2.8% had motile sperm. Three patients underwent repeat vasectomy for persistent rare nonmotile sperm. If the criteria defined by the 2012 guidelines had been used to monitor these men, the occlusive success rate would have improved to 97.6% (949 patients) (p <0.05). Repeat vasectomies as well as 896 subsequent post-vasectomy semen analyses would have been avoided. Conclusions The AUA vasectomy guidelines provide clear, evidence-based criteria for vasectomy success. The guidelines simplify followup protocols, improve patient compliance and help avoid unnecessary post-vasectomy semen analyses and repeat vasectomies.

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“…11,16–18 Even when motile sperm are found in the first PVSA, more than 50% of patients ultimately achieve delayed success. 19 …”

Section: Discussionmentioning

confidence: 99%

Impact of the 2012 American Urological Association Vasectomy Guidelines on Post-Vasectomy Outcomes

et al. 2014

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“…Although most studies suggest that post-vasectomy testing be conducted at three months after vasectomy, the issue remains debatable, with some studies suggesting earlier examinations and others proposing later examinations. 33,38,39 The difficulty in establishing a set time point for semen testing stems largely from the variable success of the vasectomy occlusion techniques. 25 Azoospermia is achieved much later with the ligation (and excision) compared to the cautery or fascial interposition techniques.…”

Section: Timing Of Post-vasectomy Testingmentioning

confidence: 99%

“…25,38,40 The argument in favor of waiting at least three months is that this will reduce the number of false-positive samples and minimize the need for repeat laboratory assessment and counselling. 39 Recommendation: Post-vasectomy testing should be conducted at three months after vasectomy (Grade C). CUA BPR: Vasectomy…”

Section: Timing Of Post-vasectomy Testingmentioning

confidence: 99%

UPDATE – 2022 Canadian Urological Association best practice report: Vasectomy

Zini

Grantmyre

Chow

et al. 2022

CUAJ

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The following is an update of the 2016 Canadian Urological Association vasectomy guideline. The changes introduced are relatively minor, and include:-Clarified text on the optimal vasectomy occlusion technique, with a statement added about the surgeon being able to choose his/her preferred technique so long as outcomes are good. -Clarification of the recommendations on the number of post-vasectomy semen analyses.

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“…Several studies evaluating men with motile sperm on PVSA have reported the complete disappearance of spermatozoa over subsequent semen analyses ( 23 , 24 ). According to one series following 309 men with motile sperm on first post vasectomy semen analysis, 56.3% experienced complete disappearance of spermatozoa on subsequent semen analysis, with mean number of semen analysis 2.4±0.8 ( 25 ). However, if motile sperm are identified on semen analysis 6 months after vasectomy, these men should be offered repeat vasectomy for persistent recanalization.…”

Section: Post Vasectomy Follow Upmentioning

confidence: 99%

Vasectomy: tips and tricks

Johnson

Sandlow

2017

Transl. Androl. Urol.

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According to data from the National Study of Family Growth, vasectomy is utilized by 6–13% of American couples for their form of contraception. Physician surveys have shown that over 500,000 men undergo vasectomies per year, and more than 75% of vasectomies are performed by urologists. This chapter provides a brief history of vasectomy, as well as recommendations for preoperative counseling, an overview of the modified no-scalpel vasectomy technique, and a brief description of the complications of vasectomy.

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Delayed vasectomy success in men with a first postvasectomy semen analysis showing motile sperm

Cited by 18 publications

References 23 publications

Impact of the 2012 American Urological Association Vasectomy Guidelines on Post-Vasectomy Outcomes

Impact of the 2012 American Urological Association Vasectomy Guidelines on Post-Vasectomy Outcomes

UPDATE – 2022 Canadian Urological Association best practice report: Vasectomy

Vasectomy: tips and tricks

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