How Little Is Enough? The Evidence for Post-Vasectomy Testing

Abstract

The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations. If the sample is positive, periodic testing can continue until azoospermia is achieved. Patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success. No evidence was located to support histological testing of the excised vas deferens.

Impact of the 2012 American Urological Association Vasectomy Guidelines on Postvasectomy Outcomes in a Military Population

“…Consequently, many urologists adhere to strict protocols to confirm postvasectomy sterility, often requiring patients to provide repetitive semen analyses. 1,[4][5][6] Our institution historically defined postvasectomy success as azoospermia in uncentrifuged fresh semen obtained at least 8 weeks after vasectomy. In 2012, the American Urological Association (AUA) guidelines were amended to include 100,000 nonmotile sperm per mL in an uncentrifuged specimen as a measure of postvasectomy success.…”

Fertility preservation following torsion and severe ischemic injury of a solitary testis

“…This may account for viable sperm found in this case, with sperm beyond the level of obstruction of the ischemic/edematous vas. This is also seen after vasectomy with semen analyses showing near normal counts and motility in the initial few ejaculates (12). The possibility of the sperm being from the epididymis 50 hours after torsion cannot be excluded, although the quality of the sample was near normal.…”

CUA guideline:Vasectomy

“…33 Most agree that a single azoospermic semen sample is sufficient to deem the vasectomy effective. 30,34 However, because spermatozoa are detected in 10-40% of the three-month post-vasectomy samples (the percent depends on the vasectomy technique and the accuracy of the semen analysis), it may be necessary for up to 40% of the men to submit a second semen sample. 25,35 As such, requesting two semen samples at the onset may be more efficient, as this may reduce the number of postvasectomy counselling sessions (e.g., phone calls or office visits), but this may also reduce the overall compliance.…”

“…The laboratory should give an estimation of sperm concentration or numbers of spermatozoa observed per high-power field (×400 magnification). [28][29][30] It is important to recognize that compliance with postvasectomy semen testing is a significant issue, with up to 30% of men failing to submit a single sample. 31,32 One vs. two post-vasectomy samples Surveys have shown significant variability in the postvasectomy testing protocols.…”