Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices

Abstract

Purpose The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.

The Global Andrology Forum (GAF): Structure, Roles, Functioning and Outcomes: An Online Model for Collaborative Research

“…Table 2 [ 3 22 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 ] illustrates that 23 articles were published in prestigious peer-reviewed journals by author contributions representing 46 countries. Broadly classified, these articles tackled contemporary challenges in andrology spanning across topics of sperm DNA damage, semen analysis, laboratory issues in relation to assisted reproductive technique (ART), sperm recovery, etc.…”

Leveraging Electronic Medical Records from Two Hospital Systems Identifies Male Infertility Associated Comorbidities Across Time

“…Even with this caveat, the vast majority of UC patients in our study (> 98%) have either a known vasectomy date or recorded postvasectomy semen analysis, which usually occurs around 3 months after a vasectomy. 51 Moreover, vasectomy patients were chosen for their presumptive fertility, as previous studies have shown that 90% of patients seeking a vasectomy are fertile. 12 Thus, that the precise date of vasectomy may be unknown may not have a meaningful impact on our findings.…”

A new approach to postvasectomy semen analyses eliminates the need to evaluate a fresh specimen

“…There are several surgical techniques for vasectomy, 4 but whatever the approach, it is necessary to verify the absence of ejaculated spermatozoa to guarantee sterility because of spermatozoa storage on the abdominal side of the ligation site and the potential for recanalization of the cut ends of the vas deferens 4,6 …”

“…5 There are several surgical techniques for vasectomy, 4 but whatever the approach, it is necessary to verify the absence of ejaculated spermatozoa to guarantee sterility because of spermatozoa storage on the abdominal side of the ligation site and the potential for recanalization of the cut ends of the vas deferens. 4,6 Postvasectomy semen analyses are routinely ordered by surgeons performing the vasectomy, but patient compliance is low, ranging from 58% to 75%. 7,8 The 2002 British Andrology Society guidelines recommended three postvasectomy semen analyses: two within several weeks of the procedure and a third at 1 year to rule out re-canalization.…”