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