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

Authors
Agarwal, AshokGupta, SajalSharma, Rakesh K.Finelli, RenataKuroda, ShinnosukeVij, Sarah C.Boitrelle, FlorenceKavoussi, ParvizRambhatla, AmarnathSaleh, RamadanChung, EricMostafa, TaymourZini, ArmandKo, EdmundParekh, NeelMartinez, MarlonArafa, MohamedTadros, Nicholasde la Rosette, JeanLe, Tan, VRajmil, OsvaldoKandil, HusseinBlecher, GideonLiguori, GiovanniCaroppo, EttoreHo, Christopher C. K.Altman, AndrewBajic, PetarGoldfarb, DavidGill, BradleyZylbersztejn, Daniel SuslikCorral Molina, Juan ManuelGava, Marcello M.Cardoso, Joao Paulo GrecoKosgi, RaghavenderCeker, GokhanZilaitiene, BirutePescatori, EdoardoBorges, EdsonDuarsa, Gede Wirya KusumaPinggera, Germar-MichaelBusetto, Gian MariaBalercia, GiancarloFranco, GiorgioCalik, GokhanSallam, Hassan N.Park, Hyun JunRamsay, JonathanAlvarez, JuanKhalafalla, KareimBowa, KasondeHakim, LukmanSimopoulou, MaraRodriguez, Marcelo GabrielSabbaghian, MarjanElbardisi, HaithamTimpano, MassimilianoAltan, MesutElkhouly, MohamedAl-Marhoon, Mohamed S.Gilani, Mohammad Ali SadighiSoebadi, Mohammad AyodhiaNasr-Esfahani, Mohammad HosseinGarrido, NicolasVogiatzi, ParaskeviBirowo, PoncoPatel, PremalJaved, QaisarAmbar, Rafael F.Adriansjah, RickyAlSaid, SamiMicic, SavaLewis, Sheena E.Mutambirwa, ShingaiFukuhara, ShinichiroParekattil, SijoAhn, Sun TaeJindal, SunilTakeshima, TeppeiPuigvert, AnaAmano, ToshiyasuBarrett, TrentonToprak, TuncayMalhotra, VineetAtmoko, WidiYumura, YasushiMorimoto, YoshiharuLima, Thiago Fernandes NegrisKunz, YannicKato, YukiUmemoto, YukihiroColpi, Giovanni M.Durairajanayagam, DamayanthiShah, Rupin
Issue Date
Jul-2022
Publisher
대한남성과학회
Keywords
Male contraception; Semen; Sperm; Survey; Vasectomy
Citation
The World Journal of Men's Health, v.40, no.3, pp.425 - 441
Indexed
SCIE
SCOPUS
KCI
Journal Title
The World Journal of Men's Health
Volume
40
Number
3
Start Page
425
End Page
441
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/55304
DOI
10.5534/wjmh.210191
ISSN
2287-4208
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.
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