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Evidence-Based Clinical Practice: Ronald E. Christensen and Dalton C. Maples, Jr. Postvasectomy Semen Analysis: Are Men Following Up? J Am Board Fam Pract 2005; 18: 44-47 [Abstract] [Full text] [PDF]

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Postvasectomy Semen Analysis: Are Men Following Up?

Kalyanakrishnan Ramakrishnan   (8 April 2005)

Postvasectomy Semen Analysis: Are Men Following Up? 8 April 2005
Kalyanakrishnan Ramakrishnan, Family Physician Department of Family and Preventive Medicine, OUHSC, Oklahoma City, OK 73104 Send response to journal: Re: Postvasectomy Semen Analysis: Are Men Following Up? kramakrishnan{at}ouhsc.edu Kalyanakrishnan Ramakrishnan	To the Editor: I read with interest the article by Christensen and Maples addressing post-vasectomy semen analysis and the low compliance with instructions to confirm azoospermia.1 It begs the following questions - when and how often is semen analysis required following a vasectomy, and, is it ever necessary after a vasectomy? Furthermore, is it necessary to send the excised ends of the vas for histopathological evaluation? A review of the literature suggests that there is no definite agreement regarding the timing or the frequency of post-vasectomy semen analysis. All ejaculates contain potentially fertile spermatozoa immediately post vasectomy, which become rapidly immobile within a few days, and usually by 3 weeks following the procedure.2 The British Andrology Society guidelines requires patients to wait four months or have at least 24 ejaculations before semen analysis.3 The society also recommends that patients not ejaculate for 48 hours prior, collect semen by masturbation directly into the container, avoid condoms and deliver the semen within an hour of collection.3 The World Health Organization has differing recommendations- one or two semen analyses after 12 weeks or 15 ejaculations.4 Azoospermia proven on a single semen analysis at three months is probably sufficient grounds for discontinuing other methods of contraception.5 Further semen analyses should be required only if live sperms are present. Non-motile sperm is probably not an indication for checking further semen samples.6 Patient compliance is good if they are required to submit only one sample for analysis but decreases significantly when asked to provide a second sample.5 I suspect that post-vasectomy semen analysis, though logical, is simply not necessary. Perhaps many patients (nearly 40% of my 360) realize this instinctively, wait the specified three to four months, or in many instances, 12-15 ejaculations, before commencing unprotected intimacy with their partners. A small percentage will, doubtless have unintended issues, but humans gamble on success, and change will be difficult. There is also no uniformity regarding histological evaluation of the vasectomy specimens. One series from the United Kingdom showed that only three-fourths of the surgeons followed this practice.6 Provided the vasa are confidently identified and sectioned, routinely evaluating specimens just adds to the cost. The majority of patients requesting vasectomy in my practice is self-pay, and can ill-afford this added expense. Hence, I have tended to preserve the specimens until azoospermia is established at 3 months, or for one year, after which time the specimens are discarded due to space constraints. This is explained to the patients, prior to the vasectomy. I suspect many family physicians practicing in rural communities do the same. References 1.Christensen RE, Maples DC Jr. Postvasectomy Semen Analysis: Are Men Following Up? J Am Board Fam Pract 2005: 18: 44-7. 2.Edwards IS. Earlier testing after vasectomy, based on the absence of motile sperm Fertil Steril 1993; 59:431-6. 3.Hancock P, McLaughlin E. British Andrology Society guidelines for the assessment of post vasectomy semen samples. J Clin Pathol 2002 ; 55:812-6. 4.WHO's manual: "Technical and Managerial Guidelines for Vasectomy Services", Geneva, 1988, pg. 67. 5.Badrakumar C, Gogoi NK, Sundaram SK Semen analysis after vasectomy: when and how many? BJU Int 2000; 86: 479-81. 6.Sivardeen KA, Budhoo M Post vasectomy analysis: call for a uniform evidence-based protocol Ann R Coll Surg Engl 2001; 83:177-9.