Author’s Reply

To the Editor: Dr Ramakrishnan has raised some very good points. There is no absolute protocol for the number or timing of postvasectomy semen analyses. He suggests that a single 3-month postvasectomy semen analysis would probably suffice, which seems reasonable. My research, however, indicates that less than half the men returned at 3 months (25%) than returned for the 6-week check (58%). Because a semen analysis is the only way to know that one has achieved azoospermia—and that is the purpose of the vasectomy—then this noninvasive sampling is logical.

Our study followed Denniston and Pfenninger,1 which suggested customary postoperative care, with the exception that we also encouraged a 12-month postoperative semen check, in which only 8% of men participated. I also agree that because 42% of my patients did not return for ANY postvasectomy semen analysis, there are a significant number of risk-takers getting a vasectomy. It has been our practice not to routinely send specimens of excised vas deferens to pathology, because it just incurs more cost and does not determine the success of the vasectomy.