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


Ashok Agarwal
Sajal Gupta
Rakesh K. Sharma
Renata Finelli
Shinnosuke Kuroda
Sarah C. Vij
Florence Boitrelle
Parviz Kavoussi
Amarnath Rambhatla, Henry Ford HealthFollow
Ramadan Saleh
Eric Chung
Taymour Mostafa
Armand Zini
Edmund Ko
Neel Parekh
Marlon Martinez
Mohamed Arafa
Nicholas Tadros
Jean de la Rosette
Tan V. Le
Osvaldo Rajmil
Hussein Kandil
Gideon Blecher
Giovanni Liguori
Ettore Caroppo
Christopher C. K. Ho
Andrew Altman
Petar Bajic
David Goldfarb
Bradley Gill
Daniel Suslik Zylbersztejn
Juan Manuel Corral Molina
Marcello M. Gava
Joao Paulo Greco Cardoso
Raghavender Kosgi
Gökhan Çeker
Birute Zilaitiene
Edoardo Pescatori
Edson Borges
Gede Wirya Kusuma Duarsa
Germar-Michael Pinggera
Gian Maria Busetto
Giancarlo Balercia
Giorgio Franco
Gökhan Çalik
Hassan N. Sallam
Hyun Jun Park
Jonathan Ramsay
Juan Alvarez
Kareim Khalafalla
Kasonde Bowa
Lukman Hakim
Mara Simopoulou
Marcelo Gabriel Rodriguez
Marjan Sabbaghian
Haitham Elbardisi
Massimiliano Timpano
Mesut Altan
Mohamed Elkhouly
Mohamed S. Al-Marhoon
Mohammad Ali Sadighi Gilani
Mohammad Ayodhia Soebadi
Mohammad Hossein Nasr-Esfahani
Nicolas Garrido
Paraskevi Vogiatzi
Ponco Birowo
Premal Patel
Qaisar Javed
Rafael F. Ambar
Ricky Adriansjah
Sami AlSaid
Sava Micic
Sheena E. Lewis
Shingai Mutambirwa
Shinichiro Fukuhara
Sijo Parekattil
Sun Tae Ahn
Sunil Jindal
Teppei Takeshima
Ana Puigvert
Toshiyasu Amano
Trenton Barrett
Tuncay Toprak
Vineet Malhotra
Widi Atmoko
Yasushi Yumura
Yoshiharu Morimoto
Thiago Fernandes Negris Lima
Yannic Kunz
Yuki Kato
Yukihiro Umemoto
Giovanni M. Colpi
Damayanthi Durairajanayagam
Rupin Shah

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Publication Title

World J Mens Health


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.

PubMed ID



ePub ahead of print