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

Agarwal A 1 , Gupta S 2 , Sharma RK 2 , Finelli R 2 , Kuroda S 2 , Vij SC 3 Show all authors , Boitrelle F 4 , Kavoussi P 5 , Rambhatla A 6 , Saleh R 7 , Chung E 8 , Mostafa T 9 , Zini A 10 , Ko E 11 , Parekh N 3 , Martinez M 12 , Arafa M 2 , Tadros N 13 , de la Rosette J 14 , Le TV 15 , Rajmil O 16 , Kandil H 17 , Blecher G 18 , Liguori G 19 , Caroppo E 20 , Ho CCK 21 , Altman A 3 , Bajic P 3 , Goldfarb D 3 , Gill B 3 , Zylbersztejn DS 22 , Molina JMC 23 , Gava MM 24 , Cardoso JPG 25 , Kosgi R 26 , Çeker G 27 , Zilaitiene B 28 , Pescatori E 29 , Borges E 30 , Duarsa GWK 31 , Pinggera GM 32 , Busetto GM 33 , Balercia G 34 , Franco G 35 , Çalik G 36 , Sallam HN 37 , Park HJ 38 , Ramsay J 39 , Alvarez J 40 , Khalafalla K 41 , Bowa K 42 , Hakim L 43 , Simopoulou M 44 , Rodriguez MG 45 , Sabbaghian M 46 , Elbardisi H 41 , Timpano M 47 , Altan M 48 , Elkhouly M 49 , Al-Marhoon MS 50 , Sadighi Gilani MA 46 , Soebadi MA 43 , Nasr-Esfahani MH 51 , Garrido N 52 , Vogiatzi P 53 , Birowo P 54 , Patel P 55 , Javed Q 56 , Ambar RF 57 , Adriansjah R 58 , AlSaid S 41 , Micic S 59 , Lewis SE 60 , Mutambirwa S 61 , Fukuhara S 62 , Parekattil S 63 , Ahn ST 64 , Jindal S 65 , Takeshima T 66 , Puigvert A 67 , Amano T 68 , Barrett T 69 , Toprak T 70 , Malhotra V 71 , Atmoko W 54 , Yumura Y 66 , Morimoto Y 72 , Lima TFN 73 , Kunz Y 32 , Kato Y 74 , Umemoto Y 75 , Colpi GM 76 , Durairajanayagam D 77 , Shah R 78

Affiliations 

  • 1 American Center for Reproductive Medicine, Cleveland, OH, USA. agarwaa@ccf.org
  • 2 American Center for Reproductive Medicine, Cleveland, OH, USA
  • 3 Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
  • 4 Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
  • 5 Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
  • 6 Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
  • 7 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  • 8 Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
  • 9 Department of Andrology, Sexology & STIs, Faculty of Medicina, Cairo University, Cairo, Egypt
  • 10 Department of Surgery, McGill University, Montreal, QC, Canada
  • 11 Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
  • 12 Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
  • 13 Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
  • 14 Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
  • 15 Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
  • 16 Department of Andrology, Fundacio Puigvert, Barcelona, Spain
  • 17 Fakih IVF Fertility Center, Abu Dhabi, UAE
  • 18 Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
  • 19 Department of Urology, University of Trieste, Trieste, Italy
  • 20 Reproductive and IVF Unit, Asl Bari, Bari, Italy
  • 21 Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
  • 22 Department of Reproductive Medicine and Urology, Hospital Israelita Albert Einstein, São Paulo, Brazil
  • 23 Servicio de Urología, Hospital Clínico de Barcelona, Barcelona, Spain
  • 24 Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
  • 25 Divisao de Urologia, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, São Paulo, Brazil
  • 26 Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India
  • 27 Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey
  • 28 Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
  • 29 Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
  • 30 Fertility Medical Group, São Paulo, Brazil
  • 31 Department of Urology, Faculty of Medicine, Sanglah General Academic Hospital, Udayana University, Denpasar, Indonesia
  • 32 Department of Urology, Innsbruck Medical University, Innsbruck, Austria
  • 33 Department of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
  • 34 Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
  • 35 UOC Urologia, Department Materno-Infantile e Scienze Urologiche, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
  • 36 Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
  • 37 Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
  • 38 Department of Urology, Pusan National University School of Medicine, Busan, Korea
  • 39 Department of Andrology, Hammersmith Hospital, London, UK
  • 40 Centro ANDROGEN, La Coruña, Spain
  • 41 Department of Urology, Hamad Medical Corporation, Doha, Qatar
  • 42 Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
  • 43 Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
  • 44 Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
  • 45 Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
  • 46 Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  • 47 A.O.U. Città della Salute e della Scienza di Torino, Molinette, Italy
  • 48 Department of Urology, Hacettepe University, Ankara, Turkey
  • 49 Bourne Hall Fertility Center, Dubai, UAE
  • 50 Department of Surgery, Urology Division, Sultan Qaboos University, Muscat, Oman
  • 51 Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
  • 52 IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
  • 53 Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
  • 54 Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • 55 Section of Urology, University of Manitoba, Winnipeg, MB, Canada
  • 56 Department of Urology, Ahalia Hospital, Hamdan Street Branch, Abu Dhabi, UAE
  • 57 Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
  • 58 Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
  • 59 Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
  • 60 Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
  • 61 Division of Urology, Safeko Makgatho Health Scienses University and Dr George Mukhari Academic Hospital, Pretoria, South Africa
  • 62 Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
  • 63 Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
  • 64 Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
  • 65 Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
  • 66 Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
  • 67 Fundació Puigvert, Hospital de la Santa Cruz y San Pablo, Universidad Autonoma de Barcelona, Barcelona, Spain
  • 68 Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
  • 69 Perth Urology Clinic, Perth, WA, Australia
  • 70 Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
  • 71 Department of Andrology and Urology, Diyos Hospital, New Delhi, India
  • 72 HORAC Grand Front Osaka Clinic, Osaka, Japan
  • 73 Department of Urology, Veredas Hospital, Maceió, Brazil
  • 74 Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
  • 75 Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
  • 76 Andrology Unit, Procrea Institute, Lugano, Switzerland
  • 77 Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  • 78 Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
World J Mens Health, 2022 Jul;40(3):425-441.
PMID: 35021311 DOI: 10.5534/wjmh.210191

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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