The British Andrology Society guidelines for the assessment of post vasectomy semen samples recommend that initial assessment is undertaken 16 weeks post vasectomy and after the patient has produced at least 24 ejaculates. The laboratory should examine a freshly produced seminal fluid specimen by direct microscopy and if no sperm are seen the centrifugate should be examined for the presence of motile and non-motile spermatozoa. It is recommended that the clinician should give clearance after the production of two consecutive sperm free ejaculates. In cases of persistent identification of non-motile spermatozoa the referring clinician should advise the patient regarding the cessation of other contraceptive precautions. Surgeons are responsible both preoperatively and postoperatively for the counselling of couples regarding complications and the possibility of late recanalisation after clearance.

https://jcp.bmj.com/content/jclinpath/55/11/812.full.pdf

British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002)

How little is enough? The evidence for post-vasectomy testing.

Vasectomy follow-up: clinical significance of rare nonmotile sperm in postoperative semen analysis.

OBJECTIVES

To examine patient compliance, significance of rare nonmotile sperm (RNMS) and to determine the timing and number of semen analyses required to confirm sterility.



PATIENTS AND METHODS

From November 2001 to November 2004, 436 consecutive primary vasectomies were performed by one surgeon. All patients were instructed to submit two initial semen specimens for analysis (2 and 3 months after vasectomy) and additional samples (at 1-month intervals) if sperm were identified on the initial and subsequent analyses.



RESULTS

A quarter of the patients submitted no semen specimens and only 21% followed the full instructions to provide two consecutive negative semen analyses. Three-quarters of the patients provided a semen specimen at 8 weeks after vasectomy; of these, 75% were azoospermic and 25% contained sperm. At 12 weeks after vasectomy half the patients provided a semen specimen; of these, 91% were azoospermic and 9% contained sperm. Of the 83 patients with semen containing sperm at 8 weeks, 80 had RNMS and three had rare motile sperm (one of whom subsequently proved to have vasectomy failure). Of the 80 patients with RNMS, at 3, 4, 5, 6, 8, 10 and 11 months, 65, four, three, four, two, one and one, respectively were azoospermic.



CONCLUSIONS

The present results indicate that many patients are not compliant with the protocol after vasectomy. Provided patients have been adequately counselled, we think that one negative semen analysis at 3 months or one with RNMS at 2 months may be adequate to determine the success of vasectomy. This should reduce the number of semen analyses, including reducing the number of men who must undergo repeat testing, without sacrificing the accuracy of determining paternity. Simplifying the follow-up after vasectomy is important; not only would it be cost-effective but it may also improve patient compliance.

Determining the success of vasectomy.

Objective To determine the effect of perioperative distal vasal lavage with 50 mL of normal saline on subsequent time to azoospermia after vasectomy



Patients and methods Seventy-two patients were prospectively enrolled and randomized to undergo vasectomy with or without vasal lavage Infertility rates at 8, 10 and 12 weeks were compared for both groups and for those undergoing the procedure under local or general anaesthesia Patient compliance for returning postoperative semen for analysis was also assessed



Results There was no statistically significant difference in infertility rates at 8, 10 or 12 weeks after vasectomy with or without vasal lavage Vasectomies performed under local and general anaesthesia had comparable rates of infertility at 12 weeks after surgery Compliance in providing semen for analysis was poor



Conclusions The routine adoption of distal vasal lavage during vasectomy for contraception cannot be recommended As compliance in providing semen for analysis was poor, the clinician has a responsibility to remind the patient of the consequences of such action

The effect of perioperative distal vasal lavage on subsequent semen analysis after vasectomy: a prospective randomized controlled trial

BACKGROUND: Vasectomy is a safe and reliable means of contraception that is used by 42 million couples world-wide There are no standardised guidelines in the follow-up of these patients to assess the efficacy of the procedure, however Through this paper we aim to recommend a guideline that is both clinically effective and cost effective, and would avoid medicolegal debate PATIENTS AND METHODS: A questionnaire was sent to consultant general surgeons and urologists working both within and outside the North-West region, to assess the range of protocols used in the follow-up of patients undergoing vasectomy RESULTS: Of respondents, 75% sent the vas deferens routinely for histology: 904% requested 2 sperm samples routinely whilst 48% requested 1 sample and 48% requested 3 samples 952% requested further sperm samples if non-motile sperm were present 988% performed their first sperm sample by 12 weeks CONCLUSIONS: There is a wide range of protocols used in the follow-up of patients post-vasectomy Most do not appear to be evidence-based We recommend a guideline which re-emphasises the importance of pre-operative counselling, only 1 routine sperm sample taken 16 weeks post-vasectomy, and further samples taken only if motile sperm is seen Non-motile sperm is not an indication for further sperm samples We believe this guideline would be both clinically effective and cost effective

M Budhoo

Papers

Post vasectomy analysis: call for a uniform evidence-based protocol.