The most important thing to tell the couple after performing a vasectomy?

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No unprotected sex until it is proven that there is no significant number sperm in the ejaculate! Don’t assume that just because you had a vasectomy that all is well to resume unprotected activity.

Men With Non-Motile Sperm in the Ejaculate May Be Considered Sterile

Urology – June 30, 2014 – Vol. 31 – No. 8

Men who have undergone a vasectomy and have <100,000 non-motile sperm in the ejaculate, as well as those who are azoospermic, are considered sterile.

Article Reviewed: Impact of the 2012 American Urological Association Vasectomy Guidelines on Post-Vasectomy Outcomes. Coward RM, Badhiwala NG, et al: J Urol; 2014;191 (January): 169-174.

Background: In 2012, the American Urological Association (AUA) commissioned a panel of experts to create guidelines for one of the most common urologic procedures, vasectomy. Prior to this guideline, there was no consensus on appropriate post-vasectomy semen analysis timing. Additionally, the definition of sterile was presumed to be azoospermia, with some experts suggesting the specimen should be centrifuged and the pellet examined.

Objective: To determine the effects of a less stringent post-vasectomy protocol suggested by the AUA guideline on vasectomy.

Design: Retrospective review.

Methods: The charts of all men who underwent a vasectomy by a single surgeon and returned for at least 1 semen analysis were reviewed. Initially, the patients were requested to provide 2 specimens, which were examined with centrifugation to ensure azoospermia at least 3 months after vasectomy. The new AUA guidelines suggest a man can be considered sterile after a vasectomy if the specimen is azoospermic without centrifugation and pellet evaluation, or if there are <100,000 non-motile sperm present. The surgeon used a technique with 2 high scrotal incisions and titanium clip ligation of the vas after removing a segment.

Results: A total of 1740 vasectomies were performed over a 12.5-year time period. Of these, 55.9% of men returned for at least 1 semen analysis. At the initial post-vasectomy semen analysis, 76% were azoospermic and 19% had <100,000 non-motile sperm. Based on the new guidelines, 94.8% would have been cleared after the initial semen analysis. Of the 972 men who had 1 semen analysis, only 34.3% returned for a second and 18.6% required ≥3 semen analyses due to persistent sperm in the ejaculate. Of the men who only had 1 semen analysis, 2.8% had motile sperm in the ejaculate at that evaluation and 1.5% had >100,000 non-motile sperm. Three patients underwent repeat vasectomy due to persistent non-motile sperm <100,000, which would have been unnecessary with the current guidelines.

Conclusions: The 2012 AUA vasectomy guidelines provide an evidence-based protocol that will simplify follow-up, decrease cost and time until considered sterile, and hopefully improve patient compliance.

Reviewer’s Comments: I had the fortune to review these guidelines during fellowship training and have since employed this protocol for post-vasectomy semen analysis. I typically have the patients evaluated at 2 months and do see a reasonable number of patients who continue to have <100,000 non-motile sperm at that time. My experience has been that it typically is well over or under the 100,000. In review of 250 vasectomies in the last 1.5 years, I have only had 48% of men return for even a single post-vasectomy semen analysis. Unfortunately, even with simplified guidelines compliance remains an issue.(Reviewer–Gregory Lowe, MD).

 

Vasectomy-Three questions answered.

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From Vasectomy.com

How effective is a vasectomy?

Vasectomies are more than 99 percent effective: In the first year after a vasectomy, only one to two women out of every 1,000 becomes pregnant by their partner.

Are vasectomies covered by insurance?

Vasectomy is often covered by health insurance. Depending on your personal plans deductible and co-insurance, however, your insurance policy may or may not cover the entire cost of the surgery. Check with your insurance company before scheduling a procedure.

Does a vasectomy affect ejaculate?

A vasectomy has very little effect on ejaculate itself. Semen consists of sperm, fluid from the seminal vesicles, and fluid from the prostate gland. During a vasectomy, strictly the vas deferens is blocked, not the seminal vesicles or prostate, so sperm is the only thing missing from the ejaculate. (Sperm comprise only 2-5 percent of typical ejaculate, so removing them has little or no effect on the volume, appearance, color, or consistency.)

Reviewed October 12, 2012, by Larry Lipshultz, MD – Urologist