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).

 

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