(385) Compliance with Post-Vasectomy Semen Analysis (PVSA): A Retrospective Survey Study

Abstract

Abstract Introduction After undergoing vasectomy, sterility must be confirmed with PVSA obtained ~12 weeks and at least 20 ejaculations after the procedure. Sterility is defined as azoospermia or rare non-motile sperm (<100,000 non-motile sperm/mL). In the literature, compliance for obtaining PVSA has been reported at ~53%. Prior retrospective research has demonstrated that the compliance rate for PVSA at our institution is considerably higher than this, at 89%, which may relate to practice patterns that improve follow-up. Noncompliance has been linked to a number of patient circumstances, though limited studies have explored this from the patient’s perspective. Objective To identify patient-related factors associated with PVSA compliance and describe perceived barriers for not obtaining PVSA. Methods An anonymous survey was sent via REDCap to patients who underwent vasectomy at our institution from February 2020 to February 2023 (n = 134, 14.4 RR; 7.3% in 2020, 31.8% in 2021, 60.9% in 2022). Participants provided demographics, answered questions about their vasectomy, and reported reasons for completing or failing to complete PVSA (IRB 2022H0457). Results Study Sample: Patients were 98.4% cis male, 88.7% heterosexual, and 93.2% white, with a mean age of 37.9 years (SD = 6.05 yrs). The majority of patients held a Bachelor’s degree or higher (79.6%) and the mean reported annual income was $100,000–150,000. Eighty-two percent of patients were married; the majority had been married for more than 5 years (85.3%). Seventy-four percent had at least one child. Fifty-one percent said insurance covered the procedure completely while 48% said insurance covered the procedure partially. Survey Results: Patients rated their vasectomy procedure pain at 4.3/10 (SD = 2.6) and their post-vasectomy pain at 3.6/10 (SD = 2.03). Patients reported an average out-of-pocket cost for their vasectomy of $439.57 (SD = $358.66). Ninety-nine percent of patients said they had completed their PVSA and 16.2% reported that there was an out-of-pocket cost for their SA. PVSA Compliance Factors: 97.5% of patients were told about the need to verify their sterility at their initial consultation, 97.5% were told this again on their procedure day, 99.2% were given clear PVSA instructions, 92.4% had their lab appointment pre-scheduled, 89.9% were given a semen cup, and 80.7% received an appointment reminder for their SA. Ninety-five percent of patients were sterile on their first SA; of the 5.1% who were not, all but one had already completed a second SA. We asked men what made them most likely to comply with getting a PVSA. The most popular answer was being provided with an appointment reminder, followed by lab proximity to home. Conclusions Our institution has an impressively high PVSA compliance, possibly because of several workflow interventions, including appointment reminders, pre-scheduling of PVSA, and repetitive provider-facilitated engagement about PVSA necessity. Lab-home proximity is specifically important to patients, likely because it allows for them to obtain specimen at home. These results may provide a model for other institutions and centers hoping to increase their PVSA compliance. Disclosure No.