Postvasectomy Semen Research Articles

Balancing Post-Vasectomy Adequate Sperm Clearance with Patient Compliance: Time to Rethink?

Background/Objectives: The American Urological Association (AUA) vasectomy guidelines’ current recommendation to obtain the first post-vasectomy semen analysis (PVSA) from 8 weeks to 16 weeks post-vasectomy is based predominantly on azoospermia rates. However, non-compliance with semen analysis after vasectomy is a known problem in this patient population. An approach that optimizes clearance and compliance is essential when adopting appropriate post-vasectomy care guidelines, specifically the scheduling of the first PVSA. We aimed to conduct a systematic review and meta-analysis of studies assessing compliance and clearance to determine the optimal time of first PVSA. Methods: Databases (MEDLINE, EMBASE, POPLINE) were searched for studies that contained the following: rate of azoospermia and rare nonmotile sperm (RNMS), compliance, recanalization, persistent RNMS, pregnancies, and incidence of repeat vasectomy. Results: A total of 28 studies were included in this review. The patient compliance was 47–100% and trended downward with increasing time to first PVSA. There was a positive trend in azoospermia rate as post-vasectomy time increased, but this plateaued at 8 weeks. Compliance and post-vasectomy semen analysis clearance (PVSAC) converged at 5.7 weeks, with rates of 74.5% and 74.6%, respectively. A proportion of 1.5% of patients exhibited persistent RNMS. Recanalization events had an incidence rate of 1.5%. Repeat vasectomies were performed in 1.6% of patients. Conclusions: Based on our study optimizing post-vasectomy semen clearance with follow-up compliance, we recommend initial PVSA between 6 to 18 weeks post-vasectomy, as this offers improved compliance over current AUA guidelines which recommend PVSA at 8 to 16 weeks and allows for the identification of instances of “subclinical recanalization” that may be missed at later time points.

Post-Vasectomy Semen Analysis: What's All the Fuss about?

Vasectomy is a reliable male contraceptive method with a success rate exceeding 98%. Despite its efficacy, vasectomy is not foolproof, with potential early and late failures requiring careful postoperative monitoring via post-vasectomy semen analysis (PVSA). Published guidelines emphasize the necessity of conducting PVSA to ensure clinical sterility. Despite these clear guidelines, discrepancies in adherence and interpretation persist, with significant mismatches between guidelines and actual practice. Recent shifts in societal attitudes toward reproductive autonomy, spurred by significant political events and socioeconomic factors, have increased vasectomy rates, particularly among younger, childless men. This demographic change calls for enhanced PVSA compliance and clear communication about the non-immediate contraceptive effect of vasectomy. Home test kits have emerged as a convenient, though not always reliable, method for conducting PVSAs, which may require reevaluation in clinical practice. Given the variations across clinical guidelines and the challenges in achieving consistent PVSA outcomes, further research is needed to harmonize PVSA protocols across different health systems. PVSA is typically conducted between 8 and 16 weeks post-vasectomy, depending on the surgeon's preference. Success is confirmed when a fresh, uncentrifuged sample exhibits either azoospermia, rare non-motile sperm (RNMS), or fewer than 100,000 non-motile sperm per milliliter. This effort will ensure that both patients and practitioners can rely on vasectomy as a safe and effective form of contraception. Effective patient counseling and strategic follow-up are crucial when it comes to managing expectations and ensuring compliance with post-vasectomy protocols, thereby minimizing the risk of unintended pregnancies post-procedure.

Vasectomy histology: Is it still useful?

To determine if histological evaluation of the vasa is useful when post-vasectomy semen analysis (PVSA) compliance is low and to determine whether compliance could be predicted. A retrospective evaluation of patients undergoing vasectomy between 2018 and 2022 was undertaken. A comparison of the PVSA between three vasa histological categorisations was made: complete divisions, incomplete division(s), absent vas(a). A multivariate model was constructed to predict PVSA compliance. From 388 patients, 191 (49.2%) undertook PVSA. Four patients had a revision of vasectomy. On 3 occasions this was due to the histology findings and once from semen analysis with normal histology. There was no significant difference in the number of azoospermic samples (95.4% vs 91.2%, ns), of samples with presence of Rare Non-Motile Sperm (RNMS) (2.6% vs 8.8%, ns) and those with sperm present (2.0 vs 0%, ns), between patients with complete division of the vasa on both sides and those with incomplete division on one side respectively. There was no difference in patient characteristics between those who complied with PVSA and those who did not. This paper suggests that there is a role for histological evaluation of the vasa when PVSA compliance is poor. Incompletely divided vasa on histology are not associated with an adverse PVSA.

A Male Surgical Contraceptive Method Based on Recommendations and Techniques Used in Vasectomy

Background: Vasectomy is a well-established method of male sterilization, offering a reliable and permanent contraceptive solution. Despite its effectiveness, the procedure remains underutilized due to limited counseling and awareness among patients. Objective: The objective of this study was to evaluate the efficacy and safety of a standardized vasectomy technique based on the 2012 American Urological Association (AUA) guidelines and to identify factors influencing postoperative outcomes and patient satisfaction. Methods: This prospective cohort study was conducted at the Department of Zoology, Rawalpindi Women University, from January 2022 to December 2023. A total of 150 male patients aged 25 to 50 years seeking permanent contraception were enrolled. Preoperative evaluations included detailed medical history, physical examination, and baseline semen analysis. The vasectomy procedures involved isolation, division, and management of the vasal ends using techniques such as proximal fascial interposition and thermal luminal fulguration. Postoperative care included instructions on scrotal support, avoidance of strenuous activities, and use of alternative contraception until azoospermia was confirmed through post-vasectomy semen analysis (PVSA) conducted at three months post-procedure. Data were analyzed using SPSS version 25, with statistical significance set at p < 0.05. Results: The mean age of participants was 37.5 years (range: 25-50 years). The overall efficacy rate was 98.7%, with 140 participants (93.3%) achieving azoospermia and 8 participants (5.3%) having less than 100,000 non-motile sperm/mL at three months post-procedure. Complications included infection (1.3%), hematoma (2.0%), chronic pain (2.7%), and sperm granuloma (0.7%). The mean VAS scores for pain were 2.3 at one week, 1.1 at one month, and 0.5 at three months post-procedure. Patient satisfaction was high, with 95% of participants reporting satisfaction with the procedure. Conclusion: This study demonstrated that vasectomy, when performed using standardized techniques, is a highly effective and safe method of male sterilization with high patient satisfaction and low complication rates. Enhanced preoperative counseling and follow-up are essential to optimize outcomes and increase the utilization of vasectomy as a contraceptive method.

Patient Portal Engagement Affects Postvasectomy Semen Analysis Completion

To identify factors that affect completion of post-vasectomy semen analysis (PVSA) in men receiving telehealth pre-vasectomy counseling. Telehealth visits have become increasingly common for pre-vasectomy consultations. Prior studies have shown that men prefer telehealth vasectomy consultations over in-person options. Post-vasectomy semen testing should be completed to confirm sterilization. Three-hundred and seventy-one men aged 19 and older who saw a single physician for a telehealth pre-vasectomy consultation and completed an in-office vasectomy were included in the study. Demographic information such as age, patient relationship status, and distance from the clinic were accessed via EMR. Patients were assessed based on their engagement with electronic pre-procedure instructions, and the primary outcome measured was completion of PVSA. 45.6% of men completed a PVSA. There was no significant difference in completion of the PVSA between those who opened their electronic instructions before their vasectomy and those who did not (46.1% vs 44.4%, p=0.77). Of those who messaged the clinic for any reason at least once after their consultation, 62% completed their PVSA; 41% who did not contact the clinic completed the PVSA (p=0.0009). While there was no difference in completion of PVSA in patients who opened their instructions vs. those who did not, patients with a higher level of engagement with the patient portals were more likely to complete their semen test. By understanding factors influencing patient compliance with post-vasectomy semen testing, healthcare professionals can develop targeted interventions to ensure safe and successful outcomes.

(259) Providing a Post-Vasectomy Semen Analysis Cup at the Time of Vasectomy Rather Than Post-Operatively Improves Compliance

Abstract Introduction Post-vasectomy semen analysis (PVSA) completion rates after vasectomy are poor, and minimizing the need for an additional in-person visit may improve compliance. We hypothesized that providing PVSA specimen cup at time of vasectomy instead of at a postoperative appointment might be associated with higher PVSA completion rates. We also hypothesized that performing virtual postoperative visits after vasectomy might improve PVSA completion rates. Objective To evaluate PVSA completion rates between patients receiving specimen cups at time of vasectomy versus at post-operative appointment. Methods We performed a retrospective review of all patients seen by a single provider for vasectomy consultation between October 2016 and June 2022. All patients who underwent vasectomy were included. Patients who underwent vasectomy prior to May 2020 had PVSA specimen cup given at postoperative appointment and those who underwent vasectomy after May 2020 were given PVSA specimen cup at time of vasectomy. PVSA completion and postoperative visit type were recorded. Demographic and clinical outcomes data were collected. Logistic regressions were used to investigate associations between PVSA completion rates and both timing of providing PVSA specimen cup and postoperative visit setting. Results 491 patients were seen for vasectomy consultation between October 2016 and June 2022. 370 (75.4%) of all patients seen for consultation ultimately underwent vasectomy. 173 (45.7%) patients underwent vasectomy prior to May 2020 and were given PVSA specimen cup at postoperative visit. 197 (53.2%) patients underwent vasectomy after May 2020 and were given PVSA specimen cup at vasectomy. 160 (47.2%) of patients were seen virtually for postoperative visit, whereas 179 (52.8%) were seen in-person. Providing PVSA specimen cup at time of vasectomy was associated with higher odds of PVSA completion than providing PVSA specimen cup at postoperative visit (62.4% vs. 49.7%; OR = 1.68; 95% CI: 1.11, 2.55). No association was noted between PVSA completion rate and whether the postoperative visit was virtual or in-person (63.8% vs. 55.3%; OR = 1.42; 95% CI: 0.92, 2.20). Conclusions PVSA specimen cup provided at time of vasectomy versus at postoperative appointment is associated with higher rates of PVSA completion. Virtual postoperative visit after vasectomy is feasible and has no detectable association with PVSA completion rates. These findings together support the growing role of telehealth in urology practices. Disclosure No.

(384) Post-Vasectomy Semen Analysis Compliance Correlated with Patient Driving Distance to Drop-off Site

Abstract Introduction Successful vasectomy is confirmed with post-vasectomy semen analysis (PVSA) completed eight to sixteen weeks after the procedure. However, compliance rates remain low throughout the literature with an estimated 34% to 58% of patients never receiving a PVSA. Objective We sought to quantify the relationship between driving time and compliance with PVSA. Methods A retrospective chart review was conducted of vasectomies provided by urologists from an academic hospital system between 4/1/2020 and 12/31/2022. Physicians who primarily performed in-office PVSA or referred patients to outside clinics were excluded from the study. Compliance with post-vasectomy semen analysis was defined as at least 1 PVSA sample submitted. In our study we considered variables including age, virtual or in-person preoperative visit, paternity, and driving time. The shortest driving time was calculated from each patient’s residence to the single PVSA drop-off site using ArcGIS. The study received IRB approval. The factors associated with compliance were analyzed via multivariable logistic regression. Driving time, age at vasectomy, paternity, and preop location were included as predictors. Driving time and age were included as continuous variables. For driving time the odds ratio reflects the change in odds of PVSA per 30 minutes of driving; for age the odds ratio reflects the change in odds of PVSA per 10 years of age. A generalized additive model was used to explore a nonlinear relationship between driving time and PVSA compliance. Results A total of 515 patients were included in the analysis. 296 patients obtained a PVSA (57.5%). Of those who obtained a PVSA, 41% took more than 16 weeks to do so. The median driving distance for those who obtained a PVSA was 18.9 miles (11.3, 26.4) and 22.3 miles (13.9, 34.3) for those who did not (p<0.01). The median estimated driving times for those who did and did not provide PVSA were 30.6 minutes (23.0, 42.1) and 34.2 minutes (25.5, 46.8) respectively (p<0.05). Adjusted for age, paternity, and pre-op location, each 30 minutes of driving time was associated with a 48% (63%, 27%) reduction in the odds of obtaining a PVSA (p<0.001). Age at vasectomy, paternity, and pre-op location were not found to be associated with decreased PVSA compliance. (Table 1). The generalized additive model shows a similar relationship between driving distance and compliance (Figure 1). Conclusions These results demonstrate a statistically significant correlation between longer driving time to a drop-off site and probability of PVSA non-compliance. However, factors such as paternity, age at vasectomy, and pre-op visit format were not significant. Increasing access to semen analysis drop-off centers close to patients residences may serve to increase compliance with PVSA. At-home PVSA kits and in-office semen analyses are other options for reducing this barrier. Further research is needed to see if this relationship between driving time and compliance is seen in other aspects of medical care. Disclosure No.

Providing a post-vasectomy semen analysis cup at the time of vasectomy rather than post-operatively improves compliance.

Post-vasectomy semen analysis (PVSA) completion rates after vasectomy are poor, and minimizing the need for an additional in-person visit may improve compliance. We hypothesized that providing PVSA specimen cup at time of vasectomy instead of at a postoperative appointment might be associated with higher PVSA completion rates. We performed a retrospective cohort study with historical control using medical records of all patients seen by a single provider for vasectomy consultation between October 2016 and June 2022. All patients who underwent vasectomy were included. Patients who underwent vasectomy prior to 05/01/2020 had PVSA specimen cup given at postoperative appointment two weeks following vasectomy, and those who underwent vasectomy after 05/01/2020 were given PVSA specimen cup at time of vasectomy. PVSA completion, demographic, and clinical outcomes data were collected. Logistic regressions were used to investigate associations between PVSA completion rates and timing of PVSA specimen cup provision. There were no significant differences among study cohorts across all patient demographics analyzed, including age, body mass index (BMI), age of primary partner, presence of children, and history of prior genitourinary infection. A total of 491 patients were seen for vasectomy consultation between October 2016 and June 2022; among these patients, 370 underwent vasectomy. Of these, 173 (46.8%) patients underwent vasectomy prior to 05/01/2020 and were given PVSA specimen cup at postoperative visit; 197 (53.2%) patients underwent vasectomy after 05/01/2020 and were given PVSA specimen cup at vasectomy. Providing PVSA specimen cup at time of vasectomy was associated with higher odds of PVSA completion than providing PVSA specimen cup at postoperative visit [62.4% vs. 49.7%; odds ratio (OR) =1.68; 95% confidence interval (CI): 1.11, 2.55]. Adjusting for all identified confounders excludes 35 (9.5%) patients without a primary partner and shows no statistically significant association in cup timing [adjusted OR (aOR) =1.53; 95% CI: 0.98, 2.39]. Adjusting for all identified confounders except age of primary partner revealed timing of specimen cup provision at time of vasectomy was associated with higher odds of PVSA completion (aOR =1.64; 95% CI: 1.08, 2.52). PVSA specimen cup provision at time of vasectomy versus at postoperative appointment is associated with higher rates of PVSA completion in this retrospective cohort study.

Driving Time and Compliance With Postvasectomy Semen Analysis Drop-Off

Current literature demonstrates low rates of compliance with post vasectomy semen analysis (PVSA). This study sought to determine factors that correlate with non-compliance with PVSA. A retrospective chart review was conducted for patients who underwent vasectomy within our institution. ArcGIS was used to securely calculate the shortest driving time from each patient’s home to the single PVSA drop-off site. Kruskal-Wallis and chi-squared tests analyzed characteristics of patients who did and did not submit PVSA samples, and odds ratios were calculated via multivariable logistic regression. Overall, 515 of 850 patients met inclusion criteria and 219 (42.5%) of these had no recorded PVSA. Of those with a PVSA, 59% were completed within 16 weeks. Compliance with PVSA was associated with a shorter median driving time (30.6min vs 34.2min), more vasectomy in the operating room (19% vs 10%), and attending a follow-up appointment (40% vs 17%) (p<0.005 for all). Age at vasectomy, race, ethnicity, BMI, paternity, and location of pre-operative consultation did not significantly differ between the groups. Each 30 minutes of driving time was associated with a 48% reduction in the odds of a patient submitting PVSA at any time (OR 0.52 [0.37, 0.73]). As driving time to a drop-off center appears to be a significant barrier to PVSA compliance, providers should consider alternative collection methods such as at-home or in-office semen analysis.

P-100 The influence of vasectomy on seminal microbiome

Abstract Study question Does male sterilisation with vasectomy induce changes in the seminal microbiome composition? Summary answer Human semen harbours an enriched microbial community and the seminal microbiome composition significantly differed in semen samples from the same men before and after vasectomy. What is known already The semen harbours a polymicrobial community, where Lactobacillus, Corynebacterium, Staphylococcus, Prevotella, and Finegoldia are common. The origin of the seminal microbiome, however, has not yet been established. One-third of the seminal microbes originate from the urethra, whereas a considerable part could originate from the upper genital tract. Similarly, male reproductive organs, such as prostate, seminal vesicles, and testicles contain its own microbiome. Recent pioneering studies analysing a total of 18 men indicates that vasectomy procedure alters the seminal microbiome, suggesting a testicular or epididymal microbial origin. Study design, size, duration This cohort study included 36 men (age = 40.4 ± 5.2 years, BMI = 26.2 ± 3.9 kg/m²) who were planning to undergo vasectomy at the University Hospital from February to June 2021 and volunteered to donate semen samples before vasectomy and 3 months after the procedure. The study was approved by the Ethics Committee of Investigación Biomédica de Andalucia. Participants/materials, setting, methods Samples were collected after washing the penis with soap and water, and after urinating. Semen was obtained by masturbation (3-5 days of abstinence) before the vasectomy and 3 months post-vasectomy. The seminal microbiome was analysed by sequencing the V4 hypervariable region of the 16S rRNA gene (Illumina MiSeq). Raw sequences were pre-processed and taxonomy assigned using Quantitative Insights Into Microbial Ecology version 2 (QIIME2). Bacterial diversity and abundance analyses were performed in R software. Main results and the role of chance Fifty-six bacterial genera were detected in the semen samples, where Campylobacter, Finegoldia, Ezakiella, Streptococcus, Staphylococcus, Corynebacterium, Peptoniphilus, and Anaerococcus prevailed (each genus with a relative abundance ≥5%). Post-vasectomy semen samples had significantly higher alpha diversity (observed richness diversity Wilcoxon signed-rank p-value = 0.035) and markedly increased abundance of genera Porphyromonas, Finegoldia, and Anaerococcus, while Acetobacter genus was reduced when compared with semen samples collected before the vasectomy procedure (FDR p-value&amp;lt;0.05). Beta diversity analysis indicated a significant microbial dissimilarity between seminal samples collected before and after vasectomy (weighted and unweighted PERMANOVA p-value = 0.001). Limitations, reasons for caution This study did not include urine samples, which do share around 30% of the microorganisms with semen. Therefore, in the next step we aim to integrate urine samples into the analysis. Wider implications of the findings Male sterilisation with vasectomy gave rise to fluctuations in the seminal microbiome composition and abundance. Our study findings provide new insight into the origin of seminal microbes, indicating that some accompanying bacteria could originate already from the testicular environment and their changes could entail microbial unbalance in semen. Trial registration number NA

(250) Male Physicians as Patients: Is Fertility an Issue?

Abstract Introduction Physicians may be subjected to grueling work hours, sleep deprivation, and a stressful work environment during their prime reproductive years. While attention to fertility among female physicians has garnered interest in recent years, little is known about the fertility of their male colleagues. Objective In this study we sought to compare semen parameters of male physicians presenting for a fertility evaluation compared to their non-physician counterparts. Methods Upon IRB approval, a retrospective review of all hospital employed individuals (or their partners) who underwent a semen analysis between 2013-2019 was performed. Post-vasectomy semen analysis patients were excluded. Baseline patient demographics including age, comorbidities, occupation, and BMI were recorded. Normal semen parameters were defined by the World Health Organization 2010 criteria. A comparison analysis of semen analysis parameters, baseline characteristics, and comorbidities was conducted with a significant p-value defined as &amp;lt;0.05. Results Of the 169 physicians and 438 non-physicians identified, physicians were more likely to have a lower BMI (median 25.8 vs. 28.0, p&amp;lt;0.0001) when compared to their non-physician counterparts. Physicians were less likely to have ADHD, depression, obstructive sleep apnea, malignancy, alcohol abuse, and history of smoking (p&amp;lt;0.05). Physicians had better semen parameters including pH, concentration, motility, volume, and morphology (p&amp;lt;0.05), with a greater sperm concentration (68.4 vs. 52.2 million/mL, p&amp;lt;0.0001) and higher total motile sperm count (125 vs. 86.4 million, p&amp;lt;0.0001) compared to non-physicians. However, male physicians were more likely to be older at time of semen analysis (33.8 versus 32.7 years, p&amp;lt;0.05), more likely to utilize assisted reproductive technology (IVF and IUI, p=0.0277), have older female partners (p=0.0053), and have older female partners at time of delivery (p=0.0124). Conclusions In this study we report, for the first time, semen parameters of physicians compared to non-physicians. Physicians had a significantly higher total motile sperm count and sperm concentration; however, they were older at time of semen analysis, more likely to utilize ART, and more likely to have older female partners. While physicians may be healthier, this may indicate increased difficulty achieving pregnancy. Patient care is directly impacted by the health and safety provided to their physicians. As the paradigm in the medical field shifts from caring only for our patients to caring for ourselves, fertility amongst male physicians warrants further investigation. Disclosure No

(437) Post-Vasectomy Semen Analysis (PVSA) Compliance Rates and Associations

Abstract Introduction Vasectomy is a highly effective, permanent method of contraception. Poor compliance rates have been observed for patients in obtaining their post-vasectomy semen analyses (PVSA). Few studies have looked at associations with low compliance. Objective The objective of our study was to identify compliance rates of post-vasectomy semen analysis and to identify associations that may increase or decrease the rates of compliance. Methods We studied 111 patients between November 2018 and April 2022 who underwent vasectomy at a single institution. Only patients who underwent vasectomy for fertility-related reasons were included in our final analysis. We excluded any patients who had undergone previous vasectomy or vasectomy reversal. Variables analyzed included age, relationship status, presence of primary care provider, anxiety diagnosis, and race. Variables were obtained via chart review which included but was not limited to reviewing notes, summary diagnostic pages, problem lists, and medication lists. All analyses were performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Categorical data were described with the number and percentage of patients. Continuous data were described with the median, minimum, and maximum. Associations of race and anxiety diagnosis with PVSA were explored using Fisher’s exact test. All p-values were two-sided at the 5% significance level without adjustment for multiple testing. Results Our cohort included 111 men who underwent vasectomy with exclusion of 1 patient who underwent vasectomy for non-fertility reasons. The median age of vasectomy was 38 years (range 26-59 years). Of 110 patients, 83 (75%) returned for PVSA. There were 103 (94%) married patients. Additional cohort characteristics can be seen in Table 1. As shown in Table 2, African American patients were less likely to return for PVSA than either white patients (14% vs. 79%, p&amp;lt;0.001) or Hispanic patients (14% vs. 100%, p=0.015). we did not find evidence of difference between white and Hispanic patients (p=0.58). Patients with an anxiety diagnosis were more likely to undergo PVSA compared to patients without an anxiety diagnosis (p&amp;lt;0.001). Conclusions Patients in our cohort of African American race were significantly less likely to undergo PVSA compared to white and Hispanic patients. This suggests an opportunity for improved counseling in the African American population. We do recognize a disparity in the number of white patients studied (n=95) versus African American (n=7) and Hispanic (n=5) patients. Additionally, patients with an anxiety disorder were more likely to undergo PVSA compared to patients without an anxiety disorder. The prevalence of anxiety disorder in our cohort is somewhat high relative to the overall population in the United States. This could be due to questionnaires used at our institution and the timeliness of those questionnaires. Personality traits could also lead to confounding in anxiety diagnoses. Overall, a 75% rate of PVSA speaks to an opportunity for better counseling regarding PVSA, especially in particular populations such as the African American population. Disclosure No

(095) Contribution of Testicular Microbiome to the Seminal Microbiota: Are There Repercussions After Vasectomy?

Abstract Introduction The human microbiome has been implicated in a variety of clinical conditions. The semen harvests a compendium of microorganisms that potentially originate in different anatomic structures, such as the testis, prostate, and seminal vesicles. However, there is a paucity of data delineating the significance of the human microbiome in male reproductive health, specifically the testicular microbiome and its role over the seminal microbiota. Objective To analyze the changes in seminal microbiome after impeding the paracrine migration of testicular microbiome caused by undergoing a vasectomy. Methods Seminal samples were collected from 40 normozoospermic patients (normal concentration and motility according to the WHO parameters) and 36 post-vasectomy patients (samples were collected &amp;gt;3 months after vasectomy, the timeframe in which the microbiome is expected to have stabilized after the procedure). Sixteen patients gave a pre- and post-vasectomy semen sample. Richness (α-diversity) of the seminal microbiome, calculated by the number of operational taxonomic units, and clusterization (β-diversity), obtained by Bray Curtis distances, were compared between the normozoospermic and post-vasectomy SS, and then only among the paired SS. The relative abundance of species, genera, and phylum was compared among groups using analysis of compositions of microbiomes with bias correction (ANCOM-BC). Secondarily, the association between age, BMI, ethnicity, and recent antibiotic use (&amp;lt;3 months before obtaining SS) with seminal microbiome profiling was analyzed. Statistical significance was assessed at p&amp;lt;0.05. Results Operational taxonomic units (OTUs) were found to be higher in the normozoospermic group (median=35 OTUs) than in the post-vasectomy group (median=29 OTUs) (p=0.018). Similarly, in men who had paired semen samples, the pre-vasectomy samples (median=43 OTUs) had a higher α-diversity than the post-vasectomy samples (median=29 OUTs) (p&amp;lt;0.001), suggesting a higher community heterogenicity in the normozoospermic and pre-vasectomy groups. β-diversity was similar between normozoospermic and post-vasectomy groups (p=0.584), and also between paired semen samples (p=0.080) suggesting a similar community composition among groups. The relative abundance of species, genera, and phylum remained, in its majority, similar between groups. Nonetheless, when relative abundances with a prevalence of less than 10% were analyzed, we found that 12 species and 8 genera differed between normozoospermic and post-vasectomy samples. Age, BMI, ethnicity, and recent antibiotic use were not associated with seminal microbiome composition. Conclusions Our study highlights that the seminal microbiome without the paracrine contribution of testicular microbiome due to vasectomy, would exhibit fewer OTUs and a change in the relative abundance of species and genera. This causes a modification in α-diversity of the semen, implying that testicular microbiome contributes to the configuration and composition of the seminal microbiota. Further investigations are needed to determine the impact of these findings in male’s reproductive health. Disclosure Yes, this is sponsored by industry/sponsor: MicroGenDX Clarification Industry funding only - investigator initiated and executed study Any of the authors act as a consultant, employee or shareholder of an industry for: Acerus, Boston Scientific, Endo Pharmaceuticals and Coloplast.

Factors affecting post-vasectomy semen analysis compliance in home- and lab-based testing.

We used a home-based (HB) post-vasectomy semen analysis (PVSA) between 2014 and 2017, but we have since reverted to local lab-based (LB) testing. In this study, we compared PVSA compliance rates in HB and LB test settings and describe factors that may influence completion rates. We retrospectively identified patients who underwent vasectomy at our institution. Surgeons X and Y performed vasectomies from 2014-2017 using a HB immunochromatographic PVSA kit. From 2017-2020, surgeon X used a local LB PVSA. We collected data on PVSA completion status and patient demographics to perform two analyses. HB testing was examined by assessing all patients who had a vasectomy from 2014-2017. Another compared HB and LB testing by looking at surgeon X vasectomies from 2014-2017 and 2017-2020. We identified 285 patients who underwent vasectomy from 2014-2017 and were assessed with HB testing. Compliance with PVSA was 35% with HB PVSA. Age at vasectomy, number of children, and surgeon influenced PVSA completion in the 2014-2017 cohort. Surgeon X PVSA completion was 29% for the HB (n=136) testing cohort and 46% for the LB (n=201) cohort (odds ratio 0.47, 95% confidence interval 0.29-0.74). Again, more children decreased PVSA completion. Compliance with PVSA testing was inadequate in both test settings, although it was significantly higher in local LB setting. Based on these findings, the convenience of HB testing appears to decrease compliance with PVSA, although surgeon factors may be influential. These findings may help surgeons identify factors that improve PVSA compliance rates.

A new approach to postvasectomy semen analyses eliminates the need to evaluate a fresh specimen.

According to current guidelines, confirmation that vasectomy results in sterility depends on microscopic examination of postvasectomy semen for the presence of spermatozoa. Guidelines established in 2012 require examination of a fresh specimen within 2 h of collection, which necessitates the patient making an appointment with either the surgeon's office or a licensed clinical laboratory. Twenty-five to 42% of patients fail to comply with postvasectomy semen analysis (PVSA). To determine if an at-home semen collection kit can substitute for the evaluation of a fresh specimen and improve patient compliance with postvasectomy spermatozoa assessment. The kit contains a patented aldehyde-fixative that maintains spermatozoa and semen cells in suspension for quantitation. Patients order a PVSA kit to be delivered to their home and can collect a semen specimen and return it to the laboratory through regular US mail. From January 2011 through December 2018, 6096 men undergoing vasectomy by 184 urologists in 33 states in the US ordered PVSA kits, of which 5408 (89%) returned at least one for analysis. Of those, 398 men (7.4%) returned the first kit with greater than 10,000 spermatozoa/ml within a year of vasectomy, of which only 4.4% contained greater than 100,000 spermatozoa/ml 12 weeks postsurgery. This suggests that fewer than 5% of postvasectomy patients might need follow-up fresh semen analyses, greatly easing the logistical burden of PVSA. Ninety percent of surgeons returning a patient satisfaction questionnaire said their patients "never" complained about using PVSA kits. These data support the adoption of a new standard for PVSA that does not involve an initial evaluation of a fresh semen specimen.

Risk Factors for Post-Vasectomy Semen Analysis Non-Adherence in Home-based and Local Lab-based Testing

ABSTRACT Introduction Post-vasectomy semen analysis (PVSA) is the recommended method for confirming sterility after vasectomy. Current literature reports poor PVSA adherence rates. Our institution utilized a home-based PVSA test between 2014 and 2017 to address this issue, but we have since reverted back to lab-based testing. Objective In this study, we compare PVSA adherence rates in home- and lab-based test settings and describe factors that may influence completion rates in each cohort. Methods We retrospectively identified adult patients who underwent a vasectomy at our institution. Surgeon X and Surgeon Y performed vasectomies from December 2014 to January 2017, while only Surgeon X performed them from July 2017 to August 2020. From 2014-2017, each patient was offered purchase of a home immunochromatographic PVSA kit (SpermCheck®). From 2017-2020, each patient was offered local lab-based testing. We collected data on PVSA completion status and patient demographics to perform two analyses. One compared patients of Surgeon X from 2014-2017 to patients of Surgeon Y from 2014-2017. Another compared patients of Surgeon X from 2014-2017 to patients of Surgeon X from 2017-2020. Results We identified 285 patients who underwent a vasectomy from 2014-2017 (Surgeon Y, 149; Surgeon X, 136). Adherence with PVSA was 36%. The completion of PVSA increased by a factor of 1.04 per year of patient age at which vasectomy was performed (95% CI 1.01-1.08). The completion of PVSA decreased by a factor of 0.70 with each child (95% CI 0.56-0.87). Patients treated by Surgeon X were less likely to complete PVSA than Surgeon Y (OR 0.56, 95% CI 0.34-0.92). No significant difference in completion was found between insurance type, body mass index (BMI), or if a post-operative call or unplanned visit occurred. We identified 629 patients who underwent a vasectomy by Surgeon X (home-based PVSA, 136; lab-based PVSA, 472). Adherence with PVSA was 29% for the home cohort and 52% for the lab cohort. Patients in the home-based cohort were less likely to complete PVSA than the lab-based cohort (OR 0.37, 95% CI 0.24-0.56). The completion of PVSA decreased by a factor of 0.95 as BMI increased (95% CI 0.92-0.98). The completion of PVSA decreased by a factor of 0.74 with each child (95% CI 0.64-0.85). Patients with self-pay or private insurance were more likely to complete PVSA than those with public insurance (OR 2.37, 95% CI 1.22-4.60). Black patients were less likely to complete PVSA than white patients (OR 0.24, 95% CI 0.08-0.72). No significant difference in completion was found between age at vasectomy, distance between patient home and office, or if a post-operative call or unplanned visit occurred. Conclusions Adherence with PVSA testing was low in both test settings, though it was significantly higher in local lab setting. Age at vasectomy, number of children, and surgeon influenced PVSA completion rate in the 2014-2017 cohort. Sperm analysis test setting, BMI, number of children, insurance type, and race influenced PVSA completion rate for Surgeon X's patients in both time periods. These findings may help surgeons identify groups to focus on in future initiatives to improve PVSA adherence rates. Disclosure No

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

PurposeThe 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 MethodsWe 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.ResultsResults 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.ConclusionsOur 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.

757 An Audit of Post-Vasectomy Semen Analysis Adherence

Abstract Aim Following vasectomy, patients undergo post-vasectomy semen analysis (PVSA) to determine whether they can be “cleared” to safely discontinue contraception. The adherence rates to PVSA are notoriously poor in the literature. The aim of this project is to assess our patient’s adherence to PVSA and identify areas for improvement. Method All vasectomies undertaken at a large urology centre between 01/01/2019 and 31/12/2019 were included. PVSAs were scrutinised one year later to determine clearance or special clearance according to the 2016 Laboratory Guidelines for Post-vasectomy Semen Analysis endorsed by the British Andrology Society. Results 256 patients underwent bilateral vasectomy, with 132 (51.6%) undergoing PVSA, at a median of 16.4 weeks (range 7.3 – 71.6). At time of review, 71 (54.5%) of these have been cleared; 45 (63.4%) after a single PVSA and 19 (26.8%) after the second. Seven patients (9.9%) received special clearance, two patients (1.5%) were not cleared despite meeting the special clearance criteria and one patient suffered early failure (0.8%). Clearance letters were issued at a median of 2.7 weeks (range 0.1 – 28.8) following satisfactory PVSA results. Moreover, 33 patients (25%) had at least one PVSA sample rejected by the lab, mainly due to timing issues or incomplete information on the request form. Conclusions The adherence rate to PVSA in our cohort is in keeping with the literature, and the majority of patients who are cleared achieve this with just one PVSA. Interventions aimed at counselling patients about the importance of PVSA, reducing unnecessary repeats and reducing rejected samples are necessary.

Comparison of postal and non-postal post-vasectomy semen sample submission strategies on compliance and failures: an 11-year analysis of the audit database of the Association of Surgeons in Primary Care of the UK

BackgroundVasectomy occlusive success is defined by the recommendation of ‘clearance’ to stop other contraception, and is elicited by post-vasectomy semen analysis (PVSA). We evaluated how the choice of either a...

Systematic STR analysis of old post-vasectomy seminal fluid stains to examine evidence stored for 16\xa0years

To understand stored evidence and the insertion in genetic databases is important in forensic investigations. Blood, pre- and post-vasectomy semen from 90 fertile male individuals, aged 24 to 45, were donated for research after informed consent. The semen samples were stored in the form of 30 µL stains on cotton fabric, for 16 years at room temperature in the laboratory. As well as the seminal fluid post vasectomy stains, which were performed after microscopy analyzes and certainty of the absence of spermatozoon. The pre vasectomy stains contained mainly haploid spermatozoon and the post vasectomy stains diploid epithelial cells and leukocytes. DNA extraction was performed with magnetic resin, followed by quantification and analysis of degradation of DNA. In this study we analyze these genetic profiles of DNA from stains on cotton fabric, using two Short Tandem Repeat multiplex systems, the PowerPlex Fusion 6C and Y23. Electrophoresis was performed on a 3500xL and analyzed using the Gene Mapper ID-X software. The genetic profiles of the 90 individuals were fully amplified in pre-vasectomy and partially in post-vasectomy stain samples, using the both multiplex systems. The results provide information about 0.25 cm2 semen stains on cotton fabric from 90 individuals, correlating concentration, degradation, and allele analysis. It also provides an understanding of the cells present in semen stains and the implications of individual factors. In the stains of post-vasectomy samples the small quantity of DNA was one of the limiting factors, in addition to degradation. Considering that all evaluations were carried out in a laboratory that has a quality control certificate and audited for being part of the national genetic profile database, the results were very consistent. Many aspects of the semen samples stored in the form of stains on cotton fabric have been clarified. The performance and sensitivity of the amplification systems used in the genotyping of azoospermic individuals were assessed. Conclusions: Genetic profiles were satisfactorily amplified in pre-vasectomy stain samples, and partially amplified in post-vasectomy stain samples, stored for almost two decades at room temperature in a tropical country. The small amount of DNA was one of the limitations in post-vasectomy stain samples, in addition to degradation and fragmentation. There are no publications in the literature on PowerPlex Fusion 6C and Y23 analyses using blood, sperm, and seminal fluids of the same individual, much less in the form of stains. This study can serve as a benchmark for the tracking analyses of stored samples. In addition, it anticipates a few social issues related to the analysis of post-vasectomy samples in forensic cases, most notably sex crimes.