The World Journal of Men's Health (Jul 2022)
Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices
- Ashok Agarwal,
- Sajal Gupta,
- Rakesh K. Sharma,
- Renata Finell,
- Shinnosuke Kuroda,
- Sarah C. Vij,
- Florence Boitrelle,
- Parviz Kavoussi,
- Amarnath Rambhata,
- Ramadan Saleh,
- Eric Chung,
- Taymour Mostafa,
- Armand Zini,
- Edmund Ko,
- Neel Parekh,
- Marlon Martinez,
- Mohamed Arafa,
- Nicholas Tadros,
- Jean de la Rosette,
- Tan V. Le,
- Osvaldo Rajmil,
- Hussein Kandil,
- Gideon Blecher,
- Giovanni Liguori,
- Ettore Caroppo,
- Christopher C.K. Ho,
- Andrew Altman,
- Petar Bajic,
- David Goldfarb,
- Bradley Gill,
- Daniel Suslik Zylbersztejn,
- Juan Manuel Corral Molina,
- Marcello M. Gava,
- Joao Paulo Greco Cardoso,
- Raghavender Kosgi,
- Gökhan Çeker,
- Birute Zilaitiene,
- Edoardo Pescatori,
- Edson Borges Jr,
- Gede Wirya Kusuma Duarsa,
- Germar-Michael Pinggera,
- Gian Maria Busetto,
- Giancarlo Balercia,
- Giorgio Franco,
- Gökhan Çalik,
- Hassan N. Sallam,
- Hyun Jun Park,
- Jonathan Ramsay,
- Juan Alvarez,
- Kareim Khalafalla,
- Kasonde Bowa,
- Lukman Hakim,
- Mara Simopoulou,
- Marcelo Gabriel Rodriguez,
- Marjan Sabbaghian,
- Haitham Elbardisi,
- Massimiliano Timpano,
- Mesut Altan,
- Mohamed Elkhouly,
- Mohamed S. Al-Marhoon,
- Mohammad Ali Sadighi Gilani,
- Mohammad Ayodhia Soebadi,
- Mohammad Hossein Nasr-Esfahani,
- Nicolas Garrido,
- Paraskevi Vogiatzi,
- Ponco Birowo,
- Premal Patel,
- Qaisar Javed,
- Rafael F. Ambar,
- Ricky Adriansjah,
- Sami AlSaid,
- Sava Micic,
- Sheena E. Lewis,
- Shingai Mutambirwa,
- Shinichiro Fukuhara,
- Sijo Parekattil,
- Sun Tae Ahn,
- Sunil Jindal,
- Teppei Takeshima,
- Ana Puigvert,
- Toshiyasu Amano,
- Trenton Barrett,
- Tuncay Toprak,
- Vineet Malhotra,
- Widi Atmoko,
- Yasushi Yumura,
- Yoshiharu Morimoto,
- Thiago Fernandes Negris Lima,
- Yannic Kunz,
- Yuki Kato,
- Yukihiro Umemoto,
- Giovanni M. Colpi,
- Damayanthi Durairajanayagam,
- Rupin Shah
Affiliations
- Ashok Agarwal
- ORCiD
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Sajal Gupta
- ORCiD
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Rakesh K. Sharma
- ORCiD
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Renata Finell
- ORCiD
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Shinnosuke Kuroda
- ORCiD
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Sarah C. Vij
- ORCiD
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Florence Boitrelle
- ORCiD
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy
- Parviz Kavoussi
- ORCiD
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
- Amarnath Rambhata
- ORCiD
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
- Ramadan Saleh
- ORCiD
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- Eric Chung
- ORCiD
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
- Taymour Mostafa
- ORCiD
- Department of Andrology, Sexology & STIs, Faculty of Medicina, Cairo University, Cairo, Egypt
- Armand Zini
- ORCiD
- Department of Surgery, McGill University, Montreal, QC, Canada
- Edmund Ko
- ORCiD
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
- Neel Parekh
- ORCiD
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Marlon Martinez
- ORCiD
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
- Mohamed Arafa
- ORCiD
- American Center for Reproductive Medicine, Cleveland, OH, USA, 2Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Nicholas Tadros
- ORCiD
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
- Jean de la Rosette
- ORCiD
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
- Tan V. Le
- ORCiD
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Viet Nam
- Osvaldo Rajmil
- ORCiD
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
- Hussein Kandil
- ORCiD
- Fakih IVF Fertility Center, Abu Dhabi, UAE
- Gideon Blecher
- ORCiD
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
- Giovanni Liguori
- ORCiD
- Department of Urology, University of Trieste, Trieste, Italy
- Ettore Caroppo
- ORCiD
- Reproductive and IVF Unit, Asl Bari, Bari, Italy
- Christopher C.K. Ho
- ORCiD
- Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor’s University, Subang Jaya, Malaysia
- Andrew Altman
- ORCiD
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Petar Bajic
- ORCiD
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- David Goldfarb
- ORCiD
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Bradley Gill
- ORCiD
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
- Daniel Suslik Zylbersztejn
- ORCiD
- Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil
- Juan Manuel Corral Molina
- ORCiD
- Servicio de Urología, Hospital Clínico de Barcelona. Barcelona, Spain
- Marcello M. Gava
- ORCiD
- Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
- Joao Paulo Greco Cardoso
- ORCiD
- Divisao de Urologia, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Raghavender Kosgi
- ORCiD
- Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India
- Gökhan Çeker
- ORCiD
- Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey
- Birute Zilaitiene
- ORCiD
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Edoardo Pescatori
- ORCiD
- Gynepro Medical, Bologna, Italy
- Edson Borges Jr
- ORCiD
- Fertility Medical Group, São Paulo, Brazil
- Gede Wirya Kusuma Duarsa
- ORCiD
- Department of Urology, Faculty of Medicine, Sanglah General Academic Hospital, Udayana University, Denpasar, Indonesia
- Germar-Michael Pinggera
- ORCiD
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
- Gian Maria Busetto
- ORCiD
- Department of Urology and Organ Transplantation, Ospedali Riuniti of Foggia, University of Foggia, Foggia, Italy
- Giancarlo Balercia
- ORCiD
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
- Giorgio Franco
- ORCiD
- UOC Urologia, Department Materno- Infantile e Scienze Urologiche, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
- Gökhan Çalik
- ORCiD
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Hassan N. Sallam
- ORCiD
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
- Hyun Jun Park
- ORCiD
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Jonathan Ramsay
- ORCiD
- Department of Andrology, Hammersmith Hospital, London, UK
- Juan Alvarez
- ORCiD
- Centro ANDROGEN, La Coruña, Spain
- Kareim Khalafalla
- ORCiD
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Kasonde Bowa
- ORCiD
- School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
- Lukman Hakim
- ORCiD
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
- Mara Simopoulou
- ORCiD
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Marcelo Gabriel Rodriguez
- ORCiD
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
- Marjan Sabbaghian
- ORCiD
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Haitham Elbardisi
- ORCiD
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Massimiliano Timpano
- ORCiD
- A.O.U. Città della Salute e della Scienza di Torino, Molinette, Italy
- Mesut Altan
- ORCiD
- Department of Urology, Hacettepe University, Ankara, Turkey
- Mohamed Elkhouly
- ORCiD
- Bourne Hall Fertility Center, Dubai, UAE
- Mohamed S. Al-Marhoon
- ORCiD
- Department of Surgery, Sultan Qaboos University, Muscat, Oman
- Mohammad Ali Sadighi Gilani
- ORCiD
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
- Mohammad Ayodhia Soebadi
- ORCiD
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
- Mohammad Hossein Nasr-Esfahani
- ORCiD
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
- Nicolas Garrido
- ORCiD
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Paraskevi Vogiatzi
- ORCiD
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
- Ponco Birowo
- ORCiD
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Premal Patel
- ORCiD
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
- Qaisar Javed
- ORCiD
- Department of Urology, Ahalia Hospital, Hamdan Street Branch, Abu Dhabi, UAE
- Rafael F. Ambar
- ORCiD
- Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
- Ricky Adriansjah
- ORCiD
- Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
- Sami AlSaid
- ORCiD
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Sava Micic
- ORCiD
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
- Sheena E. Lewis
- ORCiD
- Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
- Shingai Mutambirwa
- ORCiD
- Division of Urology, Safeko Makgatho Health Scienses University and Dr George Mukhari Academic Hospital, Pretoria, South Africa
- Shinichiro Fukuhara
- ORCiD
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
- Sijo Parekattil
- ORCiD
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
- Sun Tae Ahn
- ORCiD
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
- Sunil Jindal
- ORCiD
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
- Teppei Takeshima
- ORCiD
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
- Ana Puigvert
- ORCiD
- Fundació Puigvert, Hospital de la Santa Cruz y San Pablo, Universidad Autonoma de Barcelona, Barcelona, Spain
- Toshiyasu Amano
- ORCiD
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
- Trenton Barrett
- ORCiD
- Perth Urology Clinic, Perth, WA, Australia
- Tuncay Toprak
- ORCiD
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
- Vineet Malhotra
- ORCiD
- Department of Andrology and Urology, Diyos Hospital, New Delhi, India
- Widi Atmoko
- ORCiD
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Yasushi Yumura
- ORCiD
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
- Yoshiharu Morimoto
- ORCiD
- HORAC Grand Front Osaka Clinic, Osaka, Japan
- Thiago Fernandes Negris Lima
- ORCiD
- Department of Urology, Veredas Hospital, Maceió, Brazil
- Yannic Kunz
- ORCiD
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
- Yuki Kato
- ORCiD
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
- Yukihiro Umemoto
- ORCiD
- Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
- Giovanni M. Colpi
- ORCiD
- Andrology Unit, Procrea Institute, Lugano, Switzerland
- Damayanthi Durairajanayagam
- ORCiD
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
- Rupin Shah
- ORCiD
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
- DOI
- https://doi.org/10.5534/wjmh.210191
- Journal volume & issue
-
Vol. 40,
no. 3
pp. 425 – 441
Abstract
Purpose:Purpose: The 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 se-men analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods:Materials and Methods: We 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 sce-narios. 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. Results:Results: Results 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 unpro-tected 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 major-ity 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. Conclusions:Conclusions: Our 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 compli-ance. 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.
Keywords
