PURPOSE: Post-vasectomy semen analysis (PVSA) is the traditional method of confirming sterility after vasectomy. However, PVSA protocols vary in the end points accepted, and the number and timing of tests. In this systematic review we make evidence based recommendations on the appropriate PVSA protocol. MATERIALS AND METHODS: Databases (MEDLINE, Current Contents, Cochrane Library and EMBASE) were searched up to and including March 2003. Studies were included if they dealt with post-vasectomy testing and contained data on at least 1 of the time or number of ejaculations to azoospermia, pregnancy, repeat vasectomy and histological analysis of vas specimens. RESULTS: A total of 56 studies were included in the review. Time to achieve azoospermia was variable, although the median incidence of patients with azoospermia was consistently more than 80% after 3 months and after 20 ejaculations. A small percent of patients (14,845 or 1.4%) demonstrated persistent nonmotile sperm, although some of them eventually achieved azoospermia. The reappearance of nonmotile sperm was reported in 7 studies, occurring up to 22 months after vasectomy. CONCLUSIONS: The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations. If the sample is positive, periodic testing can continue until azoospermia is achieved. Patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success. No evidence was located to support histological testing of the excised vas deferens.
PURPOSE: Post-vasectomy semen analysis (PVSA) is the traditional method of confirming sterility after vasectomy. However, PVSA protocols vary in the end points accepted, and the number and timing of tests. In this systematic review we make evidence based recommendations on the appropriate PVSA protocol. MATERIALS AND METHODS: Databases (MEDLINE, Current Contents, Cochrane Library and EMBASE) were searched up to and including March 2003. Studies were included if they dealt with post-vasectomy testing and contained data on at least 1 of the time or number of ejaculations to azoospermia, pregnancy, repeat vasectomy and histological analysis of vas specimens. RESULTS: A total of 56 studies were included in the review. Time to achieve azoospermia was variable, although the median incidence of patients with azoospermia was consistently more than 80% after 3 months and after 20 ejaculations. A small percent of patients (14,845 or 1.4%) demonstrated persistent nonmotile sperm, although some of them eventually achieved azoospermia. The reappearance of nonmotile sperm was reported in 7 studies, occurring up to 22 months after vasectomy. CONCLUSIONS: The evidence supports a PVSA protocol with 1 test showing azoospermia after 3 months and 20 ejaculations. If the sample is positive, periodic testing can continue until azoospermia is achieved. Patients with persistent nonmotile sperm in low numbers could be given cautious assurance of success. No evidence was located to support histological testing of the excised vas deferens.
Authors: Ashok Agarwal; Sajal Gupta; Rakesh K Sharma; Renata Finelli; Shinnosuke Kuroda; Sarah C Vij; Florence Boitrelle; Parviz Kavoussi; Amarnath Rambhatla; 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; 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 Journal: World J Mens Health Date: 2022-01-02 Impact factor: 6.494
Authors: Francisco Barros de Oliveira; Vadelias Xavier Pereira; Fernando Rocha Oliveira; Luiz Carlos de Abreu; Blanca Elena Guerrero Daboin; Alex Rey Norberto; Luiz Vinicius de Alcantara Sousa; Luis Fernando B Tavares; Sidney Glina Journal: Clinics (Sao Paulo) Date: 2018-10-08 Impact factor: 2.365