A novel cost-effective approach to post-vasectomy semen analysis

  1. Eshan Senanayake,
  2. Allan A. Pacey,
  3. Vinod Maddireddy,
  4. Umar Shariff,
  5. Ken Hastie,
  6. Derek J. Rosario*

Article first published online: 21 SEP 2010

DOI: 10.1111/j.1464-410X.2010.09637.x

Issue

BJU International

BJU International

Volume 107, Issue 9, pages 1447–1452, May 2011

Additional Information

How to Cite

Senanayake, E., Pacey, A. A., Maddireddy, V., Shariff, U., Hastie, K. and Rosario, D. J. (2011), A novel cost-effective approach to post-vasectomy semen analysis. BJU International, 107: 1447–1452. doi: 10.1111/j.1464-410X.2010.09637.x

Author Information

  1. Department of Urology, Royal Hallamshire Hospital, Sheffield, *University of Sheffield School of Medicine and Biomedical Sciences, Academic Unit of Reproductive & Developmental Medicine, Sheffield, †University of Sheffield School of Medicine and Biomedical Sciences, Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK

*D. J. Rosario, University of Sheffield School of Medicine and Biomedical Sciences, Academic Urology Unit, K Floor, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK. e-mail: d.j.rosario@sheffield.ac.uk

Publication History

  1. Issue published online: 21 APR 2011
  2. Article first published online: 21 SEP 2010
  3. Accepted for publication 7 May 2010

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Keywords:

  • post-vasectomy semen analysis;
  • semen analysis;
  • persistent non-motile sperm;
  • vasectomy;
  • semen viability

Study Type – Diagnostic (cost minimisation analysis) Level of Evidence 3b

OBJECTIVE

  • • 
    To examine compliance, clearance rates and cost-effectiveness of a novel approach to managing men following vasectomy based on the testing of sperm viability.

PATIENTS AND METHODS

  • • 
    Between January 2003 and March 2005, 832 men undergoing vasectomy were followed prospectively for a minimum of 12 months.
  • • 
    Post-vasectomy semen analysis (PVSA) was carried out at 16 weeks with repeat at 20 weeks only if sperm were detected on initial PVSA i.e. a single clear PVSA on simple microscopy was deemed sufficient for declaring vasectomy successful.
  • • 
    In men with persistent non-motile sperm (PNMS) in the second specimen, comprehensive analysis of number and viability of sperm using a fluorescent probe was carried out on a fresh semen specimen taken in accordance with British Andrology Society (BAS) guidelines.

RESULTS

  • • 
    Overall compliance with the PVSA protocol was 81.3% (95% CI 78.5 to 83.8). No sperm were seen in 540 (78.8%) and 70 (10.3%) at the initial and 2nd PVSA respectively.
  • • 
    Persistent spermatozoa at 20 weeks were present in 66 (9.8%, 7.8 to 12.2) cases with 58 (8.6%, 6.7 to 11.0) having PNMS and 8 (1.2%, 0.6 to 2.3) having motile sperm.
  • • 
    Fluorescent viability testing in 53 of the 58 with PNMS showed viable sperm in 2 (3.8%, 1.0 to 12.8). The failure rate of vasectomy defined by PVSA (8 with motile sperm on 2nd PVSA and 2 with viable non-motile sperm on fluorescent testing) was 1.2% (0.7 to 2.2).
  • • 
    Average cost per vasectomy of PVSA using this protocol was £10.77 (US$ 16.67) compared with a minimum likely average cost using BAS guidelines of £18.10 (US$ 28).

CONCLUSION

  • • 
    Demonstrating absence of sperm on simple light microscopy in a single specimen of semen at 16 or 20 weeks post-vasectomy and reserving comprehensive testing of sperm viability for only the higher risk group with PNMS improves compliance and represents a cost-effective strategy for declaring surgical success. This reduces the costs of PVSA by least 40% compared with adherence with BAS guidelines without compromising success in determining outcome after vasectomy.
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