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 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. LeOsvaldo 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, Yasushi Yumura, Yoshiharu Morimoto, Thiago Fernandes Negris Lima, Yannic Kunz, Yuki Kato, Yukihiro Umemoto, Giovanni M. Colpi, Damayanthi Durairajanayagam, Rupin Shah, Widi Atmoko

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


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 semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. 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 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. 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 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. 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 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.

Original languageEnglish
JournalWorld Journal of Men's Health
Publication statusPublished - 2022


  • Male contraception
  • Semen
  • Sperm
  • Survey
  • Vasectomy


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