Post-vasectomy semen analysis: what is the best protocol?

Vasectomy is a safe, quick, and highly effective form of permanent sterilization. However, vasectomy does not render patients sterile immediately, and they must continue to use alternate forms of contraception until cleared by a post-vasectomy semen analysis (PVSA). Historically, the criteria for post-vasectomy clearance have varied widely amongst providers, with most physicians requiring azoospermia in order to consider vasectomy a success. The 2012 American Urological Association (AUA) guidelines expanded the definition of post-vasectomy clearance to include ≤100,000 non-motile sperm (NMS). This has decreased the need for subsequent semen analyses and increased initial clearance rates. Despite this, patient compliance with PVSA has been poor, which has led to research focused on factors associated with compliance and interventions to enhance PVSA completion. There are many factors that affect patient compliance. Mail-in and at-home PVSA have the potential to increase compliance due to inherent convenience and less patient embarrassment. While no currently at-home test fulfills the AUA guidelines on post-vasectomy clearance, mail-in testing can be utilized to clear patients on the basis of azoospermia alone. Future research should focus on continued strategies to enhance PVSA compliance as well as explore patient preferences and alternative options.