Presentation Authors: Alexandra Berger*, Valary Raup, Alexander Cole, Ramy Abou Ghadya, Michael O'Leary, Martin Kathrins, Boston, MA
Introduction: The 2012 AUA Vasectomy Guidelines recommend that post-vasectomy semen analysis (PVSA) be performed 8-16 weeks after vasectomy, and failure is defined as presence of motile sperm or >100,000 non-motile sperm/mL persisting beyond 6 months. However, compliance with PVSA in the published literature is low. We sought to determine factors associated with PVSA non-compliance.
Methods: We performed an IRB-approved, retrospective chart review of consecutive patients undergoing vasectomy at a single institution with 6 surgeons between January 2013 and June 2018. Demographic information was collected, and multivariable logistic regression was utilized to determine which factors were associated with PVSA non-compliance.
Results: 664 patients underwent vasectomy. 389 (58.58%) patients returned for at least one PVSA at a median 103 days (17-917). 373 (56.17%) patients were confirmed sterile at the conclusion of our study, with mean 1.17 (1-4) PVSAs and median follow-up of 846.01 days (123-2085). There was no difference in age between compliant and noncompliant patients (39.86 vs 40.76, p=0.051). On multivariable analysis, non-white race, alcohol use, smoking, having no primary care physician (PCP), undergoing concurrent surgery, and distance from home to closest andrology lab >= 50th percentile (13.6 miles) had a statistically significant association with PVSA non-compliance. We did not demonstrate an association between age, socioeconomic quintile, marital status, drug use, number or age of children, complication or presence of other urologic comorbidities with PVSA compliance. This study had 80% power to detect a 20% difference in odds of PSVA between groups with a maximum type I error of 5%.
Conclusions: We found that PVSA compliance remains low and that non-white race, alcohol or tobacco use, lack of PCP, undergoing concurrent surgery and living far from an andrology lab are associated with PVSA non-compliance. This suggests that measures to improve PVSA compliance - such as developing home semen analysis technology - are necessary and should be targeted to patients with these risk factors.