Authors' objectives:

To make evidence-based recommendations on the appropriate protocol for postvasectomy testing to confirm sterility, on the basis of a systematic assessment of the peer reviewed literature.

Authors' results and conclusions: There were 65 included studies of which 2 were comparative and 63 were case series or case reports. The quality of the available evidence was poor. The evidence-base was weakened by the lack of comparability between studies and losses to follow-up. There were large losses to follow-up with some studies reporting up to 66% loss. The median percentage of patients who fully complied with post-vasectomy testing was 77% (range: 33-100%, n=29). The median percentage of patients who failed to supply any samples was 19% (range: 0-63%, n=29). While compliance varied greatly between studies, it did not appear to depend on the number of tests in the postvasectomy protocol or the timing of the first or last tests. There was high variability in the percentage of patients reaching azoospermia even between studies that reported testing at the same time periods following vasectomy. However, the median percentage of azoospermic patients consistently stayed over 80% from three months onwards. When the timing of post-vasectomy testing was based on the number of ejaculations, more than 80% of patients showed azoospermia after 10 ejaculations (but this was only based on 3 studies). Seven studies reported the percentage of patients reaching azoospermia in the first and second tests. In each of these studies there was an increase in the percentage of patients who were azoospermic at the second test, and this increase got smaller when the first test was conducted later. A total of 205 from 14 845 (1.4%) patients (from 15 studies) demonstrated persistent non-motile sperm, although some of these eventually reached azoospermia. Ten studies reported the reappearance of sperm in patients who had previously demonstrated azoospermia. Temporary reappearance of motile sperm was reported in one study (and azoospermia was eventually reached). The reappearance of non-motile sperm was reported in seven studies, occurring up to 22 months post-vasectomy and 17 months after azoospermia was demonstrated. There were a total of 69 (<0.1%) pregnancies reported in 20 studies (from a pool of more than 92 000 vasectomies). Pregnancies where paternity was confirmed by DNA analysis showed that vasectomy failure can occur up to 10 years after vasectomy.

Authors' recommendations: The evidence presented in this review supports a post-vasectomy testing protocol with only one test (showing azoospermia) at three months post-vasectomy and after a minimum of 20 ejaculations. If the sample is positive at three months, then periodic testing can continue until azoospermia is reached. In patients who do not reach azoospermia after prolonged testing, cautious assurance of success could be given provided only low levels of non-motile sperm are present. No evidence was found to support a recommendation of histological testing of the excised vas deferens. The proposed protocol could considerably reduce costs of post-vasectomy testing.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.surgeons.org/asernip-s/publications_vasectomy.htm

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Australian Safety and Efficacy Register of New Interventional Procedures-Surgical

Contact Address: ASERNIP-S 24 King William Street, Kent Town SA 5067 Australia Tel: +61 8 8219 0900

Contact Name: racs.asernip@surgeons.org

Contact Email: racs.asernip@surgeons.org

Copyright: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical