Compliance Rates for Post-Vasectomy Semen Analysis Using Laboratory Versus Home-Based Tests
James Trussler, MD, Brendan M. Browne, MD, Daneil Kuftinec, MD, Manuel Merino, MD, Andrew McCullough, MD
Lahey Hospital and Medical Center, Burlington, MA.
BACKGROUND: Vasectomy is a common urologic procedure. Post-vasectomy semen analysis (PVSA) is an important test to ensure successful sterilization. Compliance rates are reported around 50%. FDA approved home-based sperm antigen semen tests might improve PVSA compliance when done in the privacy and convenience of home with the immediate gratification of the knowing the results. Current AUA guidelines recommend visual laboratory inspection of the post-vasectomy semen 8-16 weeks following the procedure. This study explores differences in compliance rates between lab-based and home-based PVSA.
METHODS: We conducted a retrospective chart review of patients who underwent vasectomy by one of three surgeons between May 2017 and June 2018. Patients were excluded if they had undergone prior vasectomy or vasectomy reversal. Following vasectomy, two surgeons prescribed laboratory-based PVSA and the third prescribed home-based PVSA (SpermCheck). Patients were considered to be compliant if they completed PVSA within the 8-16 week post-vasectomy time frame recommended by the AUA.
RESULTS: Two hundred and two patients underwent vasectomy in the capture period. One hundred and twenty-five patients comprised the lab-based PVSA cohort and 77 patients in the SpermCheck cohort. The patients in each group were similar in terms of age (39.2 vs 39.9, p=0.497) and prior children (2.38 vs 2.41, p=0.804). The compliance rate for lab-based PVSA was 60.2% and for SpermCheck was 80.4% (p=0.020). The rate of negative semen analysis was equivalent between the two groups (94.2% vs 96.0%, p=0.482).
CONCLUSIONS:
Utilization of a home-based semen analysis showed a higher rate of PVSA compliance compared with a traditional lab-based test. Compliance rates for the lab-based PVSA cohort is similar to that reported in the literature. Use of an at-home testing kit may increase compliance with PVSA by means of convenience and reduced stigma surrounding semen analysis, and improved compliance will ideally reduce unintentional pregnancies. As a small retrospective cohort, this study expands the conversation about the role of home-based testing within the AUA guidelines.
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