BACKGROUND: Trends in Post-Vasectomy Semen Analysis (PVSA) testing have led to a significant shift from standard fresh semen analysis to mail-in testing. However, limitations exist in measuring motility with a mail-in system. The AUA 2012 Vasectomy guidelines recommend that a fresh specimen should be utilized and evaluated within 2 hours of collection for clearance. The body of the guidelines clarify however, that: Some clinicians recommend for convenience and compliance reasons, that PVSA specimens can be sent by mail (following regulations regarding shipping biohazards). This approach is adequate to assess only the presence or absence of sperm. Motility cannot be evaluated reliably in a semen sample produced more than two hours before microscopic examination.The objective of our study was to evaluate the percentage of patients that required repeat mail-in testing compared to a single, fresh PVSA sample.
METHODS: We evaluated all mail-in PVSA tests processed by Fellow Health, Inc. from April 2021 to March 2024. We excluded samples collected within 8 weeks post-vasectomy, re-tests, samples collected where time from vasectomy was not recorded, and samples where clear inaccurate information was self-reported.
RESULTS: Overall, 18,966 specimens were included for evaluation. Of these, 17,660 (93.1%) were azoospermic, 801 (4.2%) had concentrations >0 - ≤100,000 cells/mL, and 505 (2.7%) had concentrations > 100,000 cells/mL. As a result, when using mail-in testing, 6.9% of patients required a re-test after their initial PVSA. If these same patients had used fresh samples, an estimated 2.7% would still have required a re-test. Therefore, in 4.2% of cases a mail-in patient was required to retest when they would have been cleared with fresh sample, based on concentration alone.
CONCLUSIONS: Analyzing prospective cohort data from men utilizing the Fellow mail-in PVSA test in a very large, nation-wide sample across a range of practice settings, only 4.2% of patients required additional testing (provided without additional cost), that may not have been necessary with a freshly evaluated sample if those sperm had been non-motile. The Fellow system enables a highly efficient clearance approach for the patient and their physician.
