Poor Compliance With Postvasectomy Semen Testing: Analysis of Factors and Barriers

Abstract

Objective: To ensure procedure success, American Urological Association Guidelines recommend postvasectomy semen analysis (PVSA); however, current literature suggests poor compliance. We sought to measure PVSA compliance and assess barriers to completion.

Methods: A retrospective review was performed of vasectomies at San Diego Veterans Administration Hospital and UC San Diego Health between 2006 and 2018. Patients received preprocedural counseling regarding semen analysis necessity. Postprocedural management included follow-up visit within 2-4 weeks and semen analysis after 15-20 ejaculations. Demographics and periprocedural variables were collected. Telephone interviews assessed patient reported reasons for noncompliance. Multivariable analysis was performed for factors associated with semen analysis.

Results: 503 men, mean age 38.8 years, underwent vasectomy at San Diego Veterans Administration Hospital (n = 331) and UC San Diego (n = 172). Overall, 80% completed clinical follow-up (n = 401) and 53% completed semen analysis (n = 268). The cohorts exhibited significantly different rates of semen analysis completion (46% vs 67%, P <.001) and clinical follow-up (64% vs 85%, P = .038). No difference was observed in age, fatherhood, or marital status. On multivariable analysis, fatherhood was the only factor associated with noncompliance of semen analysis (odds ratio 0.52, 95% confidence interval 0.33-0.83). Among men interviewed, the primary barriers to semen analysis completion were distance (38%), time constraints (34%), and forgetfulness (23%). Ninety-two% reported increased likelihood of completion with home-based semen testing.

Conclusion: Patients demonstrated poor PVSA compliance despite preprocedural counseling. Given that distance and time constraints limited compliance, incorporating home-based semen testing may improve the quality of care for men undergoing vasectomy.