Reduced Postvasectomy Semen Analysis Testing With the Implementation of Special Clearance Parameters

Bieniek, J; Fleming, Tyler; Clark, Joseph Y.

doi:10.1016/j.urology.2015.05.024

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…Our data demonstrate a similarly low follow-up rate of approximately 60%, which was comparable in both the FMP and urology cohort. This is similar to other studies which have cited rates of 48%–66% 3689. Factors including younger age, larger number of children, and lower education level predict decreased compliance with PVSA 810.…”

Section: Discussionsupporting

confidence: 90%

“…In 2012, the AUA released guidelines regarding various aspects of vasectomy care including the timing for obtaining PVSAs and their interpretation. These guidelines have been shown to improve compliance, decrease the use of multiple PVSAs, and reduce the number of repeat vasectomies in civilian and military urologic practices 3467. The implementation and use of these guidelines by nonurologists (FMPs) has not previously been studied.…”

Section: Discussionmentioning

confidence: 99%

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Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

et al. 2019

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Urologists perform the majority of vasectomies in the United States; however, family medicine physicians (FMPs) perform up to 35%. We hypothesized that differences exist in practice patterns and outcomes between urologists and FMPs. Patients who underwent a vasectomy from 2010 to 2016 were identified. Postvasectomy semen analysis (PVSA) practices were compared between urologists and FMPs, before and after release of the 2012 AUA vasectomy guidelines. From 2010 to 2016, FMPs performed 1435 (35.1%) of all vasectomies. PVSA follow-up rates were similar between the two groups (63.4% vs 64.8%, P = 0.18). Of the patients with follow-up, the median number of PVSAs obtained was 1 (range 1–6) in both groups (P = 0.22). Following the release of guidelines, fewer urologists obtained multiple PVSAs (69.8% vs 28.9% pre- and post-2012, P < 0.01). FMPs had a significant but lesser change in the use of multiple PVSAs (47.5% vs 38.4%, P < 0.01). Both groups made appropriate changes in the timing of the first PVSA, but FMPs continued to obtain PVSAs before 8 weeks (15.0% vs 6.5%, P < 0.01). FMPs had a higher rate of positive results in PVSAs obtained after 8 weeks, the earliest recommended by the AUA guidelines (4.1% vs 1.3%, P < 0.01). Significant differences in PVSA utilization between FMPs and urologists were identified and were impacted by the release of AUA guidelines in 2012. In summary, FMPs obtained multiple PVSAs more frequently and continued to obtain PVSAs prior to the 8-week recommendation, suggesting less penetration of AUA guidelines to nonurology specialties. Furthermore, FMPs had more positive results on PVSAs obtained within the recommended window.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

et al. 2019

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“… a , secondary contraception use: use of any of the following contraception methods [pill; condoms; injection once every 3 months (Depo-Provera ® ); contraceptive implant; contraceptive patch (OrthoEvra ® ); diaphragm, cervical cap, or sponge; vaginal ring (NuvaRing ® ); IUD (including Mirena ® ) rhythm method or natural family planning; withdrawal (pulling out); and spermicide] in addition to having a vasectomy; b , data aggregated for 15 sites (Arkansas, Colorado, Michigan, Missouri, North Carolina, Nebraska, New York, Ohio, Oregon, Rhode Island, South Carolina, Tennessee, Utah, West Virginia, and New York City) with data available for 2007–2011; c , unweighted sample size; d , weighted percent; e , based on contraceptive failure rates during typical use: most effective (<1%), moderately effective (6%–12%), and least effective (≥18%) ( 13 , 15 ). CI, confidence interval.…”

Section: Resultsmentioning

confidence: 99%

“…However, the AUA guidelines do not specify a recommended type of secondary contraceptive method that should be used ( 9 ). Reported rates of compliance with PVSA are low and estimated to range from 48–71% ( 9 , 13 , 14 ). Similarly, use of secondary contraception following vasectomy is also thought to be low; however evidence is limited ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Use of secondary contraception following vasectomy: insights from the Pregnancy Risk Assessment Monitoring System, 2007–2011

Patel

Williams

Warner

et al. 2018

Transl. Androl. Urol.

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BackgroundTo assess postpartum use of secondary contraception with vasectomy within Pregnancy Risk Assessment Monitoring System (PRAMS).MethodsSecondary contraception and type of method used were assessed among married women reporting partner vasectomy 4 months after a recent live birth in female residents of 15 US states and New York City who participated in the 2007–2011 PRAMS.ResultsBetween 2007 and 2011, 1,004 married women who had a recent live birth participating in PRAMS reported they and their partners relied on vasectomy for postpartum contraception. Among these couples, 57.8% reported not using additional forms of contraception postpartum. Of those reporting additional contraception, condoms were most commonly used (50.0%), followed by oral contraceptive pills (26.5%), and withdrawal (9.5%). Multivariable modeling showed that use of secondary contraception was twice as high among women reporting a second birth versus women reporting a fourth or higher birth [adjusted prevalence odds ratio (POR) =2.0 (1.1–3.2)]. No other sociodemographic characteristics (maternal age, maternal race, parental education, household income) were significantly associated with use of secondary contraception with vasectomy.ConclusionsMost couples within PRAMS reporting partner vasectomy as postpartum contraception did not use secondary contraception in the months immediately after vasectomy, and, of those who did, most relied on less effective methods. Clinicians need to better understand reasons for limited use of secondary contraception with vasectomy to improve counseling strategies for reducing unintended pregnancy.

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“…Compliance with PVSA can be poor, with some studies reporting compliance rates as low as 50%. [6][7][8] It is recognised that increasing sample requests may reduce patient compliance. 9 Our rates of compliance are encouraging, and at the higher end of quoted ranges seen in the published literature.…”

Section: Discussionmentioning

confidence: 99%

The case for early post-vasectomy semen analysis combining small non-motile sperm and azoospermia

Hendry

Small

Zreik

et al. 2018

Journal of Clinical Urology

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Background: Post-vasectomy semen analysis timing and criteria guidelines have evolved over time. Through analysis of our unit's practice of post-vasectomy semen analysis from earlier sampling protocols at 8 weeks to single sampling at 12 weeks then 16 weeks, the impact on success rates and patient compliance were assessed. In addition, the use of small numbers of non-motile sperm and azoospermia combined rates as a marker of sterility were examined. Methods: All patients who underwent vasectomy in 2011 (8 and 12-week samples), 2013 (12-week samples) and 2016 (16-week samples) were included. Patients were given written and verbal instructions explaining the sample delivery protocol and samples. χ 2 Testing was used to compare patient compliance and the results of post-vasectomy semen analysis with significance set at P<0.05. Results: In total 1124 vasectomies were performed, with 21% (N=232) of patients non-compliant with submitting samples at the requested time period. Azoospermia rates increased with a longer time to post-vasectomy semen analysis from 82% to 95%, P<0.001; however, declining compliance meant the proportion of patients given clearance remained the same (70% vs. 68%, P=0.32). Rates of small non-motile sperm declined over an increasing time to post-vasectomy semen analysis. Therefore combined azoospermia and small non-motile sperm rates remained stable over an increasing sampling time (95% vs. 99%, P=0.39). Conclusion: The use of earlier post-vasectomy semen analysis is recommended as patient compliance decreases with the time from vasectomy. When azoospermia and small non-motile sperm rates are combined the rates of success of the procedure remain the same over time therefore earlier testing at 8 weeks is feasible without compromising clearance rates. Level of evidence: Not applicable for this single centre audit.

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Reduced Postvasectomy Semen Analysis Testing With the Implementation of Special Clearance Parameters

Cited by 13 publications

References 23 publications

Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

Do I need to see a urologist for my vasectomy? A comparison of practice patterns between urologists and family medicine physicians

Use of secondary contraception following vasectomy: insights from the Pregnancy Risk Assessment Monitoring System, 2007–2011

The case for early post-vasectomy semen analysis combining small non-motile sperm and azoospermia

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