Comparison of postal & non-postal post-vasectomy semen.

Vasectomy is an effective, non-reversible form of contraception for men. However, it's important to confirm its success through a post-vasectomy semen analysis (PVSA). In the past, this analysis was conducted on fresh semen samples at a local laboratory shortly after production. Initially, two sperm-free samples were required for the vasectomy to be considered a success, but this changed in 2014 to just one.

The newer guidelines also allow for the presence of a small number of non-motile sperm without increasing the risk of pregnancy. However, many men who undergo vasectomies don't follow up with semen analysis, putting them at risk of an unnoticed vasectomy failure until a pregnancy occurs.

Some surgeons have adopted a postal method for PVSA, which is accessible to all patients. While this approach is acceptable to some medical organizations, it is not recommended by others, including the Association of Biomedical Andrologists, the British Andrology Society, and the British Association of Urological Surgeons.

A study analysed compliance and failure rates for PVSA, comparing non-postal local laboratory testing of fresh specimens and postal testing. Postal testing, though less ideal in some ways, resulted in higher compliance, with 1 in 5 more men receiving clearance to discontinue other contraception methods. The early failure rate for postal testing was slightly lower, and late failure rates were also reduced, though not significantly.

Even when considering vasectomies performed after the change in guidelines, postal testing continued to show higher compliance, with no significant differences in failure rates. The study suggests that postal testing can help detect more early vasectomy failures due to improved compliance.

Some concerns were raised about sperm degradation during transit with postal testing. However, the study's findings indicate that this concern may be unfounded, as both testing strategies had similar failure rates. In cases of early failure suspicion, fresh non-postal testing at a local laboratory is still required.

While the study has some limitations, such as variations in surgeon experience and criteria, it highlights the benefits of postal semen sample submission. It's a less resource-intensive approach that's more acceptable to patients and provides clear advantages to both patients and surgeons. The study suggests that future clinical practice guidelines should consider postal semen sample submission as a reliable option.

For the full article, you can reference doi:10.1136/bmjsrh-2021-201064.

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