Lost to follow up: Semen analysis compliance following potential vasectomy failure

Many patients do not follow up for repeat semen analysis after potential vasectomy failure, indicating a need for strategies to enhance compliance and maximize outcomes.

To evaluate the rate of men who do not return for repeat semen analysis after suspected or confirmed vasectomy failure, defined as presence of motile or >100,000 non-motile sperm on post-vasectomy semen analysis, and investigate subsequent management.

We conducted a retrospective chart review of males aged ≥18 years old who underwent vasectomy for the first time between January 2004 and January 2024. We examined adherence to and timing of follow-up semen analyses and subsequent vasectomy outcomes, rates of non-compliance with follow-up, management strategies.

Of 2567 patients, 42.1% did not follow up at any time point post-vasectomy. Of those with spermatozoa on initial semen analysis < 3 months post-vasectomy, 43.3% failed to return for repeat testing. Nearly, 47% percent of those with spermatozoa present on first post-vasectomy semen analysis at or after 3 months also failed to follow up to re-evaluate sterility. Management of patients who did follow up often included repeat semen analyses at 6-week intervals until a negative result was produced or repeat vasectomy.

Alarmingly, many patients who could not be cleared to resume sexual activity after vasectomy did not follow up for repeat semen analyses. This highlights a significant deficit in compliance, which may benefit from interventions such as improved counseling and reminder systems. Future research should explore the impact of these interventions on compliance rates and explore rates of unintended pregnancy associated with loss to follow up.