Factors and Reasons Influencing Compliance with Post-vasectomy Semen Analysis: A Systematic Review

Clinical practice guidelines recommend post-vasectomy semen analysis (PVSA) to confirm vasectomy success two to four months after the procedure. However, only 55-71% comply in typical North American practices. We conducted a systematic review to summarise factors and reasons associated with PVSA compliance.

We included all studies assessing the association between socio-demographic, clinical, and facilitating factors and compliance with PVSA. We searched PubMed, Web of Science, and EMBASE. Two independent reviewers selected, extracted, appraised the quality, and synthesized all peer-reviewed literature that met our inclusion criteria. We assessed the risk of bias using the Joanna Briggs Institute critical appraisal tool for cohort, prevalence, and quasi-experimental studies. Given substantial heterogeneity across studies, meta-analyses were not performed, and results were synthesized narratively.

Among 4068 references, 25 (N=∼91,084) met our inclusion criteria with studies rated at lower (28%), moderate (32%), and higher (40%) risk of bias. Compliance rates varied from 8%-84%. The median compliance rate was 56% [Interquartile Range: 29%]. There was evidence of an association between compliance with PVSA and the number of children, level of education, distance from home to the andrology lab, number of prescribed PVSA, providing a semen container at the time of vasectomy, and postal submission. Inconsistencies were observed with the following factors: age, ethnicity or race, vasectomy provider, post-vasectomy contact or visit to the clinic, PVSA instruction methods, scheduling PVSA, and home-based versus fresh-lab testing. Marital status showed no association. Reasons for noncompliance included constraints related to specimen collection, transport, and delivery; forgetfulness and negligence, insufficient information, embarrassment, trust in the provider, and concerns about repeat vasectomy.

PVSA compliance is influenced by both logistical, behavioral and knowledge-related barriers. Findings should be interpreted with caution due to overall low quality of studies. Interventions that simplify access and reduce patient burden appear most effective, yet interventions to foster informed decision-making remain under-addressed. High-quality studies, including randomized trials, are needed to evaluate multimodal strategies targeting these barriers to improve compliance and optimize patient-centered care.