(391) Post-Vasectomy Semen Testing Compliance and Outcomes: A 2022–2025 Retrospective Cohort

Introduction Vasectomy is a minimally invasive and nearly 100% effective method of male contraception. According to the American Urological Association (AUA) guidelines, procedural success can be confirmed by a single fresh, uncentrifuged semen sample with ≤100,000 non-motile sperm/mL. However, the greatest challenge in vasectomy aftercare remains poor patient compliance with post-vasectomy semen analysis (PVSA) follow-up, leaving a risk of unconfirmed fertility. Objective To retrospectively evaluate the effectiveness (time to azoospermia), safety (complications and post-vasectomy pain), and patient compliance with PVSA in men undergoing vasectomy over a 4-year period, and to consider potential strategies to improve follow-up rates. Methods We conducted a retrospective chart review of all patients who underwent vasectomy between January 2022 and May 2025 in a regional healthcare system. A total of 71 men (median age 38 years) were included. The primary outcome was time to confirmed permanent azoospermia within 24 weeks post-procedure. Secondary outcomes included early postoperative complications (within 30 days), occurrence of post-vasectomy pain syndrome (PVPS), late vasectomy failure, and PVSA compliance. PVPS was defined as chronic scrotal pain persisting for ≥3 months after vasectomy (assessed at 12 months postoperatively), and late failure was defined as the reappearance of motile sperm after initial clearance. Patient attendance for semen testing at approximately 3 and 6 months post-vasectomy was recorded to calculate PVSA compliance rates. Data were obtained from electronic medical records. Time-to-event analysis for achieving azoospermia was conducted using the Kaplan-Meier method, and 95% confidence intervals (CI) for proportions were calculated with the Wilson method. Results By 24 weeks after vasectomy, the estimated cumulative probability of sterility was 93% (95% CI 86–97%), rising to 98.6% by 52 weeks. The median time to azoospermia was 15 weeks (interquartile range 12–18 weeks). Early complications occurred in 4.2% of patients (3/71; two scrotal hematomas and one superficial infection), consistent with the 3–4% rate reported in the literature. PVPS persisting ≥12 months was documented in 3.1% of cases (2/64 patients with at least one-year follow-up), aligning with the ~1–2% incidence reported in contemporary reviews. One patient (1.4%) experienced a late failure (reappearance of motile sperm after initial azoospermia) with no resulting pregnancy; this falls within the 0.6–1.5% late failure rate reported in large registries. PVSA compliance was 62% at 3 months and only 52% by 6 months postoperatively, markedly below the ~70–80% compliance achieved in centers with mail-in sample programs. No unintended pregnancies were observed in our series during the follow-up period. Conclusions This study confirms that vasectomy is a highly effective (≥98% one-year sterility rate) and safe procedure with minimal morbidity, consistent with contemporary guidelines (e.g., EAU 2025). Nonetheless, suboptimal patient compliance with post-vasectomy semen testing remains a major limitation. These findings highlight the need for improved strategies to enhance PVSA follow-up (such as patient education, reminders, or mail-in testing kits) to ensure verification of sterility and reduce the risk of unplanned pregnancies after vasectomy. Disclosure No