Factors Affecting Post-Vasectomy Semen Analysis Compliance in Thai Men

Background: Vasectomy is a highly effective permanent contraceptive method. Its success is confirmed by azoospermia through post-vasectomy semen analysis (PVSA) that indicates the efficacy of the procedure. However, the compliance of patients with PVSA testing presents a significant challenge. Objective: To identify the factors influencing patient compliance with PVSA at a tertiary hospital in Thailand. Materials and Methods: A retrospective analysis was conducted on 73 male patients who underwent a vasectomy procedure between 2018 and 2024. Fifty-three of the subjects attended the recommended follow-up for semen analysis. Demographic data, comorbidities, number of children, geographical location, age, and operative complications were assessed as potential predictors of follow-up compliance. Reasons for non-compliance were explored through retrospective phone interviews. Results: Of the 73 patients, 53 (72.6%) complied with the recommended follow-up for PVSA. No significant associations were found among follow-up compliance and age, underlying health conditions, number of children, or complications. However, significant differences were observed with geographical locations. By multivariable analysis, patients residing in other provinces were more likely to miss the PVSA appointment than those who lived in Bangkok (odds ratio OR 3.32, 95% confidence interval CI 1.08 to 10.22, p=0.036). The primary reasons for non-compliance were forgetfulness in 40%, time constraints in 33.3%, and geographical distance in 26.7%. Post-vasectomy complications were minimal, with 6.8% of patients experiencing minor issues such as surgical site pain, wound infection, and hematoma. Conclusion: Geographical location was the only factor significantly associated with post-vasectomy follow-up compliance. The main barriers to adherence were forgetfulness, time limitations, and geographical distance.