Ask the Doctor

From SB:-
I had a non-scalpel vasectomy with both vas cut and cauterized. It was done back in the end of July 2007. In September after at least 20 or more ejaculations I had a negative result of any semen present. It however, only lists the volume, PH, and if any spermatozoa were present or not. It listed none present, but nothing else. The doctor was pleased with the results, but reminded me to go for the 2nd test. I went for the follow-up semen analysis in the middle of October 2007 and this test came back with motile spermatozoa present. How could it go from none, to this?

My doctor thinks something went wrong in the lab or the results are wrong. I now have to go for two more tests and see what these results show. As listed in your website, I see you recommend a pelted semen analysis, but I am not sure if that was done or not. The lab results don’t even give a sperm count or really any in depth information.

What do you suggest, and also please provide your thoughts on if the vasectomy failed. It was painful and hard enough going through it once, I really don’t want to do it all over again. Should I be worried or will new tests or maybe a new lab be helpful? I hope this question gets forwarded to you as I am going nuts and looking all over the internet for answers. I really don’t want to go through all these tests and waste all this time for more bad news. I’d like to get this over with and move on. Any suggestions or comments you would have would be gratefully appreciated!

A semen analysis with motile sperm after a vasectomy and an adequate number of ejaculates most likely represents a failed vasectomy. Oftentimes, we will only see non-motile sperm after a vasectomy and this usually represents inadequate clearance of residual sperm. Motile sperm represents a persistent patency of the vasal lumen on one or both sides. This scenario is precisely why every patient should have two pelleted samples demonstrating no sperm after a vasectomy prior to having unprotected intercourse. A normal semen analysis will miss sperm in up to 8% of patients after a vasectomy. A pelleted sample concentrates any sperm in the sample and makes for easier detection at the time of the evaluation.