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Has my vasectomy failed?

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  • Retired account

    Hello. I am 35 years old and have 5 children. I had a no scalpel vasectomy in November of last year. The vas were cut, cauterized AND tied off. I have had 3 post vasectomy semen analyses and all have showed sperm still present. One of the reports actually differentiated and said they were non-motile. The count was 2000, which I understand is very low. After each successive positive analysis, the doctor’s office said “test again after SEVERAL more ejaculations. I would say I have had more than 30-40 ejaculations since November. I don’t know if I should trust the lab report that said they were non-motile because the sample was not tested within 1 hour of collection, so if they were live, they could have expired. I am repeating the analysis one more time.

    The doctor said if it comes back positive for sperm that he would recommend repeating the vasectomy, which I would really rather not do (once was enough, thanks). If I get the lab to test the sample within an hour and it still show non-motile with a count of less than 2000, would it be safe to say I am infertile? If it does come back positive, is there anything to be done before trying another vasectomy? (i.e. scrotal ultrasound to try and identify each vas and see if they are still separated? I can’t imagine after being cut, cauterized and tied that they recanulated.

    Lastly, after 30-40 ejaculations, I cannot imagine any left over sperm would still be in the vas, I read that they could be stored in the seminal vesicles and that that is a harsh environment for sperm and thus they would likely be non-motile– can you speak to this?

    Dr. Edward Karpman

    Persistent non-motile sperm in the ejaculate can be a frustrating issue. It is important to first make sure that the sperm is truly non-motile and not just dying before it is analyzed in the lab. It is important to have the specimen brought to the lab no later than 30 minutes after collection to sort this out. If there are any motile sperm at this point after your vasectomy then it likely represents a failed vasectomy. This far after your vasectomy and after 40 ejaculates we should only be seeing a few non-motile sperm at most. Unfortunately, there is no other study that can be done to confirm the patency of your reproductive tract except a semen analysis. In studies looking at the failure rate of vasectomy in men with rare non-motile sperm, only 1% of patients experienced a failed vasectomy.

    I usually DO NOT recommend that a man have unprotected intercourse until there is confirmatory evidence based on two semen analyses that he is sterile.

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