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Audit of Post V asectomy Semen Analysis

Explore the adherence to local guidelines on post-vasectomy semen analysis with a retrospective audit of patients at PCH. Evaluate the availability and timing of semen analysis data to inform patients of sterility.

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Audit of Post V asectomy Semen Analysis

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  1. Audit of Post Vasectomy Semen Analysis Dr L Bibby (CT1) & Mr C Dawson (Cons) Department of Urology Project Registration Number: (1607) Date of presentation: 31 Jan 18

  2. Background: • Semen analysis required to confirm clearance of stored spermatozoa and identify technical failure/early recanalization • Timing of semen analysis post procedure is controversial • Local guidelines: Semen analysis at 12 and 16 weeks post procedure • If both clear →sterile • If small numbers non-motile sperms → additional sample at 28 weeks • If persistent non-motile sperms → fertility test a 7 months (if <10’000 non-motile sperms/ml →special clearance) • BAUS guidelines: Single semen analysis at least 12 weeks post procedure and after a minimum of 20 ejaculations • If first count shows no sperms → sterile • If first count shows <100’000 non-motile sperms/ml → second sample • If persistent count shows <100’000 non-motile sperms/ml → special clearance • If motile sperm → procedure failure

  3. Project’s aims and objectives: Aim: To audit compliance with local guidelines on semen analysis post vasectomy Objectives: • Identify total number of patients undergoing vasectomy at PCH • Determine which of these patients have semen analysis results available on ICE in accordance with local policy • Quantify the number of patients formally informed of sterility

  4. Audit standard/s

  5. Methodology Sample: • All men undergoing a vasectomy at PCH between January 2016 and June 2017 • 76 patients in total (of which 9 were redo-vasectomies) • Age range 24-57 years • Average age 37 years

  6. Methodology Data collection • Retrospective audit • All patients undergoing vasectomy at PCH between January 2016 and June 2017 identified using computer database (list generated by Daniel Grimes) • Data obtained from • ICE semen analysis reports and requests • ICE discharge summaries • Epro theatre and clinic letters

  7. Results • Of those who did have semen analysis result available on ICE…

  8. Results • Of the patients who did have semen analysis, the first semen sample was received between 8 and 24 weeks post procedure • Of the patients who had two semen analysis, the second semen sample was received between 11 and 40 weeks post procedure

  9. Results • In total 13 patients were found to have a letter on epro declaring them sterile • Of these patients, sterility was declared between 13-59 weeks post procedurally (Average: 25 weeks) • No patients were given special clearance but one patient was referred to Cambridge for special clearance

  10. Results • Looking at the patients with no semen analysis available on ICE 15 (40.5%) had semen analysis requested on ICE • The theatre letter of 9 (11.8%) patients requested the GP or medical officer to follow up the patient or perform semen analysis. Of these 7 (18.9%) had no semen analysis available on ICE • 22 (59.5%) patients were commanding officers or had Kendrew Barracks as their address. None had semen analysis on ICE. 2 had ICE requests.

  11. Project outcome

  12. Discussion: • PCH guidance advises level for special clearance <10’000 non-motile sperms/ml whereas BAUS suggest <100,000 non-motile sperms/ ml • Why is this so different?

  13. Discussion:

  14. Discussion:

  15. Discussion: • No semen analysis for 48.7% - this most likely relates to members of Armed Forces (for whom we do not perform semen analysis – these 22 patients should be excluded from this audit) • Of those with semen analysis 17.9% provided only one sample • Why? • Compliance • GP/Medical officer asked to do follow up (9 patients, of which 7 had no semen analysis on ICE)

  16. Discussion: • Is there anything we can do to improve compliance? • Send reminder to patients who have not provided a sample within 12 weeks?

  17. Discussion: • Is there anything we can do to improve compliance? • minimum number of weeks before testing of between 12 and 16 weeks - decreased patient compliance with longer intervals

  18. Discussion: • Is there anything we can do to improve compliance? • Would compliance improve if we altered our guidelines in line with BAUS

  19. Discussion:

  20. Discussion: • 13 patients provided more than 2 sperm samples. Of these 4 had at least one NA result. The rest had a result of occasional or low non-motile sperm. • Why? PCH guidance states if persistent non-motile sperm in 12 and 16 week samples then 7 month sample for special clearance otherwise technical failure/early recanalisation

  21. Discussion: • Of those with semen analysis available on ICE, only 13 (33.3%) were declared sterile • Why? • 7 patients only provided one semen analysis • 1 patient referred to Cambridge for special clearance

  22. Discussion:

  23. Actions to be taken

  24. References • ECH Urology Department Revised Vasectomy Guidelines 10/04/08 • British Andrology Society guidelines for the assessment of post vasectomy semen samples (2002): file:///C:/Users/Lisa/Downloads/BAS-Post-Vas-2002-Guidelines.pdf • BAUS Post-vasectomy semen analysis (sperm counts): http://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Postvasectomy%20counts.pdf

  25. References

  26. References

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