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    Post-vasectomy semen analysis: Optimizing laboratory procedures and test interpretation through a clinical audit and global survey of practices
    (Pusan National University's Medical School, 2022) Agarwal, Ashok; Gupta, Sajal; Sharma, Rakesh K.; Finelli, Renata; Kuroda, Shinnosuke; Vij, Sarah C.; Boitrelle, Florence; Kavoussi, Parviz; Rambhatla, Amarnath; Saleh, Ramadan; Chung, Eric; Mostafa, Taymour; Zini, Armand; Ko, Edmund; Parekh, Neel; Martinez, Marlon; Arafa, Mohamed; Tadros, Nicholas; Rosette, Jean de la; Le, Tan V.; Rajmil, Osvaldo; Kandil, Hussein; Blecher, Gideon; Liguor, Giovanni; Caroppo, Ettore; Ho, Christopher C.K.; Altman, Andrew; Bajic, Petar; Goldfarb, David; Gill, Bradley; Zylbersztejn, Daniel Suslik; Molina, Juan Manuel Corral; Gava, Marcello M.; Cardoso, Joao Paulo Greco; Kosgi, Raghavender; Çeker, Gökhan; Zilaitiene, Birute; Pescatori, Edoardo; Borges Jr, Edson; Duarsa, Gede Wirya Kusuma; Pinggera, Germar-Michael; Busetto, Gian Maria; Balercia, Giancarlo; Franco, Giorgio; Çalik, Gökhan; Sallam, Hassan N.; Park, Hyun Jun; Ramsay, Jonathan; Alvarez, Juan; Khalafalla, Kareim; Bowa, Kasonde; Hakim, Lukman; Simopoulou, Mara; Rodriguez, Marcelo Gabriel; Sabbaghian, Marjan; Elbardisi, Haitham; Timpano, Massimiliano; Altan, Mesut; Elkhouly, Mohamed; Al-Marhoon, Mohamed S.; Gilani, Mohammad Ali Sadighi; Soebadi, Mohammad Ayodhia; Nasr-Esfahani, Mohammad Hossein; Garrido, Nicolas; Vogiatzi, Paraskevi; Birowo, Ponco; Patel, Premal; Javed, Qaisar; Ambar, Rafael F.; Adriansjah, Ricky; AlSaid, Sami; Micic, Sava; Lewis, Sheena E.; Mutambirwa, Shingai; Fukuhara, Shinichiro; Parekattil, Sijo; Ahn, Sun Tae; Jinda, Sunil; Takeshima, Teppei; Puigvert, Ana; Amano, Toshiyasu; Barrett, Trenton; Toprak, Tuncay; Malhotra, Vineet; Atmoko, Widi; Yumura, Yasushi; Morimoto, Yoshiharu; Lima, Thiago Fernandes Negris; Kunz, Yannic; Kato, Yuki; Umemoto, Yukihiro; Colpi, Giovanni M.; Durairajanayagam, Damayanthi; Shah, Rupin
    Purpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.
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    Sperm vitality and necrozoospermia: Diagnosis, management, and results of a global survey of clinical practice
    (Korean Society for Sexual Medicine and Andrology, 2022) Agarwal, Ashok; Sharma, Rakesh K.; Gupta, Sajal; Boitrelle, Florence; Finelli, Renata; Parekh, Neel; Durairajanayagam, Damayanthi; Saleh, Ramadan; Arafa, Mohamed; Cho, Chak Lam; Farkouh, Ala’a; Rambhatla, Amarnath; Henkel, Ralf; Vogiatzi, Paraskevi; Tadros, Nicholas; Kavoussi, Parviz; Ko, Edmund; Leisegang, Kristian; Kandil, Hussein; Palani, Ayad; Salvio, Gianmaria; Mostafa, Taymour; Rajmil, Osvaldo; Banihani, Saleem Ali; Schon, Samantha; Le, Tan V.; Birowo, Ponco; Çeker, Gökhan; Alvarez, Juan; Molina, Juan Manuel Corral; Ho, Christopher C.K.; Calogero, Aldo E.; Khalafalla, Kareim; Duran, Mesut Berkan; Kuroda, Shinnosuke; Colpi, Giovanni M.; Zini, Armand; Anagnostopoulou, Christina; Pescatori, Edoardo; Chung, Eric; Caroppo, Ettore; Dimitriadis, Fotios; Pinggera, Germar-Michael; Busetto, Gian Maria; Balercia, Giancarlo; Elbardisi, Haitham; Taniguchi, Hisanori; Park, Hyun Jun; Rosas, Israel Maldonado; de la Rosette, Jean J. M. C. H.; Ramsay, Jonathan; Bowa, Kasonde; Simopoulou, Mara; Rodriguez, Marcelo Gabriel; Sabbaghian, Marjan; Martinez, Marlon; Gilani, Mohamed Ali Sadighi; Al-Marhoon, Mohamed S.; Kosgi, Raghavender; Cannarella, Rossella; Micic, Sava; Fukuhara, Shinichiro; Parekattil, Sijo; Jindal, Sunil; Abdel-Meguid, Taha Abo-Almagd; Morimoto, Yoshiharu; Shah, Rupin
    Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra -testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.