Does a vasectomy decrease sperm count?

From the Guidelines

A vasectomy significantly decreases sperm in ejaculate, with motile sperm disappearing within a few weeks after the procedure, and azoospermia or rare nonmotile sperm achieved in most men by 12 weeks after vasectomy. A vasectomy is a surgical procedure that blocks or cuts the vas deferens, the tubes that carry sperm from the testicles to the urethra. After a vasectomy, sperm can no longer travel from the testicles to become part of the semen ejaculated during orgasm. The body continues to produce sperm, but they are reabsorbed by the body instead of being ejaculated.

Key Points to Consider

• It typically takes about 8-12 weeks or 15-20 ejaculations after the procedure for the semen to become completely sperm-free 1.
• During this transition period, another form of birth control should be used, as recommended by the American Urological Association Vasectomy Guidelines 1.
• To confirm the success of the vasectomy, doctors recommend semen analysis tests to verify that no sperm remain in the ejaculate 1.
• The risk for pregnancy after a man has achieved postvasectomy azoospermia is approximately one in 2,000 1.
• While a vasectomy prevents sperm from being present in semen, it does not affect hormone production, sexual function, or the amount of semen ejaculated.

Important Considerations for Patients

• Patients should be aware that vasectomy is a highly effective form of birth control, but it is not 100% certain 1.
• The number of ejaculations after vasectomy is not a reliable indicator of when azoospermia or rare nonmotile sperm will be achieved 1.
• Assigning men an appointment after their vasectomy might improve compliance with follow-up semen analysis tests 1.

From the Research

Effect of Vasectomy on Sperm

• A vasectomy is a surgical procedure that disrupts and occludes the vas deferens, which delivers sperm from the testicles, providing permanent sterilization by interrupting sperm transport 2.
• The procedure does not render patients sterile immediately, and they must continue to use alternate forms of contraception until cleared by a post-vasectomy semen analysis (PVSA) 3.
• Post-vasectomy semen analysis is used to establish whether sperm are present in the semen following a vasectomy, and clearance can be given if no sperm are observed or if there are ≤100,000 non-motile sperm (NMS) per mL 3, 4.

Post-Vasectomy Semen Analysis

• PVSA should take place a minimum of 12 weeks after surgery and after a minimum of 20 ejaculations, and laboratories should routinely examine samples within 4 hours of production 4.
• Assessment of a single sample is acceptable to confirm vasectomy success if all recommendations and laboratory methodology are met and no sperm are observed 4.
• The level for special clearance should be <100,000/mL non-motile sperm, and special clearance cannot be provided if any motile sperm are observed 4.

Patient Compliance with Post-Vasectomy Semen Analysis

• Patient compliance with PVSA has been poor, with many patients failing to follow postoperative instructions to obtain semen analysis 5.
• The inconvenience and embarrassment of having to bring semen specimens to the laboratory were identified as factors that can affect patient adherence to instructions 5.
• Mail-in and at-home PVSA have the potential to increase compliance due to inherent convenience and less patient embarrassment 3.