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Dr. Andrew Rynne

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What does this lab report indicate?

Answered by
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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 2853 Questions

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Posted on Tue, 12 Jun 2018 in Men's Health
Question: I had a vasectomy about 12 weeks ago and my first semen test had results that I am not sure about, they read "SPERMATOZOA, POST VASECTOMY, PRESENT was highlighted in red and "none seen" below that in grey, it then read "Rare sperm observed (<1/HPF) from a centrifuged specimen. " At the top of my results, it also mentioned "out of range", can someone help me understand these results?
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Answered by Dr. Bonnie Berger-Durnbaugh 1 hour later
Brief Answer:
May need to repeat the test in 1-2 months

Detailed Answer:
Hello XXXXXXX

I'll tell you what the lab report says and what information it should include that it does not.

1. Spermatazoa Post-Vasectomy
Present: I believe your report is flagged in red because there were some sperm seen, even if not very many.

Reference Range: None Seen
This means that the lab's computer standard range is that, post-vasectomy, there should be no sperm seen. So they are comparing your sample with the standard that no sperm should be seen. Presence of any sperm would be considered "out of range".

2. Rare Sperm Observed (<1/HPF) from a centrifuged sample
Centrifuging is important to collect all of the sperm in one place so this is appropriate.
However, the report does not say whether the rare sperm that were seen were motile or immotile. This is important information to know.
They say there were rare sperm seen but not even 1 sperm was seen in a high powered field of the microscope. They likely mean a sperm was seen over the course of looking at more than 1 high powered field. One high powered field is what the tech will see through the microscope lens without moving the slide.

What needs to be told is whether there was motility in the sperm that were seen.

So what to do:
Discuss this with the doctor who performed the vasectomy. Most likely, he/she will want to repeat the test in 1-2 months. You are most likely infertile now, but I would very much hesitate to tell you so based on this lab report. It's possible your urologist will feel more comfortable with these results, but I would repeat it.

You can also call the lab and ask them about the motility. They might not bother with recording whether the sperm are motile if they see any, but it is useful information to know.

If you want to read more on the guidelines for determining infertility after vasectomy, here is a section from the physician website journal UpToDate. They compile the latest information and standards on various medical topics. I would be happy to "translate" any of it if you care to read it. For your reference, "azoospermia" means no sperm (zero).
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FOLLOW-UP TO CONFIRM STERILITY — We suggest obtaining a semen analysis three months postoperatively [7]; the patient should have had at least 20 ejaculates since the time of vasectomy [41,42]. A systematic review including 56 studies reported the time to achieve azoospermia was variable, but more than 80 percent of men were azoospermic after three months and 20 ejaculations [43]. The time to achieve azoospermia declines with increasing number of ejaculations following vasectomy and increases with patient age [44-47]. A coital frequency of at least three times per week seems to be associated with more rapid clearance, regardless of age [46].

Azoospermia in a semen sample is definitive evidence of infertility [43]. Although an at-home test is available that allows the patient to monitor sperm count after vasectomy, we recommend formal laboratory testing to confirm any results prior to assuming sterility [48]. The laboratory performing the analysis should examine a fresh specimen using direct microscopy; if sperm are not seen on the initial prepared slide, a centrifuged specimen should be evaluated.

If there are motile sperm at the three-month check-up, a follow-up test is performed in another one to two months [49]. Vasectomy is considered a failure if motile sperm are confirmed on the follow-up examination, there have been a sufficient number of ejaculations (>20), and >3 months have elapsed since the procedure. The patient should be advised to use alternative contraception and potentially undergo a repeat procedure. (See 'Vasectomy failure' below.)

Azoospermia is the ideal endpoint of vasectomy. A small proportion of patients, however, do not achieve azoospermia but consistently have nonmotile sperm. Nonmotility is a less definitive sign of infertility than azoospermia since it may reflect death of recently motile sperm due to a prolonged delay between ejaculation and laboratory analysis. The accuracy of determining whether sperm have normal motility is dependent on the timely examination of the semen specimen, ideally less than four hours from the time collected by the patient [41]. When rare, nonmotile sperm are observed, a repeat test in another one to two months may show azoospermia or continued presence of rare, nonmotile sperm.

The continued presence of rare, nonmotile sperm is probably clinically insignificant, and these men can be given cautious assurance of success. Guidelines from the British Andrology Society recommend that patients be given "special clearance" to discontinue other contraception, following appropriate counseling, provided they have a low sperm count (<10,000/mL), all sperm are immotile, seven months have elapsed from vasectomy, and there have been a minimum of 24 ejaculations [41]. The XXXXXXX Urologic Association guidelines state that patients may stop using other methods of contraception when examination of one well-mixed, uncentrifuged, fresh post-vasectomy semen specimen shows azoospermia or only rare nonmotile sperm (defined as presence of ≤100,000 nonmotile sperm/mL based on microscopic exam of at least 50 high-powered fields) [7].







Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 13 minutes later
I did call the dr's office where I had the procedure done and was told by the doctor's assistant that I was clear, and they did see sperm but it was "dead". Not sure what that means, but I really want to make sure as I no longer want any more children. Do you recommend I meet with the doctor, or maybe gain a copy of the final report from him about the tests. I have had two tests done with the same results.
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Answered by Dr. Bonnie Berger-Durnbaugh 22 minutes later
Brief Answer:
Information

Detailed Answer:
As it's been 3 months, I would have the test repeated in 1-2 months and request verification in writing that the sperm are immotile. If you are still getting the same reports at 6 months, then meet with the doctor.

In the meantime, continue to use a contraceptive.

Tests before 3 months are usually not as helpful.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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