Is a Semen Analysis a Good Test for Fertility after a Vasectomy Reversal?

No, a semen analysis is not thought to be a good measurement of fertility after a vasectomy reversal, but it is the best and easiest test that we currently have available that gives us a “ballpark” idea.

This article, written by international vasectomy reversal authority, describes why in 2023 a semen analysis is not considered a good test to measure fertility following a vasectomy reversal.

When looking at fertility or results after a vasectomy reversal, doctors order and use a semen analysis to give us an idea about a man’s potential to father children.  It is important, though, to realize that a semen analysis is not a measure of fertility. Instead, it is a “surrogate test” that we use as there really is nothing better that is commercially available to estimate a man’s fertility. Because we rarely know what a man’s semen analysis results were before the vasectomy, it makes interpreting the results after a vas reversal even more challenging.

So what is a semen analysis test good or?

A semen analysis is only a measure of two things – sperm production and sperm delivery.

Anything that interferes with the creation and maturation of sperm at any point in the 74 to 90-day sperm production cycle will result in lower sperm numbers, lower sperm motility and maybe even no sperm in the semen (called azoospermia) (1).

Just the same, anything that interferes with the normal flow of sperm along the path through the testicles, epididymis, out through the vas, through the prostate into the urethra and out of the body can also show reduced sperm counts and motility. Research shows that following a vasectomy reversal, the most common reason for low sperm counts or sperm motility is because of partial obstruction from inflammation and scarring at the vasectomy reversal connection on one or both sides.

So what hurts sperm production?
It might be easier to list what doesn’t hurt sperm production.  The main causes for low sperm counts are many medications (2), some supplements, vibrations, electromagnetic fields, excessive alcohol (3), marijuana (4), opioids, radiation or chemotherapy, excess body weight, and tobacco use to name a few.

The use of testosterone supplements hurts sperm counts because the hormones that stimulate both sperm production and testosterone production are closely intertwined. When the brain senses the higher levels of testosterone from the testosterone supplements, more than what the body’s thermostat had set, the natural testosterone production is shut down and so sperm production is reduced or stopped completely (5). This is why men who take testosterone hormone replacement usually have dramatically reduced sperm counts or even no sperm seen (not to mention smaller, softer testicles).

Other common reasons for compromised semen analysis results from the production side include the exposure of the testicles to heat such as hot tubs, hot baths, sitting in Jacuzzis or hot saunas (6). Fevers and other illnesses such as COVID-19 can hurt sperm production, sometimes for up to 6 months or more. Also, laptops on the lap can cause a lot of heat to the testicles as well as electromagnetic fields (EMF) which are not good for sperm (7). This damage from heat can be seen for up to 3 months.

Issues and problems with the delivery of sperm can be caused by old injuries or surgeries anywhere along the vas and into the prostate. Surgery or some types of radiation of the prostate can reduce or block the ability for sperm to be added to the semen. This can also be caused by other pelvic surgeries or nerve damage by diabetes or some genetic problems where parts of the vas may not have developed (cystic fibrosis). Some men, because of medications, surgery or neurological disorders, may have retrograde ejaculation where the sperm wash backwards into the bladder rather than out the urethra and so measured sperm counts and motility are lower.

Bottom line message – after a vasectomy reversal, if a person’s sperm count is low and cannot be explained by obstruction from inflammation and scarring, then it makes sense to get a more complete evaluation and discussion with the vas reversal surgeon to look for possible modifiable explanations and treatment options (8).

For questions about semen analysis after a vasectomy reversal or vas reversal success rates, please call (888) 722-2929 or to talk with one of our professional staff or to set up a no-charge consult with either Dr. Sheldon Marks or Dr. Peter Burrows by phone, in person, Zoom, Face Time, or Skype.

This page was reviewed, updated and edited by Sheldon H. F. Marks, MD on January 4, 2023.

References:

1. Rossi BV, Abusief M, Missmer SA. Modifiable Risk Factors and Infertility: What are the Connections? Am J Lifestyle Med. 2014;10(4):220-231.
2.Drobnis EZ, Nangia AK. Male Reproductive Functions Disrupted by Pharmacological Agents. Adv Exp Med Biol. 2017; 1034:13-24.
3.Jensen TK, Gottscchau M, Madsen JO, Andersson AM, Lassen TH, Skakkebaek NE, Swan SH, Priskorn L, Juul A, Jorgensen N. Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones; a cross-sectional study among 1221 young Danish men. BMJ Open 2014;4(9): e005462.
4. Gundersen TD, Jorgensen N, Andersson AM, Bang AK, Nordkap L, SkakkebaekNE, Priskorn L, Juul A, Jensen TK. Association between use of marijuana and male reproductive hormones and semen quality: a study among 1215 healthy young men. Am J Epidemiol 2015 Sep 15;182(6):473-81.
5.Kovac JR, Scovell J, Ramasamy R, Rajanahally S, Coward RM, Smith RP, Lipshultz LI. Men regret anabolic steroid use due to lack of comprehension regarding the consequences on future fertility. Andrologia 2015 Oct;47(8):872-8.
6.Rao M, Zhao XL, Yang J, Hu SF, Lei H, Xia W, Zhu CH. Effect of transient scrotal hyperthermia on sperm parameters, seminal plasma biochemical markers, and oxidative stress in men. Asian J Androl. 2015 Jul-Aug;17(4):668-75.
7.Kesari KK, Agarwal A, Henkel R. Radiations and male fertility. Reprod Biol Endocrinol. 2018 Dec 9;16(1):118.
8.Burrows PJ, Schrepferman CG, Lipshultz LI. Comprehensive office evaluation in the new millennium. Urol Clin North Am. 2002 Nov;29(4):873-94.