Why am I producing dead sperm 7 months after having a vasectomy?

As frustrating as this is to the patient and urologist, this is not unusual. The patient and the urologist desire for the sperm to clear and have the go ahead for unprotected sex. The vas deferens beyond the vasectomy site goes up the inguinal canal and then behind the bladder and joins the seminal vesicles to course through the prostate then exits through the verumontanum. So you can see that there are several potential areas where sperm can remain or be in a convolution of the tube so that with ejaculation it is not expelled. I have told patients that it is like an off shoot of a river or stream where the water is in an eddy and not flowing with the river but from time to time some of the contents do enter the stream.
Here is the tricky thing about this. It takes as a rule 20 million sperm to produce pregnancy. If you are seeing less than 100,000 sperm causing pregnancy is rare but possible. So the urologist is hesitant to give the go ahead and the patient wants to have unprotected sex without the risk of pregnancy. This in turn leads to repeated semen evaluations and continued frustration by both parties. My brother told me that his vasectomy done in his town took one year to be clear.
In the end the patient usually makes the decision whether continue to have protected sex, repeat the vasectomy or go ahead with unprotected sex. Most studies say that it is not unusual to have persistent low numbers of dead sperm and this is acceptable finding to have unprotected sex. Speaking as a urologist however, don't expect your urologist to give you the go ahead with the above mentioned caveats.

Published on Jul 11, 2012

It can be very anxiety provoking to have persistent sperm following a vasectomy, as the large majority of patients clear their ejaculate of sperm after only 3-4 months and 20+ ejaculations. After 6 months, according to the AUA guidelines on vasectomy, a patient can be cleared even when very low numbers of sperm are still present. It is important to wait at least 6 months and a special type of semen analysis - a quantitative semen analysis where they actually count the sperm present must be performed, often at a fertility lab. The AUA guidelines state you can clear a patient after a vasectomy if an an uncentrifuged fresh ejaculate sample if azoospermia is present (the complete absence of sperm) or rare, non-motile sperm (RNMS) defined as < or = to 100,000 non-motile sperm/ml are present.

If > 100,000 non-motile sperm/mL persist beyond six months after vasectomy, then trends of serial post vasectomy semen analyses (PVSAs) and clinical judgment should be used to decide whether the vasectomy is a failure and whether repeat vasectomy should be considered.

If the PVSA shows > 100,000 non-motile sperm/mL or any motile sperm, then further PVSA monitoring or repeat vasectomy may be considered.

We of course worry about recanalization and failure of the vasectomy, but sometimes sperm can get delayed and "stuck" at the level of the prostate and ejaculatory ducts which results in non-motile, rare sperm persisting.

I recommended having your urologist obtain a quantitative semen analysis at a fertility lab to see if any motile sperm are present. If there are only rare nonmotile sperm present than I would discuss with your physician the results as you may be able to be cleared from the vasectomy.

Published on Jul 11, 2012