Ideally, it would be best to obtain monthly formal semen analyses to assess for changes with the semen over time.  However, we have never had a patient who has been able to do this.  It is often just too expensive (many clinics charge $100-500 each sample), and it is a challenge logistically (going to a clinic monthly to give a sample, etc.). 

An alternative is to perform regular analyses of your sample using an at-home microscope.  We would estimate that about 5% of patients post-op choose this option.  This is often challenging as well, since microscopes which cost in the $100-400 range are often very difficult to use, and typically, you are only able to identify motile sperm. 

There are at-home tests available.  Yosperm is able to identify motile sperm, however, it is often not very good at measuring how many sperm are present.  Trak has a test which can measure the sperm concentration, but it is not very accurate below 10 million, it includes sperm parts, and it cannot identify motility. 

For these reasons, we offer the option for patients to send us specimen in the mail.  We do these at no cost to the patient and will run them as often as they are sent to us.  We are able to accurately identify how many sperm are present, but we are not able to tell you if they are motile or not.  Sperm concentration (how many are present) is a good predictor for who will ultimately go on to achieve a pregnancy, and it can be used to determine if/when to take medicines such as prednisone.

Our preferred method of measuring results would be to obtain formal semen analyses each month.  However, because these often cost patients $100-500 depending on their local lab, we have found that very few are able to do this.  So, to provide an alternative, we began offering mail-in testing at no charge.  This provides just as accurate of an assessment of concentration as a formal semen analysis but without any cost (other than shipping).  By offering these tests, we have found that many more people perform tests of their sperm, and people obtain testing more often.  Only through repeated testing are you able to know how your results have changed over time. 

Yes.  There are at least two manuscripts which have specifically evaluated sperm testing after reversal and how it can predict outcomes.  In the manuscript by Majzoub and colleagues (Fertility and Sterility, April 2017), they reported that men who had more than 5 million sperm (per milliliter) had a 63% chance of pregnancy, while those less than 5 million had only a 15% chance.  In this paper, they also looked at motility, morphology, and total motile counts.  Each of these also helped predict the chances for pregnancy, but none of them were shown to be better than one another. 

The one caveat to this is if you plan to take prednisone post-op.  In men who are considering prednisone, it is helpful to also obtain motility testing.  In this way, if you have a test which shows good counts but low motility, you may wish to go on prednisone.  However, it is important to note that the true benefits of prednisone are not known (i.e. does it actually make any difference for pregnancy rates).  We are currently conducting a randomized, controlled study to help answer this question.  We anticipate having preliminary data available by the end of 2021. 

No, since we are only testing concentration, it does not matter how quickly / slowly you ship the specimen.

When we initially started doing mail-in testing (2020), we provided boxes with pre-applied stamps.  The USPS later changed their shipping requirements and rules, which required people to drop these packages off directly at a USPS location.  This resulted in many patients thinking that their samples had been shipped, when, in reality, they were eventually returned to them. 

More recently, we were able to create printed labels, which allows patients the ability to place the packages in their mailbox or drop off at a USPS location.  We have also included patient information in the box itself, since many patients were sending specimen without their name.  We have also begun keeping track of tracking information on each of the boxes that we send out.  Typically, we provide 4 mail-in kits for patients who do the standard vasectomy reversal, with recommendations to send them in at 2-4 weeks, 3 months, 6 months, and 12 months. 

The recommended method of shipping sperm is placing it inside of a waterproof container.  This should then be placed within a small box and include a paper towel to absorb any liquid which might spill.  That box is then placed within an outer box.  The package may then be shipped.

You can choose to ship the specimen via 'ground,' since overnighting the specimen is not required.  This is ultimately up to you.  We will typically analyze a specimen within 1 business day of receiving it. 

This varies quite a bit.  On some occasions, we receive samples within a few days, while in others it may take a few weeks.  Patients are able to follow the tracking info on the sample as well if desired.  Once we receive the specimen, we will process it and send an email with results within 1 business day (check junk mail!).

The mail-in samples accurately measures sperm concentration.  Sperm concentration is a good predictor of your chances of achieving a pregnancy post-op, and it also helps us to know if sperm are currently making it across the area of repair.  It can also help us to know when it may be appropriate to consider prednisone post-op (if prednisone is being considered). 

We also specifically evaluate for the presence of fully-formed sperm and sperm parts.  Early post-op, it is common to see sperm parts, while later on, sperm parts are less common.  If we observe sperm parts later on, this may be an indicator of the repair closing down (stenosing).  So, the presence and number of sperm parts helps us to get a better idea of what may be going on overall.