Male factor infertility affects about 50% of infertile couples. However, male factor infertility is largely under-evaluated due to multiple reasons. This study is to determine the time men travel for fertility evaluation, and factors associated with driving longer. Data from the Andrology Research Consortium were analysed. Driving distance and time were calculated by comparing "patient postal code" with "clinic postal code", then stratified into quartiles. Patients with the longest driving times (> 75th percentile [Q4]) were compared with those having shorter driving times. Logistic regression analysis was used to identify factors associated with longer driving times. Sixteen clinics and 3029 men were included. The median driving distance was 18.1 miles, median driving time was 32 min, and Q4 driving time was 49 min. Factors correlated with having Q4 driving time were age > 30 years, native Indian and Caucasian race, body mass index (BMI) > 30 kg/m2 , history of miscarriage, children with previous partner, self-referral, prior vasectomy, and prior marijuana use. On logistic regression, males aged < 30 years were more likely to be in Q4 for driving time versus older males. Blacks and Asians were less likely to travel further than Caucasians. Overweight/obese men, those having children with previous partner, and with prior vasectomy were more likely to be in Q4 travelling time. Factors correlated with longer driving times include younger age, native Indian and Caucasian race, higher BMI, children with prior partner, and prior vasectomy. These may reflect groups that drive long distances for reproductive care. The study provides an opportunity to better access these groups and minimise their barriers to fertility care.

To evaluate the effects of male age on demographics, clinical characteristics, and fertility histories among men presenting for reproductive urology fertility evaluation North America. Data from the Andrology Research Consortium from 2015 and 2018 was used. This was comprised of anonymous, patient-completed questionnaires with demographic and fertility history related questions. Age was classified as continuous or categorical variables and overall differences in distribution between age groups were assessed using Wilcoxon rank-sum tests and Fisher's exact test, respectively. Dichotomous year age group comparisons were then performed using <25 vs. ≥ 25, ≤30 vs. >30,≤30 vs. >35,≤40 vs. >40,≤45 vs. >45,≤50 vs. >50. We surveyed 5100 men from 22 North American reproductive urology practices. The average age of men was 36.7 ± 7.5 years and the average partner's age was 33.2 ± 5.1 years. Obesity was most common in men 41-45 years (37.6%, p<0.001). Increasing age correlated with longer duration of infertility: men ages 31-35 years, 36-40 years, 41-50 years, 46-50 years had a mean duration of infertility of 3.2, 3.9, 4.6, and 5.4 years of infertility, respectively (all p<0.001). Younger men (age <40) were more likely to be referred by a reproductive endocrinologist, while self-referrals and primary care physician referrals increased in older men (p<0.001). The proportion of vasectomized men increased with age (p<0.001). Rates of assisted reproductive technology use varied between age groups. Female partners undergoing intrauterine insemination were more common in men >30 years compared to men≤30 years (11.5% vs. 7.8%, p<0.001) but less common in men >45 years compared to men ≤45years (7.5% vs. 11.2%, p=0.005). In vitro fertilization was more common with each older age group comparison (p<0.001). Alcohol, marijuana, and cocaine use were most common in younger men, specifically 36-40 years (77.5%, p<0.001), <25 years (27.3%, p<0.001), and 26-30 years (2.6%, p=0.036), respectively. Finasteride (2%, p=0.047), steroid (3%, p=0.003), and testosterone use (2%, p=0.011) were most common in men >50 years. Males of different ages had different fertility histories and different modifiable factors. Older males had longer infertility durations, a higher likelihood of having partners that underwent IVF, lower rates of reproductive endocrinologist referrals, and therefore may benefit from earlier male fertility evaluation. Testosterone and finasteride use were more common in men >50 years, while younger men are more likely to have modifiable substance usages.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (MP46)1 Apr 2019MP46-08 REGRET REGARDING FERTILITY PRESERVATION DECISIONS AMONG MALE CANCER PATIENTS Kelly Walker*, Joris Ramstein, and James Smith Kelly Walker*Kelly Walker* More articles by this author , Joris RamsteinJoris Ramstein More articles by this author , and James SmithJames Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556300.18991.8eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: The use of Tyrosine Kinase Inhibitors (TKI) has revolutionized the long-term survival of many patients in their battle against certain cancers. The risk of infertility caused by cancer treatments is a primary concern for many cancer patients, including male survivors. This study examines patient regret about fertility preservation (FP) decisions among male cancer patients exposed to Tyrosine Kinase Inhibitors. METHODS: A retrospective cohort study was performed to evaluate feelings of regret about fertility preservation among men undergoing or having undergone TKI treatment. Study participants were recruited from cancer patients seen at UCSF Oncology Clinics between 2012 and 2017. There were a total of 79 men enrolled and 76 men (96%) completed The Effect of TKIs on Male Reproductive Health and Sperm Function questionnaire including cancer history, counseling about impact on cancer treatment on fertility, obstacles to fertility preservation, and satisfaction with treatment decisions. RESULTS: While 26 patients (34%) said they would like to have children in the future and 32 (42%) had some degree of concern that their cancer treatment might affect their fertility, 36 (47%) were reported not receiving any information about the fertility risks of TKI by their medical team. Eighteen (24%) considered FP prior to their cancer therapy, and 8 (11%) attempted FP. When comparing desire to have a child to FP service seeking, 54% of those who desired children in the future considered FP compared to 8% in those who didn’t wish to have children in the future (p<0.001), and 27% of those who desired children in the future attempted FP compared to 2% in those who didn’t wish to have children in the future (p=0.001). Regarding decision satisfaction regarding FP, 23% of those who desired children in the future disagreed with “I made the right decision” compared to 3% in those who did not wish to conceive (p=0.003); similarly, 19% of those who wished to have children in the future agreed with “I regret the choice I made”, compared to 6% in those who did not (p=0.09). CONCLUSIONS: An overwhelming percentage of men who desired to father children in the future were not provided with enough information about the potential fertility risks of TKI cancer treatments. Furthermore, those who desired children in the future were 3 to 6 times as likely to believe they had not made the right decision or to regret not seeking fertility preservation as those who had no interest in having future children. These findings highlight the need not only to discuss the potential risks of TKI on fertility, but also to recognize and provide supportive care to patients interested in fertility preservation. Source of Funding: none San Francisco, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e680-e681 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Walker* More articles by this author Joris Ramstein More articles by this author James Smith More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making II (MP39)1 Apr 2019MP39-04 FEASIBILITY STUDY OF VIDEO TELEHEALTH CLINIC VISITS IN UROLOGY Kelly Walker* and James Smith Kelly Walker*Kelly Walker* More articles by this author and James SmithJames Smith More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556071.60611.37AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Telehealth in the form of video visits provides an opportunity for patients access to high quality healthcare at a great value and with convenience while allowing providers to reach patients with greater efficiency. We examined the telehealth video visits to determine overall patient benefit. METHODS: We examined 337 completed video visit encounters and evaluated the direct savings to patients and potential indirect savings for both patient and provider. The telehealth video visits were performed by a single provider at a busy urology practice specializing in fertility and andrology. RESULTS: Access to specialty care is increasing difficulty for patients outside of cities, and increased access was demonstrated by patient location. The cohort of patients in this study reside in 29 out of 58 counties in California and 5 patients were from outside the state. An increasing referral base translates into greater travel distances for patients to reach clinic visits. By participating in a telehealth video visit compared to in-person clinic visit the patient cohort saved 38,144.60 driving miles (calculated by multiplying county to county miles per encounter (SF to patient county Roundtrip), 996.25 driving hours, $6,675.31 in gas ($3.55/g), and $2,656 in parking fees (2 hours of parking = $8.00). From the clinician perspective telehealth video visits provided clinical efficiency in several forms. Telehealth video visits increased provider efficiency with increased number of encounters per clinic compared to an equivalent in-person clinic visits. This opens up more provider availability to see new patients or patients more appropriate for in-person clinic visits. In addition clinic cost saving for a the institution included front desk staff and nursing labor for patient rooming and vitals as well as clinic room use. CONCLUSIONS: Telehealth video visits provide the patient with increased access to care, especially specialty care not locally available. In addition telehealth video visits provide cost and convenience benefits for patients and increased efficiency for provider and institution. Source of Funding: none San Francisco, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e545-e545 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kelly Walker* More articles by this author James Smith More articles by this author Expand All Advertisement PDF downloadLoading ...