Objective:To investigate whether the minimal cyclophosphamide equivalent dose (mCED), a novel approach for estimating alkylating agent exposure, is associated with the sperm retrieval rates by microdissection testicular sperm extraction (mTESE) in azoospermic postchemotherapy cancer survivors. Design:A retrospective cohort study conducted between 2002 and 2017. Setting:An academic medical center. Patients:A total of 28 azoospermic postchemotherapy cancer survivors who underwent mTESE. Interventions:Chemotherapy exposure and mCED calculation. Main Outcome Measures:The primary outcome was the association between the mCED and sperm retrieval rate using mTESE. The mCED value for each patient's regimen received was estimated using the lowest recommended dosing regimen from the range of recommended doses at the time of administration. Results:Spermatozoa were successfully retrieved in 11 (39.3%) of the patients. Age at the time of receiving chemotherapy and mCED were significant factors associated with sperm retrieval. An mCED of <4,000 mg/m2 had a higher sperm retrieval rate (10/14, 71.4%) than an mCED of >4,000 mg/m2 (0/8, 0). The hormone levels were not significantly different when comparing patients with and without successful sperm retrieval. Seminoma, nonseminomatous germ cell tumor, and acute lymphoblastic leukemia had favorable sperm retrieval rates-100% (2/2), 66.7% (2/3), and 66.7% (2/3), respectively-although the numbers of patients in each group were small. Conclusion:Among this cohort of patients with cancer who required chemotherapy regimens, successful sperm retrieval by mTESE was only noted among cancer survivors receiving an mCED of <4,000 mg/m2.

The characteristics of men who use direct-to-consumer (DTC) men’s health services are not well understood. We conducted an online survey of adult men via ResearchMatch, assessing sociodemographic data, health behaviors, and concern for low testosterone and infertility. Logistic regression estimated the association between participant characteristics and familiarity with and reported use of DTC services such as Hims® and Roman®. Among 1276 men surveyed, 62.2% were concerned about low testosterone. While almost half (48.5%) were familiar with men’s DTC health services, only 37 (2.9%) reported using these services. On multivariable analysis, men who used DTC men’s health services were more likely to be younger (age 18–39: odds ratio [OR] 2.94, 95% confidence interval [CI] 1.03–8.38, p = 0.04; age 40–59: OR 3.26, CI 1.17–9.10, p = 0.02; referent age ≥60), have annual income between $75k and $100k (OR 5.25, CI 1.39–19.87.45, p = 0.02), and be concerned about low testosterone (OR 3.81, CI 1.46–9.96, p = 0.01). In conclusion, younger men and those with mid-range incomes were more likely to use online DTC men’s health services compared to older or wealthier men. Likewise, men with concerns about low testosterone were more likely to use DTC services, but other health-conscious behaviors and frequency of doctor visits did not predict use.

OBJECTIVE To determine whether health-conscious men are more likely to be concerned about infertility and self-initiate semen analysis at a laboratory/clinic or through a direct-to-consumer at-home product without a health care provider recommendation. METHODS Cross-sectional survey conducted online via ResearchMatch.org between November 2019 and January 2020. Men age 18 and older without children (n = 634) were included for analysis. Outcomes were likelihood of self-initiating a semen analysis, prevalence of infertility concern. RESULTS Of the 634 participants, 186 expressed concern about infertility but only 29% were likely to discuss these concerns with a health care provider. More men would self-initiate a semen analysis using an at-home product than through a traditional laboratory/clinic (14.2% vs 10.4%, P = .04). Odds of self-initiating a traditional semen analysis were higher for men concerned about low testosterone (odds ratio [OR] 2.30, 95% confidence interval [CI] 1.12-4.74, P = .023) and infertility (OR 3.91, 95% CI 2.14-7.15, P G.001). Self-initiating an at-home semen analysis was associated with concern for low testosterone and infertility as well as middle age (age 40-59: OR 3.02, 95% CI 1.16-7.88, P = .024) and fitness tracker use (OR: 1.95, 95% CI 1.12-3.39, P = .018). CONCLUSION Many men were unlikely to discuss infertility concerns with a health care provider. Middle aged men and those who used fitness trackers were more likely to self-initiate fertility evaluation through at-home semen analysis. Concern about low serum testosterone was pervasive and strongly associated with concern for being infertile and self-initiating a semen analysis of any kind. (C) 2021 Elsevier Inc.

You have accessJournal of UrologyCME1 May 2022PD20-05 HIGH PREVALENCE OF HORMONAL ABNORMALITIES IN MEN WITHOUT OLIGOSPERMIA Matthew Hudnall, Bailey Goyette, Minh Pham, Jeremy Lai, Justin Dubin, Richard Fantus, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Matthew HudnallMatthew Hudnall More articles by this author , Bailey GoyetteBailey Goyette More articles by this author , Minh PhamMinh Pham More articles by this author , Jeremy LaiJeremy Lai More articles by this author , Justin DubinJustin Dubin More articles by this author , Richard FantusRichard Fantus More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002558.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Newly updated male infertility guidelines from the American Urological Association recommend against universal hormone evaluation with measured levels of follicle stimulating hormone (FSH) and testosterone (T) in men with normal semen parameters due to prior limited data suggesting a low prevalence of abnormalities in this cohort. We sought to compare the prevalence of abnormal hormone parameters among men with and without sperm concentration abnormalities to determine the value of universal hormonal screening during fertility evaluation. METHODS: We retrospectively evaluated all men who underwent semen analysis (SA) and hormonal evaluation (morning serum T, FSH) at a large, integrated academic healthcare system between January 2002 and May 2021. Men were excluded if they had a prescription for T-modulating medications prior to index SA or if semen parameters were missing. Sperm concentration was dichotomized at 15 million/mL according to World Health Organization (WHO) criteria. Men with hormonal evaluation >1 year following index SA were excluded. We compared median and interquartile range (IQR) T and FSH levels according to sperm concentration using Kruskal-Wallis test. Differences in prevalence of low testosterone (<300 ng/dL) and abnormal FSH (>7.6 mIU/mL) were determined using Chi-square test. RESULTS: A total of 1,164 men had a morning serum T. There was no difference in median T among men with normal vs abnormal sperm concentration (316 ng/dL, interquartile range [IQR] 250-399 vs 316 ng/dL, IQR [253-419]; p=0.515). FSH level was measured in 1,261 men. Median FSH was higher among men with sperm concentration <15 million/mL (6 IU/mL, IQR 3.85-10.7 vs 3.8 IU/mL, IQR 2.7-5.7; p <0.001). Among men with ≥15 million/mL concentration, 44.1% were found to have low T (p=0.874) and 10.8% had an FSH ≥7.6 mIU/mL (p <0.001) (Table 1). Among men with ≥15 million/mL sperm concentration who underwent both T and FSH evaluation, 43.6% had at least 1 hormonal abnormality (Table 2). CONCLUSIONS: A large percentage of men with normal semen analysis had low T, challenging prior literature. As low T may have long-term implications for both fertility and overall health, providers should consider universal T screening in men presenting for fertility evaluation. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e357 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Hudnall More articles by this author Bailey Goyette More articles by this author Minh Pham More articles by this author Jeremy Lai More articles by this author Justin Dubin More articles by this author Richard Fantus More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF DownloadLoading ...

This study examined the relationship between stimulant medications used for the treatment of attention deficit hyperactivity disorder and semen parameters. We performed a retrospective cohort study at a large, academic institution between 2002 and 2020. We included men with a semen analysis without prior spermatotoxic medication use, empiric medical therapy exposure or confounding medical diagnoses (varicocele, Klinefelter's syndrome, cryptorchidism, cystic fibrosis, diabetes, cancer or cancer‐related treatment, and azoospermia). Men were stratified by stimulant exposure (methylphenidate or amphetamines). A multivariable linear regression was fit to assess the association between individual semen parameters, age, stimulant exposure and non‐stimulant medication use. Of 8,861 men identified, 106 men had active prescriptions for stimulants within 90 days prior to semen testing. After controlling for age and exposure to non‐stimulant medications, stimulant use was associated with decreased total motile sperm count (β: −18.00 mil/ejaculate and standard error: 8.44, p = 0.033) in the setting of decreased semen volume (β: −0.35 ml, and standard error: 0.16, p = 0.035), but not sperm concentration, motility and morphology. These findings suggest a role for reproductive physicians and mental health providers to consider counselling men on the potential negative impact of stimulants prescribed for attention deficit hyperactivity disorder on semen volume during fertility planning.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP21)1 Sep 2021MP21-07 PERCEPTIONS OF FERTILITY AMONG MEN WITH ABNORMAL SEMEN PARAMETERS WHO HAVE NOT UNDERGONE UROLOGIC EVALUATION Minh Pham, Siddhant Ambulkar, Richard Fantus, Matthew Hudnall, Jeremy Lai, James Wren, Nelson Bennett, Gregory Auffenberg, David Chu, Robert Brannigan, and Joshua Halpern Minh PhamMinh Pham More articles by this author , Siddhant AmbulkarSiddhant Ambulkar More articles by this author , Richard FantusRichard Fantus More articles by this author , Matthew HudnallMatthew Hudnall More articles by this author , Jeremy LaiJeremy Lai More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Gregory AuffenbergGregory Auffenberg More articles by this author , David ChuDavid Chu More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002006.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Reproductive endocrinologists (REI) are the gatekeepers for infertility care and often initiate the male partner evaluation, including the order and review of semen testing. This may lead to patient misperceptions regarding fertility status and whether to pursue urologic evaluation. In these men, we aimed to evaluate patient perceptions of fertility status after REI evaluation. METHODS: We surveyed adult men with abnormal semen analyses over a 1-year period who did not see a reproductive urologist. Questionnaires were administered by email and/or telephone, collecting demographic and clinical data, as well as perceptions of reproductive health. Primary self-reported outcomes were: 1) Did the patient recall being informed of an abnormal semen test result? 2) Did the patient consider their fertility status abnormal? A secondary outcome was urology referral. Multivariable logistic regression models were fit, adjusting for abnormal semen parameters. RESULTS: Of 310 men contacted, 85 (27.4%) responded. After excluding men who reported seeing a urologist, our cohort included 75 men. Seventeen (22.6%) men recalled being told their semen analysis was abnormal, and 14 (18.7%) understood their fertility was abnormal. Multivariable logistic regression (Table) showed that oligospermia, but not other semen parameter abnormalities, was significantly associated with men being told their semen analysis was abnormal (odds ratio [OR]: 7.52; 95% confidence interval [CI]: 1.77–32.1; p=0.006) & believing they had abnormal fertility (OR: 5.78; 95% CI: 1.22–27.3, p=0.027). Only 6 (8%) men reported receiving a referral to urology. CONCLUSIONS: The majority of men with impaired semen parameters seen by REI-only had inaccurate perceptions of their semen test results and fertility status. This was accompanied by a low rate of urologic referral, which represents missed opportunities for male partner evaluation. These data highlight the critical role for the reproductive urologist in counseling and caring for couples presenting for initial fertility evaluation. Source of Funding: Grant support K23DK125670 (NIDDK) to Dr. Chu © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e348-e348 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Minh Pham More articles by this author Siddhant Ambulkar More articles by this author Richard Fantus More articles by this author Matthew Hudnall More articles by this author Jeremy Lai More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Gregory Auffenberg More articles by this author David Chu More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement Loading ...

OBJECTIVE:To determine the proportion of men presenting for fertility evaluation who reported having an established primary care physician (PCP). DESIGN:Retrospective, observational study. SETTING:Academic health center. PATIENTS:All men presenting for initial male factor infertility consultation with a single reproductive urologist between 2002 and 2018. INTERVENTIONS:Men were asked to provide the name of their PCP at the time of initial visit. MAIN OUTCOME MEASURES:Descriptive statistics characterized the proportion of men with a PCP at the time of evaluation and associations between PCP status and clinical characteristics. RESULTS:Among 4,127 men presenting for initial fertility consultation, 844 (20.5%) reported having an established PCP, 480 (11.6%) reported no PCP, and 2,803 (67.9%) did not have data available. Among 1,302 men who had a prior primary care visit within our healthcare system, 414 (31.8%) had been seen within 1 year before their fertility evaluation. Men with an established PCP were slightly older than those without a PCP, with higher body mass index, and lower systolic blood pressure. Hormonal profiles were similar across groups, but men with an established PCP had a significantly higher total motile sperm count than those without a PCP, median 53 (interquartile range, 11-109) versus 35 (interquartile range, 8-98). CONCLUSIONS:More than one third of men presenting for fertility evaluation did not have an established PCP. Reproductive urologists are uniquely positioned to facilitate the critical relationship between young men and PCPs, which should be a key component of the male fertility treatment paradigm.

RESULTS: We identified 3,708 singleton and 137 multiple live births after cancer in 3,265 females with prior cancer.The most common cancer types were thyroid (22%), melanoma (21%), and breast (15%).For cancer survivors, mean age at pregnancy was 33.5 (SD 4.7).Cancer survivors used ART more than women without cancer (6% vs. 3% of singleton births, 34% vs. 21% of multiple births).The incidence of preterm birth and severe maternal morbidity in cancer survivors were 15% and 2.5%, respectively, in singleton births and 61% and 18% in multiple births.In singleton births, compared to women without cancer, cancer survivors had a 1.2-fold higher risk of preterm birth (95% CI 1.1, 1.3) and 1.3-fold higher risk of severe maternal morbidity (1.1, 1.6) after adjusting for age.In multiple births, cancer survivors did not have significantly higher risks of these outcomes.Cancer survivors had a higher Bateman maternal comorbidity index score than women without cancer.Adjusting for age and comorbidity index, the effect of cancer on outcomes was attenuated, suggesting mediation.In singleton births, controlling for cancer and age, ART was associated with 1.4-fold higher risk of preterm birth and 1.6-fold higher risk of severe maternal morbidity; in multiple births, the relative risks of each outcome with ART were 1.3 and 1.5, respectively.The interaction between AYA cancer and ART was not significant for any outcomes.CONCLUSIONS: For AYA cancer survivors, preterm birth and severe maternal morbidity risks are increased and appear to be mediated through more maternal comorbidities.ART independently increased perinatal risks, but the magnitude of increase was no higher than in women without cancer.As adverse perinatal outcomes were increased in multiples, the goal of singleton pregnancies remains paramount.AYA cancer survivors desire healthy pregnancies; ART use presents an important clinical opportunity to modify risks through singleton pregnancies.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-08 GEOGRAPHIC DISTRIBUTION AND CHARACTERISTICS OF REPRODUCTIVE UROLOGISTS IN THE UNITED STATES Arighno Das*, Anne Darves-Bornoz, Tejas Joshi, Mary Kate Keeter, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Arighno Das*Arighno Das* More articles by this author , Anne Darves-BornozAnne Darves-Bornoz More articles by this author , Tejas JoshiTejas Joshi More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While male factor infertility is present in up to half of infertile couples, studies have demonstrated that many male partners do not undergo evaluation by a reproductive urologist. We examined the geographic distribution of reproductive urologists relative to population density throughout the United States to determine whether restricted access to reproductive urologists could contribute to underutilization of male fertility evaluation. METHODS: We compiled a database of reproductive urologists using the Society for the Study of Male Reproduction (SSMR) membership directory and targeted Google searches, as these are the primary means through which patients can find a provider online. All practice locations and the male fertility procedures offered by each provider were recorded. Population data was abstracted from US Census Data (2010) and the American Community Survey 5-year estimates (2017). RESULTS: 255 reproductive urologists were identified of whom 131 (51%) were registered in the SSMR membership directory. Among all providers, 165 (65%) completed a fellowship in male infertility, andrology, and/or microsurgery. Fellowship-trained providers were more likely to mention sperm extraction, varicocelectomy, or vasectomy reversal on their website compared to non-fellowship trained providers (all p < 0.001) and more likely to practice exclusively at an academic medical center (p < 0.001). Among 3220 counties in the US, only 195 (6.1%) had a practicing reproductive urologist. Counties with a male infertility provider were more populous, had younger residents, higher mean household income and higher rate of college education (all p < 0.001). There was a dearth of reproductive urologists in rural areas (population < 50,000) with 2206 (99%) rural counties lacking a reproductive urologist. CONCLUSIONS: There are a small number of fellowship-trained reproductive urologists in the United States, and the majority of counties do not have a local reproductive urologist, regardless of fellowship training. These factors may contribute to the low rates of male partner evaluation, suggesting a potential role for telemedicine or other novel approaches to improve patient access. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e403-e403 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arighno Das* More articles by this author Anne Darves-Bornoz More articles by this author Tejas Joshi More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-05 PREVALENCE OF CLINICALLY APPARENT PROLACTINOMAS IN THE SUBFERTILE MALE Anne Darves-Bornoz*, Mehul Patel, Mary Kate Keeter, James Wren, Nelson Bennett, Joshua Halpern, and Robert Brannigan Anne Darves-Bornoz*Anne Darves-Bornoz* More articles by this author , Mehul PatelMehul Patel More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Joshua HalpernJoshua Halpern More articles by this author , and Robert BranniganRobert Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The physiologic role of prolactin in men remains unclear. However, excessive serum concentrations of prolactin can lead to clinical sequelae such as infertility and hypogonadism. Using population-based studies, the prevalence of prolactinoma in the general male population is estimated at 1:100,000 (0.0001%). Although a well-established cause of male infertility, the prevalence of prolactinoma within this subgroup has not been evaluated. METHODS: We retrospectively examined all men presenting for initial male fertility consultation at a tertiary care center with a single reproductive urologist between 1999 and 2018. Men with a prolactin level collected at this encounter were analyzed with descriptive statistics to determine incidence of hyperprolactinemia and resulting clinical significance. RESULTS: Among 4116 men presenting for initial fertility consultation, 3102 had a serum prolactin level measured. 65 men (2.1%) had a prolactin level greater than or equal to 18 ng/mL. Of the 65 men with an initial elevated prolactin level, 21 (32.3%) were evaluated by an endocrinologist and 21 (32.3%) underwent a brain MRI. 11/65 (17%) were diagnosed with a pituitary adenoma, of which 8 were microadenomas (<10 mm on MRI) and 3 were macroadenomas (>10mm). 8 of the 11 men with a prolactinoma were treated with cabergoline. The overall prevalence of a clinically apparent prolactinoma in our cohort was 11:3102 (0.35%). CONCLUSIONS: This is the largest known study to evaluate the prevalence of prolactinomas among a population of subfertile males. We found a 350-fold increased prevalence of prolactinoma among our cohort when compared to the general male population. Despite a low absolute prevalence, prolactinoma remains an important source of morbidity and potential etiology for subfertility, and clinicians should continue to include this condition in the differential diagnosis of male subfertility. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e401-e402 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne Darves-Bornoz* More articles by this author Mehul Patel More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Joshua Halpern More articles by this author Robert Brannigan More articles by this author Expand All Advertisement PDF downloadLoading ...

Background The purpose of this study is to evaluate the prognostic factors for sperm retrieval and determine if Y chromosome deletion is associated with deleterious effects. Whether Y chromosome deletion determines the sperm retrieval rate in non-mosaic Klinefelter patients has not yet been addressed. Methods We retrospectively collected medical records of azoospermic patients from Sep 2009 to Dec 2018, and enrolled 66 non-mosaic 47, XXY patients who were receiving mTESE. The predictive values of patients age, serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin, estradiol and Y chromosome deletion were assessed for successful sperm recovery. Results Testicular sperm recovery was successful in 24 (36.4%) of 66 men. The mean age (36.0 vs. 36.6 years), and levels of FSH (30.0 vs 36.9 IU/L), LH (17.7 vs 21.9 IU/L), testosterone (2.4 vs. 2.1 ng/ml), prolactin (9.1 vs. 8.8 ng/ml), and estradiol (19.4 vs. 22.3 pg/ml) did not show any significant difference when comparing patients with and without successful sperm retrieval. Partial deletion of azoospermic factor c (AZFc) was noted in 5 (20.8%) of 24 patients with successful sperm retrieval, including three b2/b3 and two gr/gr deletion cases, whereas 4 (9.5%) of 42 patients with unsuccessful sperm retrieval were noted to have AZFc partial deletion (one b2/b3 , one sY1206 and two gr/gr deletion), though the difference was not statistically significant (p=0.27) Conclusion According to present results, age and AZFc partial deletion status should not be a deterrent for azoospermic males with non-mosaic Klinefelter syndrome to undergo mTESE.

Prior studies have investigated sperm retrieval rates in men with nonobstructive azoospermia (NOA) secondary to specific etiologies, yet most cases of NOA are idiopathic. We compared sperm retrieval rates and testicular histopathology in idiopathic NOA (iNOA) and nonidiopathic NOA (niNOA). We performed a retrospective review of men with NOA who underwent microdissection testicular sperm extraction (microTESE) between 2000 and 2016. Men with no history of malignancy or cryptorchidism and negative genetic evaluation were considered idiopathic. Multivariable regression determined the association between idiopathic etiology and primary outcomes of sperm retrieval and active spermatogenesis on histopathology. Among 224 men, 86 (38.4%) were idiopathic, 75 (33.5%) were nonidiopathic, and 63 (28.1%) did not undergo genetic testing. Median age and serum testosterone were higher among iNOA or no testing versus niNOA. Median follicle-stimulating hormone (FSH) was lower among iNOA or no testing versus niNOA. A higher proportion of iNOA or no testing versus niNOA had a clinical varicocele. Sperm retrieval rates were similar between iNOA, niNOA, and no testing (41.8% vs 48.0% vs 55.6%, respectively; P = 0.255). Active spermatogenesis was seen in a higher proportion of iNOA or no testing versus niNOA (31.4% and 27.0% vs 16.0%, P = 0.073). On multivariaile analysis, iNOA was not associated with sperm retrieval or spermatogenesis (P = 0.430 and P = 0.078, respectively). Rates of sperm retrieval and spermatogenesis on testis pathology were similar in men with iNOA and niNOA. These data will be useful to clinicians in preoperative counseling for men with NOA and negative genetic evaluation.

Erectile dysfunction (ED) is widely prevalent, yet treatments are often excluded from standard health insurance coverage. Given high potential out-of-pocket expense for these therapies, we sought to determine the relationship between the national economy and interest in ED treatment. We utilized Google Trends to determine the monthly relative search volumes (RSV) for the terms “erectile dysfunction,” “Viagra,” “vacuum erection device,” “penile injections,” and “penile implant.” Median quarterly RSV was calculated for each term and correlated with quarterly economic indicators including the Standard and Poor’s 500 (S&P) closing value, national unemployment, and national health insurance coverage from January 2004 to September 2018. Linear regression was performed to determine the relationship between search terms and economic indicators. The study period captured intervals of both economic growth and depression, the latter occurring in 2009 with the S&P and unemployment rate nadiring at 797.9 and 9.9%, respectively. RSV for “erectile dysfunction” was significantly associated with the S&P (coefficient 0.41, R2=0.53, p=0.001) and health insurance coverage (coefficient 1.79, R2=0.43, p=0.04) but not unemployment (coefficient -0.21, R2=0.00, p=0.77). The S&P was positively correlated with RSV for “penile implant” (coefficient 0.26, R2=0.14, p=0.004) and “penile injection” (coefficient 0.25, R2=0.16, p=0.002), whereas an inverse relationship was observed between the S&P and “vacuum erection device” (coefficient -0.31, R2=0.25, p=0.001). No correlation was observed between “Viagra” and the S&P500 (p>0.05).

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation I (MP26)1 Apr 2020MP26-06 REFERRAL PATTERNS AND PATIENT CHARACTERISTICS OF MEN UNDERGOING FERTILITY EVALUATION: WHERE DO OUR PATIENTS COME FROM? Tejas Joshi*, Anne Darves-Bornoz, Mary Kate Keeter, James Wren, Nelson Bennett, Robert Brannigan, and Joshua Halpern Tejas Joshi*Tejas Joshi* More articles by this author , Anne Darves-BornozAnne Darves-Bornoz More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , Robert BranniganRobert Brannigan More articles by this author , and Joshua HalpernJoshua Halpern More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000865.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are limited data on the proportion of infertile couples referred to a reproductive urologist and which physicians are most likely to refer these couples for male partner evaluation. We sought to describe referral patterns and differences in patient characteristics according to referral source. METHODS: We retrospectively reviewed data on men presenting for new fertility evaluation over 17 years at a tertiary care center. We characterized patients as self-referred or referred from primary care / family practice (PCP), general obstetrics and gynecology (OBGYN), reproductive endocrinology (REI), general urology, or other physicians. Patient characteristics were compared across groups, including the proportion of men with severe oligospermia (sperm concentration < 5 million/mL). RESULTS: Among 4041 men, 2137 (52.9%) were referred by physicians, 908 (22.5%) self-referred, and 996 (24.6%) reported no referral. Physician referrals were most commonly from PCP (62.2%) followed by REI (16.8%), general OBGYN (11.3%), other specialists (5.8%), and urologists (3.8%). Groups were largely similar in terms of age, race, body mass index, and hormone levels. Severe oligospermia was present in a higher proportion of men referred by REI or self-referred versus PCPs (37.6% and 32.8% vs 20.8%, both p<0.01). When controlling for age, race, and hormone levels, men referred by PCP had significantly higher total motile sperm counts (TMSC) than other specialties, and those referred by REI had significantly lower TMSCs than those referred by PCPs and self-referred. CONCLUSIONS: A minority of male fertility patients were referred by REI, whereas most patients were referred by PCPs or self-referred. Furthermore, REI patients were more likely to be severely oligospermic than men referred by other providers. These data suggest that REI may have more restrictive criteria when referring male partners for evaluation, which presents an opportunity for interdisciplinary education, outreach, and collaboration to increase patient access. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e402-e402 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tejas Joshi* More articles by this author Anne Darves-Bornoz More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Joshua Halpern More articles by this author Expand All Advertisement PDF downloadLoading ...

Penile rehabilitation following radical prostatectomy is increasingly used to promote better recovery of post-prostatectomy erectile function. However, patient adherence to penile rehabilitation regimens is not optimal. Studies show that only 60-70% of men are compliant, with high medication cost often cited as a major contributing factor. The purpose of this study was to evaluate the medication costs associated with standard penile rehabilitation regimens at a tertiary academic medical center. Four high volume prostatectomists at our institution were surveyed regarding their preferred penile rehabilitation regimen as well as alternative regimens should the preferred regimen be ineffective or cost prohibitive. Prices for each component of the regimen were obtained using manufacturer pricing as listed on Epocrates as well as from pricing from our preferred compounding pharmacy. For cheaper oral alternatives, pricing was obtained from an offshore pharmacy. The total cost over two years was calculated for each regimen. Medical insurance coverage was not analyzed as it rarely covers the cost of sexual medicines.

To evaluate the efficacy and safety of testosterone replacement therapy (TRT) in patients with hypogonadal symptoms and low-normal to normal initial total testosterone (iTT). Institutional Review Board approval was obtained to retrospectively review men ≥ 18 years with hypogonadal symptoms without known cause and average iTT ≥ 225 ng/dL treated with TRT between January 2000 and August 2017. Exclusion criteria included TRT duration ≤ 1 month, clomid use concomitantly or within 6 months prior to TRT, prior prostate cancer (CaP), deep vein thrombosis/pulmonary embolism (DVT/PE), myocardial infarction (MI), polycythemia, or ischemic stroke. We collected data on demographics, comorbidities, medications, symptomatic changes, and adverse events (AE). Statistical analysis compared categorical and continuous variables and evaluated for predictors of improvement. 194 patients with TT ≥ 225 were treated with TRT. iTT was ≥ 300 in 33%. Mean age was 52.1 years [standard deviation (SD): 12.2]. Median length of TRT was 23.8 months [SD: 31.2]. The most common symptoms were erectile dysfunction (78.4%), low libido (75.8%), lethargy (60.3%), mood issues (15.0%), depression (11.3%), and muscle weakness (10.3%), which were comparable between those with TT of 225-299 (low-normal group) and TT ≥ 300 (normal group). Improvements in ≥ 1 symptom occurred in 73.1% of the low-normal TT group and 85.9% of the normal group (p = 0.0443). Significant factors associated with improvement of ≥ 1 symptom on univariate analysis were younger age and TT ≥ 300. On multivariate analysis (Table 1), TRT duration and younger age were independent predictors of reported improvement in ≥ 1 symptom; iTT was not. Major AE rates were comparable between both groups, and for the overall cohort were as follows: prostate biopsy 5%, CaP diagnosis 3%, polycythemia, 5%, DVT/PE 2%, ischemic stroke 0%, and MI 1.5%. One death occurred in the TT ≥ 300 group due to a gastrointestinal bleed secondary to anticoagulation.

You have accessJournal of UrologyInfertility: Therapy II (MP52)1 Apr 2019MP52-07 IDIOPATHIC NON-OBSTRUCTIVE AZOOSPERMIA: SPERM RETRIEVAL SUCCESS AND TESTICULAR HISTOPATHOLOGY Annie Darves-Bornoz*, Joshua Halpern, James Wren, Matthew Fakhoury, Mehul Patel, Mary Kate Keeter, Nelson Bennett, and Robert Brannigan Annie Darves-Bornoz*Annie Darves-Bornoz* More articles by this author , Joshua HalpernJoshua Halpern More articles by this author , James WrenJames Wren More articles by this author , Matthew FakhouryMatthew Fakhoury More articles by this author , Mehul PatelMehul Patel More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , Nelson BennettNelson Bennett More articles by this author , and Robert BranniganRobert Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556499.19278.a5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Prior studies have examined sperm retrieval rates in men with non-obstructive azoospermia (NOA) secondary to specific etiologies (Y-chromosome and karyotype abnormalities). We compared sperm retrieval and testicular histopathology in non-idiopathic and idiopathic NOA. METHODS: Retrospective review of men with NOA who underwent microdissection testicular sperm extraction (microTESE) between 2000 and 2016. Men were classified as idiopathic if they had no history of malignancy or cryptorchidism and routine genetic evaluation was negative. Demographic and clinical variables including age, preoperative testosterone (T), and follicle stimulating hormone (FSH) were abstracted. Multivariable regression was used to determine the association between idiopathic etiology and primary outcomes of sperm retrieval and spermatogenesis on histopathology. RESULTS: Among the total cohort (N=224), 86 (38.4%) were idiopathic, 75 (33.5%) non-idiopathic, and 63 (28.1%) did not undergo genetic evaluation. Non-idiopathic etiologies included cryptorchidism (N=15), malignancy (N=30), and genetic abnormality (N=28). Two additional patients had both cryptorchidism and malignancy. Median age (years) was higher among idiopathic (34, interquartile range [IQR] 31-39) versus non-idiopathic (32, IQR 29-35), p=0.004. Median serum T (ng/dL) was higher among idiopathic (365, IQR 307-477) versus non-idiopathic (343, IQR 240-421), p=0.02. Median FSH (IU) was lower among idiopathic (20.2, IQR 10.3-26.8) versus non-idiopathic (24.1, IQR 15.1-31.2), p=0.02. A higher proportion of idiopathic versus non-idiopathic men had a clinical varicocele (15.1% vs 5.3%, p=0.04). Sperm retrieval rates were similar between idiopathic and non-idiopathic NOA (41.8% vs 48.0%, p=0.4). Spermatogenesis was seen in a higher proportion of men with idiopathic versus non-idiopathic NOA, approaching but not reaching significance (31.4% vs 16.0%, p=0.07). On multivariable analysis, idiopathic etiology was not associated with sperm retrieval or spermatogenesis (p=0.27 and p=0.07). CONCLUSIONS: Rates of sperm retrieval and spermatogenesis on testis pathology are similar in men with idiopathic and non-idiopathic NOA. These data may be useful to clinicians in pre-operative counseling for men with NOA and negative genetic evaluation. Source of Funding: None Nashville, TN; Chicago, IL© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e768-e768 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Annie Darves-Bornoz* More articles by this author Joshua Halpern More articles by this author James Wren More articles by this author Matthew Fakhoury More articles by this author Mehul Patel More articles by this author Mary Kate Keeter More articles by this author Nelson Bennett More articles by this author Robert Brannigan 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 III (MP44)1 Apr 2019MP44-05 SUCCESS OF MEN'S CANCER AWARENESS CAMPAIGNS ACCORDING TO INTERNET SEARCH VOLUME: A GOOGLE TRENDS ANALYSIS Mehul Patel*, Joshua Halpern, Anuj Desai, Jeremy Lai, Matthew Hudnall, Mary Kate Keeter, James Wren, Nelson Bennett, and Robert Brannigan Mehul Patel*Mehul Patel* More articles by this author , Joshua HalpernJoshua Halpern More articles by this author , Anuj DesaiAnuj Desai More articles by this author , Jeremy LaiJeremy Lai More articles by this author , Matthew HudnallMatthew Hudnall More articles by this author , Mary Kate KeeterMary Kate Keeter More articles by this author , James WrenJames Wren More articles by this author , Nelson BennettNelson Bennett More articles by this author , and Robert BranniganRobert Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556248.35808.48AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Cancer awareness campaigns aim to educate the general public about potentially treatable diseases in order to promote screening and early diagnosis. While the success of Breast Cancer Awareness Month has been documented, the efficacy of men′s cancer awareness campaigns remains unknown. Using internet search volume as a surrogate for public interest, we sought to compare the efficacy of men′s and women′s cancer awareness campaigns. METHODS: We utilized Google Trends to determine the relative search volumes (RSV) for ″breast cancer,″ ″prostate cancer,″ and ″testicular cancer″ from 2010 to 2017. Baseline annual RSV was calculated for each cancer by determining the median RSV for each year, excluding the 3-month period surrounding the cancer-specific awareness month. RSV for each cancer was then determined for the cancer-specific awareness month: breast cancer (October), prostate cancer (September), testicular cancer (April), and Movember (November). The primary outcome was a significant increase in cancer-specific RSV during the awareness month, defined as a two-fold rise from baseline. RESULTS: Baseline search volume was substantially higher for breast cancer. Breast Cancer Awareness Month led to a significant increase in cancer-specific RSV each year during the study period (mean increase 180.1%). In contrast, none of the men′s cancer awareness campaigns led to a significant increase in cancer-specific RSV in any year during the study period. RSV for prostate cancer increased by 2.4% and 4.1% in September and November, respectively. RSV for testicular cancer increased by 9.3% and 6.2% in April and November, respectively. CONCLUSIONS: Despite similar incidence of breast and prostate cancer, men′s cancer awareness campaigns did not increase cancer-specific RSV, whereas Breast Cancer Awareness Month consistently increased RSV. While additional metrics are needed to elucidate the efficacy of public health campaigns, the current data suggest the need for further examination of the root causes for differences in popular interest. Source of Funding: none Chicago, IL© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e629-e629 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mehul Patel* More articles by this author Joshua Halpern More articles by this author Anuj Desai More articles by this author Jeremy Lai More articles by this author Matthew Hudnall More articles by this author Mary Kate Keeter More articles by this author James Wren More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2018MP19-08 AGE AND PARTIAL AZFC DELETION DO NOT PREDICT SPERM RETRIEVAL IN NON-MOSAIC KLINEFELTER PATIENTS I-shen Huang, William J Huang, James Wren, Nelson E Bennett, and Robert E Brannigan I-shen HuangI-shen Huang More articles by this author , William J HuangWilliam J Huang More articles by this author , James WrenJames Wren More articles by this author , Nelson E BennettNelson E Bennett More articles by this author , and Robert E BranniganRobert E Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.657AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Microsurgical testicular sperm retrieval (mTESE) provided the best way for sperm retrieval in nonmosaic 47, XXY men with azoospermia. Age and testosterone levels after treatment are prognostic factors for successful sperm retrieval. Whether Y chromosome deletion determine the sperm retrieval rate in non-mosaic Klinefelter patient has not been addressed. The objective of this study was to evaluate the prognostic factors for sperm retrieval and determine if Y chromosome deletion could lead to deleterious effect. METHODS The medical records of azoospermic patients were retrospectively collected from Sep 2009 to July 2017, and enrolled 53 non-mosaic 47,XXY patients receiving mTESE. The predictive values of patients age, serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, prolactin, estradiol and Y chromosome deletion testing were assessed for successful sperm recovery. The Student’s t test was used to compare hormone profiles and Fisher’s exact test was used for comparison of Y chromosome deletion among the sperm retrieval successful and failure groups. RESULTS Testicular sperm recovery was successful in 20 (37.7%) of 53 men. The mean levels of age (35.9 vs. 36.8 years), FSH (30.8 vs 37.5 IU/L), LH (17.5 vs 22.5 IU/L), testosterone (2.1 vs. 2.2 ng/ml), prolactin (9.1 vs. 8.8 ng/ml) and estradiol (19.4 vs. 22.3 pg/ml) did not show any significant difference comparing with patients with and without successful sperm retrieval. Sperm retrieval rate was comparable for patient below (36.4%) or above (37.5%) 35 years old. The partial azoospermic factor c (AZFc) deletion was noticed in 4 (20%) of 20 patients with successful sperm retrieval, including two sY1191 and two sY1291 deletion cases, whereas 4 (12.1%) of 33 patients was noted to have AZFc partial deletion (one sY1191, one sY1206 and two sY1291), but the difference was not statistically significant (p= 0.46) CONCLUSIONS According to present results, age and AZFc partial deletion status should not be the reason to discourage azoospermic non-mosaic 47,XXY men for receiving mTESE. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e247 Advertisement Copyright & Permissions© 2018MetricsAuthor Information I-shen Huang More articles by this author William J Huang More articles by this author James Wren More articles by this author Nelson E Bennett More articles by this author Robert E Brannigan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2018MP19-05 CRYPTOSPERMIA IS ASSOCIATED WITH SIGNIFICANTLY HIGHER SPERM RETRIEVAL RATES WHEN COMPARED TO PATIENTS WITH AZOOSPERMIA James Wren, Matthew Hudnall, Minh Pham, Annie Darves-Bornoz, Nelson Bennett, and Robert Brannigan James WrenJames Wren More articles by this author , Matthew HudnallMatthew Hudnall More articles by this author , Minh PhamMinh Pham More articles by this author , Annie Darves-BornozAnnie Darves-Bornoz More articles by this author , Nelson BennettNelson Bennett More articles by this author , and Robert BranniganRobert Brannigan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.654AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Cryptospermia reflects a form of testicular failure where small foci of active spermatogenesis persist within the testicles. Our study assessed the rates of successful sperm retrieval (SSR) in patients with cryptospermia and non obstructive azoospermia METHODS Following IRB approval, a retrospective chart analysis assessed microtesticular sperm extraction (mTESE) procedures performed from January 2004 to August 2017. Inclusion criteria involved males >18 years of age with cryptozoospermia and/or azoospermia that underwent a mTESE. Exclusion criteria included those with obstructive azoospermia, oligospermia or <2 semen analyses. Hormonal profile, semen analysis, testicular volumes, pathology and comorbidities were analyzed. Statistical analysis utilized chi-squared and ANOVA to compare categorical and continuous variables, respectively, between successful and unsuccessful mTESE. Univariate and multivariate logistic regression analyses were performed RESULTS We identified 40 cryptospermic and 221 non-obstructive azoospermic patients. Successful mTESE occurred in 85% of cryptospermic and 48% of azoospermic patients. Significant factors for SSR on univariate analysis included cryptospermia, FSH level and histology (hypospermatogenesis, active spermatogenesis, Sertoli cell only). On multivariate analysis, cryptospermia, hypospermatogenesis and Sertoli cell only histology remained significant. Additional factors such as age, comorbidities, hormonal labs and testicular volume were not significantly different between the two groups CONCLUSIONS Limited data exists for counselling patients with cryptospermia on the chances of successful sperm retrieval. This study, the largest to date demonstrates that patients with cryptospermia have a significantly higher chance of successful microsurgical sperm retrieval when compared to patients with non-obstructive azoospermia © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e245-e246 Advertisement Copyright & Permissions© 2018MetricsAuthor Information James Wren More articles by this author Matthew Hudnall More articles by this author Minh Pham More articles by this author Annie Darves-Bornoz More articles by this author Nelson Bennett More articles by this author Robert Brannigan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...