Background: Infertility impacts 16% of North American couples, with male factor infertility contributing to similar to 30% of cases. Reproductive hormones, especially testosterone, are essential for spermatogenesis. An age-independent population-level decline in testosterone concentrations over the past few decades has been proposed to be a consequence of diet and lifestyle changes. Vitamin B-12 is present in the testes and has been suggested as an adjuvant nutritional therapy for male infertility due to its potential to improve sperm parameters. However, evidence examining the relationship between vitamin B-12 and reproductive hormones is limited. Objectives: The objective was to cross-sectionally examine the relationship between serum vitamin B-12 and male reproductive hormones (luteinizing hormone, follicular stimulating hormone, total testosterone, estradiol, and prolactin). Methods: Men with infertility (n = 303) were recruited from Mount Sinai Hospital in Toronto, Canada. Serum was analyzed for vitamin B-12 and reproductive hormones. Statistical analyses included nonparametric Spearman's rank correlation coefficient, linear regression, logistic regression, and effect modification by age and BMI linear regressions. Results: An independent monotonic relationship between serum vitamin B12 and total testosterone (rho = 0.19, P = 0.001) was observed. Serum vitamin B12 was linearly associated with total testosterone (unadjusted beta = 0.0007, P = 0.008 and adjusted beta = 0.0005, P = 0.03). Compared to individuals in the lowest tertile of serum vitamin B-12, those in the middle tertile (adjusted odds ratio [OR] = 0.48; 95% confidence interval [CI]: 0.25, 0.93, P = 0.03) and the highest tertile (unadjusted OR = 0.41; 95% CI: 0.22, 0.77, P = 0.005 and adjusted OR = 0.44; 95% CI: 0.22, 0.87, P = 0.02) had reduced odds of testosterone deficiency. Conclusions: These findings suggest that among men with infertility, low serum vitamin B-12 is associated with a higher risk of testosterone deficiency and impaired androgenic hormonal profiles that impact spermatogenesis and consequently, fertility.

To investigate the occurrence of idiopathic secondary azoospermia (ISA) in men with oligospermia over time and identify risk factors for ISA in this population. This was a retrospective cohort study conducted in a university-affiliated male infertility clinic. A total of 1056 oligospermic men (concentration < 15 million/ml (M/ml) and no azoospermia) with at least two SA done between 2000 and 2019 were included. The primary outcome was the occurrence of ISA by oligospermia severity. In the entire cohort, 31 patients (2.9

Background: Paternal age association with sperm parameters has been previously studied, demonstrating a decrease in semen volume, sperm motility, and sperm morphology, but not in sperm concentration. However, scarce data exists on the individual intra-personal changes in semen parameters with time. Study design: Retrospective cohort study. Objective: To evaluate the changes in semen parameters and total motile count of infertile men over time. Materials and methods: In this retrospective cohort study, infertile men without known risk factors for sperm quality deterioration and at least two semen analyses done > 3 months apart, between 2005 and 2021, were evaluated. Allocation to groups was according to time between first and last semen analyses - 3-12 months, 1-3 years, 3-5 years, and > 5 years. Basic characteristics and first and last semen analyses were compared. The primary outcome was the change in sperm parameters and the secondary outcome was the occurrence of a total motile count < 5 million in men with an initial total motile count > 10 million. Results: A total of 2018 men were included in the study. The median age at first semen analyses was 36.2 (interquartile range: 32.8-40.1) years and the median time between semen analyses was 323 days (range 90-5810 days). The overall trend demonstrated an increase in concentration in the 3-12 months and the 1-3 years groups, whereas volume, motility, and morphology remained similar in these time groups. Semen analyses done more than 5 years apart showed decreased volume (p < 0.05), motility (p < 0.05) morphology (p < 0.05), and steady sperm concentration. Significant declines in TMCs were found over time (p < 0.001), with 18% and 22% of infertile men with an initial total motile count > 10 million dropping to < 5 million after 3 and 5 years, respectively. The factors independently predictive of total motile count < 5 M in the last semen analyses in men with an initial total motile count of > 10 M in a multivariate logistic regression model were baseline volume (odds ratio 0.80, p = 0.03), baseline total motile count (odds ratio 0.98, p = 0.01) and time between semen analyses - 3-5 years (odds ratio 3.79, p < 0.001) and > 5 years (odds ratio 3.49, p = 0.04) Discussion: Our study demonstrates, at the individual level, that while improvement in sperm concentration is observed in the first year and between 1 and 3 years, possibly due to fertility treatments, fertility-related counseling, and lifestyle changes, semen parameters decline with time over 3 years in individuals. Of significance, close to 22% of men with an initial total motile count > 10 million (a range where spontaneous pregnancy is attainable) declined to < 5 million (a range usually indicating a need for in-vitro fertilization/intracytoplasmic sperm injection) over 5 years. This data could contribute to individualized family planning for infertile men regarding the mode and timing of conception and the need for sperm banking, in order to minimize the need for future fertility treatments.

Approximately 16% of North American couples are affected by infertility, with 30% of cases being attributable to male factor infertility. The regulation of reproductive hormones via the hypothalamic–pituitary–gonadal axis is important for spermatogenesis and subsequently male fertility. Maintaining iron homeostasis is critical to normal reproductive physiological function. This cross-sectional study’s objective was to determine the association between serum biomarkers of iron and reproductive hormones. Men experiencing infertility (n = 303) were recruited from Mount Sinai Hospital, Toronto. Serum was analyzed for iron and ferritin as biomarkers of iron status and reproductive hormones (follicle-stimulating hormone, luteinizing hormone, testosterone, estradiol, and prolactin), which were the primary outcome. Associations were determined using non-parametric Spearman’s rank correlation coefficient, linear regressions, and logistic regressions. A significant independent monotonic inverse relationship between serum iron and prolactin (p = 0.0002) was found. In linear regression analyses, iron was inversely associated with luteinizing hormone (unadjusted p = 0.03, adjusted p = 0.03) and prolactin (unadjusted p = 0.001 and adjusted p = 0.003). Serum ferritin was inversely associated with both gonadotropins, follicle-stimulating hormone (adjusted p = 0.03), and luteinizing hormone (adjusted p = 0.02). These findings suggest that biomarkers of iron are associated with pituitary-produced reproductive hormones, which play a role in the hypothalamic–pituitary–gonadal signaling pathway involved in spermatogenesis, testicular testosterone production, and male fertility.

Background: The Cannabis Act (Bill C-45) was enacted in 2018, to legalize and regulate the use, production, and sale of nonmedical cannabis in Canada. While public health and safety implications of cannabis legalization have yet to be elucidated, the wide availability of cannabis necessitates health care providers to be knowledgeable about therapeutic potential and side effects of use. This study aimed to examine the temporal trends over two decades and the impact of the Cannabis Act in Canada, implemented in October 2018, on substance use, semen parameters, and testosterone levels of infertile men. Methods: We conducted a retrospective cohort study from a prospectively maintained database of a single infertility clinic. Demographic, fertility, and substance use history were correlated with semen and hormone assessments. Temporal trends in cannabis use and semen quality between 2001 and 2021 were investigated and compared between pre-cannabis legalization eras (PRCL) and post-cannabis legalization eras (POCL). Results: Our cohort included 11,630 patients (9411 PRCL and 2230 POCL). Cannabis use increased by 8.4% per year (p<0.001), while alcohol and tobacco consumption declined (0.8% and 1.5% per year, p<0.05 and p=0.004, respectively). Similar trends were noticed in the POCL, with higher rates of cannabis use (22.4% vs. 12.9%, p<0.001) and decreased tobacco and alcohol intake (15.2% vs. 17.7%, p=0.005 and 50.5% vs. 55.2%, p<0.001, respectively) compared to the PRCL group. Semen concentration was lower in the POCL group (24.8±44.8 vs. 28.7±48.3 million/mL, p=0.03). Testosterone did not differ between the cohorts. Comparison between cannabis users (n=1715) and nonusers (n=9924) demonstrated a slight increase in sperm motility (25.9%±15.3% vs. 23.9%±15.0%, p=0.002) and decreased sperm concentration among users (27.6±53.5 vs. 23.9±15.0 million/mL, p=0.03). Conclusion: A nearly 10% rise in cannabis use in the POCL era was observed among men being investigated for infertility. Our data suggest cannabis use may be associated with an increase in testosterone, slightly improved sperm motility, and decreased sperm concentration.

Non-surgical (reversible) male contraception methods, when approved for general clinical application, should be made available to all interested men aged 18 50 years in good general health regardless of their semen parameters. In the preliminary workup, a complete personal and family history aimed at identifying specific conditions that may potentially increase the risks for adverse effects (associated with testosterone replacement) is advisable but a general or andrological examination is not required, unless indicated by the history. Baseline body weight, blood pressure and haemoglobin should be recorded for the purpose of future monitoring. While risks and benefits of vasectomy have been well established, appropriately nuanced patient counselling and assessment are essential for ensuring a satisfactory outcome of vasectomy.

We sought to compare the demographics and fertility characteristics of men presenting to reproductive urologists (RU) for evaluation in the United States (US) and Canada using data from the Andrology Research Consortium. A standardized patient questionnaire was used to prospectively evaluate men across fifteen North American male infertility practices between 2015 and 2018. Patient demographics, fertility histories, including female partner infertility testing and treatment, and referral data were assessed. Univariate analysis was used to determine geographical differences between the various patient characteristics and the geographical region. We sampled 6,462 men with a mean age of 36.6 ± 7.5 years. The average duration of infertility was significantly higher in US men ( 4.5 ± 7.2 years) compared to Canadian men ( 3.6 ± 4 years) ( p = 0.007 ). Significantly more men in the US were obese (63% vs. 26%, p < 0.001 ) compared to Canada. Intrauterine insemination use among female partners was more common in Canada (13% vs. 7%, p < 0.001 ) while in vitro fertilization was less common (6% vs. 9%, p = 0.01 ) when compared to the US. Finasteride (3% vs. 0%) and testosterone usage (4% vs. 1) were more common among US men versus Canadians, respectively. In conclusion, geographical differences exist between North American males undergoing fertility evaluation. American men are older and more obese and have a longer average duration of infertility. Potentially reversible factors contributing to male infertility are more prevalent in the US.

We aimed to examine the longitudinal, intra-personal changes in DNA fragmentation index (DFI) over time. Men who performed at least two DFI measurements (using sperm chromatin structure assay (SCSA) between 2003 and 2019 were included in this study and allocated to groups by time between DFI tests: < 1 year, 1–3 years, 3–5 years, and > 5 years. An analysis of DFI change over time according to age groups was additionally performed. Regression models were developed to predict changes in DFI with time. Overall, 225 patients had two or more DFI measurements done at least a month apart (mean of 586.7± 710.0 days). The < 1 year (n = 124) and 1–3 years (n = 68) groups demonstrated decreased DFI levels, while an increase in DFI was shown in 3–5 years (n = 21) and more than 5 years (n = 12) groups − 7.1 ± 14.9

For these priority topics, we performed a critical evaluation of the literature using Evidence to Decision (EtD) GRADE framework to arrive at transparent evidence-based recommendations

Purpose This article aims to report the first series of men with complete AZFc microduplications and their clinical and reproductive characteristics. Methods We sampled 3000 men who presented for reproductive urology evaluation from 2012-2020, of which 104 men underwent high-resolution Y-chromosome microarray testing, and five men were identified to have complete AZFc microduplications. Medical, surgical, and reproductive histories were obtained. Semen and hormonal parameters as well as response to fertility therapies were recorded. Results Five men were identified as having complete AZFc microduplications. The mean age was 33.75 years, representing 0.2% (5/3000) of men presenting for fertility investigation, 4.8% (5/104) of men undergoing microarray testing, and 21% (5/24) of men with AZFc abnormalities. Two of the men had prior undescended testicles and one had several autoimmune processes. The mean follicle-stimulating hormone (FSH) was 5.5 IU/L, luteinizing hormone (LH) 3.6 IU/L, and testosterone 14.56 nmol/L. One man was azoospermic, one man alternated between severe oligospermia and rare non-motile sperm, one had variable parameters, with one semen analysis demonstrating azoospermia and a second demonstrating a total motile sperm count (TMSC) of 4 x106, one man was persistently oligospermic with TMSCs ranging 3.96-12.6 x10 6, and one man initially had severe oligospermia, with a mean TMSC of 1.5 x106, which increased to 21.7 x106 after intervention (varicocele embolization, clomiphene citrate). This last man then fathered a spontaneous pregnancy. Conclusion AZFc complete microduplications are a rare cause of spermatogenic failure but not an uncommon form of AZFc abnormality. Clinically, they represent a heterogeneous group, having a variable reproductive potential. Cases should be managed on an individual basis.

Background: Limited data exists on possible approaches to improve sperm DNA fragmentation index (DFI) when no identifiable cause is found. The effect of short abstinence on sperm parameters has been extensively studied, but rarely reported on the effect on DFI in infertile men. In this study, we aimed to determine whether a second ejaculate provided after very short abstinence demonstrates lower DFI rates in infertile men. Methods: This prospective cohort study was conducted at Mount Sinai Hospital, Toronto, Canada, a tertiary university affiliated hospital. All men having DFI testing in addition to the standard semen analysis were identified via a prospectively collected database. Infertile men were instructed to provide two semen samples 3–4 hours apart (the first sample was given after 2–5 days of abstinence) to test the effect on DFI levels. Data analysis was performed for the comparison of the change in sperm parameters and DFI between samples and between men with DFI above and under 30%. Results: A total of 52 men provided double ejaculates 3–4 hours apart. In the entire group, DFI decreased from 38.9%±21.4% to 35.1%±21.6% in the second sample (P<0.001). Semen volume was lower on the second sample (2.3±1.4 vs. 1.5±0.9 mL, P<0.001), while the remaining parameters did not change. Forty out of 52 patients (76.9%) had improved DFI (average of 6.0±4.0 percentage points). Change in DFI varied with 22/52 (42.3%) and 7/52 (13.5%) of patients found to have decreases in DFI >5% and >10% in the second ejaculate, respectively. For men with DFI of 30–40%, 64% (7/11) of DFIs reduced to the under 30% range. First DFI value was the only parameter associated with DFI decrease to under 30% in multivariate models [odds ratio (OR), 0.62; 95% confidence interval (CI): 0.39–0.98; P=0.04]. Conclusions: This study identified significant improvements in DFI in infertile men providing a second sample after 3–4 hours. Controlled trials are needed to determine if reproductive outcomes are improved using a second ejaculate for infertile men with high initial sperm DFI values.

You have accessJournal of UrologyCME1 Apr 2023MP43-03 CLOMIPHENE CITRATE IN IDIOPATHIC NON-OBSTRUCTIVE AZOOSPERMIA Mohamed S. Kattan, Bader Akroof, Katherine Lajkosz, Ethan Grober, Keith Jarvi, and Kirk Lo Mohamed S. KattanMohamed S. Kattan More articles by this author , Bader AkroofBader Akroof More articles by this author , Katherine LajkoszKatherine Lajkosz More articles by this author , Ethan GroberEthan Grober More articles by this author , Keith JarviKeith Jarvi More articles by this author , and Kirk LoKirk Lo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003289.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clomiphene citrate (CC) is a selective estrogen receptor modulator (SERM). Empirical off-label use of CC in men with infertility has existed for almost 50 years, yet there is not enough evidence to support its use in non-obstructive azoospermia (NOA) patients. This study aims to evaluate the efficacy of CC in sperm production in NOA, and determine the predictors for success. METHODS: A prospective study was conducted on patients who presented with idiopathic NOA from 2015-2022. Patients were evaluated with history, physical examination, karyotyping, scrotal ultrasound, semen and hormonal assessment pre and at least 3 months post treatment. Patients were treated with CC. Patients with abnormal karyotype, positive Y micro-deletion or history of testosterone use were excluded. Patients with cryptospermia were included but analyzed separately. Differences in pre-treatment characteristics by response status were evaluated using Mann-Whitney U tests. ROC analysis was conducted to select the optimal cut-offs for predicting response. 60 patients met the inclusion criteria; 48 azoospermic patients (group A), 12 cryptospmic patients (group B). Response is defined as presence of any sperm in the ejaculate for (group A) and as sperm concentration ≥10000 sperm/ml for (group B). RESULTS: 8/48 (16.6%) in group A had sperm in the ejaculate with CC (concentration mean 0.51×106/mL: sd 0.77×106 /mL: range 0.02–2.14). 8/12 (66.6%) in group B had ≥10000 sperm/mL (mean 1.4×106 /mL: sd 1.83×106/mL: range 0.1-5.90). Of the 8 responders in group A: 3 responded within 3 months, 3 responded at 3-6 months 2 responded at 6-9 months. Median time to response was 3.6 months (IQR: 2.8-6.0, range: 0.7-6.8 months). Among all pre-treatment factors analyzed, only testosterone level trended towards statistical significance (p-value: 0.08). The optimal cut-off levels are shown in Table1. CONCLUSIONS: Approximately 1 in 6 patients with idiopathic NOA treated with CC showed sperm in the ejaculate. Those patients could potentially avoid surgical sperm extraction for in vitro fertilization (IVF). Pre-treatment hormonal levels seem to be the best indicator for response with the optimal levels shown in this study. The duration of response may vary where some patients require more than 3-6 months of treatment. Future studies should focus on the success of IVF results in men with NOA on CC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e602 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed S. Kattan More articles by this author Bader Akroof More articles by this author Katherine Lajkosz More articles by this author Ethan Grober More articles by this author Keith Jarvi More articles by this author Kirk Lo More articles by this author Expand All Advertisement PDF downloadLoading ...

Introduction:Infertility affects about 16% of North American couples, with the male factor contributing to ∼30% of cases. Reproductive hormones play an integral role in regulating the reproductive system and consequently, fertility. Oxidative stress reduces testosterone synthesis, and reduction in oxidative stress can improve hormone profiles. Ascorbic acid is a potent antioxidant that accounts for up to 65% of seminal antioxidant activity; however, its effects on reproductive hormones in humans are unknown.Methods:The objective was to determine the association between serum ascorbic acid concentrations and male reproductive hormones. We conducted a cross-sectional study involving infertile males (n = 302) recruited from Mount Sinai Hospital, Toronto. Serum was analyzed for ascorbic acid, luteinizing hormone (LH), follicular stimulating hormone (FSH), total testosterone (TT), prolactin and estradiol. Statistical analyses included Spearman's rank correlations, linear regressions, logistic regressions, simple slope and Johnson-Neyman procedures.Results:After adjusting for covariates, ascorbic acid was inversely associated with LH (P = 0.01). Ascorbic acid was positively associated with TT only among males over the age of 41.6 years (P = 0.01).Discussion:Our findings show that ascorbic acid is associated with higher testosterone levels and improved androgenic status in infertile males, and some of the effects appear to be age dependent.

You have accessJournal of UrologyCME1 Apr 2023MP30-09 ARE COMPLETE AZFc DUPLICATIONS ASSOCIATED WITH SPERMATOGENIC POTENTIAL? THE FIRST REPORTED SERIES Kian Asanad, Mary Samplaski, Elena Kolomeitz, Stephen Scherer, Ryan Yuen, Christian Marshall, Kirk Lo, Ethan Grober, Brendan Mullen, Susan Lau, and Keith Jarvi Kian AsanadKian Asanad More articles by this author , Mary SamplaskiMary Samplaski More articles by this author , Elena KolomeitzElena Kolomeitz More articles by this author , Stephen SchererStephen Scherer More articles by this author , Ryan YuenRyan Yuen More articles by this author , Christian MarshallChristian Marshall More articles by this author , Kirk LoKirk Lo More articles by this author , Ethan GroberEthan Grober More articles by this author , Brendan MullenBrendan Mullen More articles by this author , Susan LauSusan Lau More articles by this author , and Keith JarviKeith Jarvi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is well established that complete AZFc microdeletions are a common cause of male factor infertility. With advances in detection methodology, increasing cases of partial AZFc deletion and Yq duplication, especially those involving the AZFc region, have started to emerge. Here, we report the first series of infertile men with complete AZFc duplications. METHODS: Men presenting for a fertility evaluation at a single male infertility specialty clinic from 2012-2014 who had AZFc complete duplications using a targeted microarray in peripheral blood were identified. Demographics, medical, surgical, family and reproductive history, semen and hormonal parameters, as well as response to therapies were characterized. Fischer’s exact test was used to compare the rate of complete AZFc duplications in the infertile population versus fertile controls. RESULTS: We identified five men having complete AZFc duplications, which represented 4.8% (5/104) of men undergoing Y-chromosome microarray testing and 21% of men with men with AZFc abnormalities. The mean age was 33.7 years. There was a significantly higher proportion of AZFc duplications in the infertile population (5/104) vs. the fertile controls (0/148) (p= 0.013). The mean testicular volume was 18 mL. One man had a left grade 2 varicocele. The mean FSH was 5.5 IU/L (range 1-11 IU/L), LH 3.6 IU/L (range 3-4.2 IU/L), and testosterone 14.5 nmol/L (range 12.5-18.3 nmol/L). With respect to semen parameters, one man was persistently azoospermic. The second man alternated between severe oligospermia and rare non-motile sperm. The third man had one semen analysis demonstrating azoospermia and a second demonstrating a total sperm count (TSC) of 4 ×106. The fourth man was persistently oligospermic with TSCs ranging from 3.96-12.6 ×106. The fifth man had severe oligospermia, with a mean TSC of 1.5 ×106; after intervention (varicocele embolization, clomiphene citrate), his TSC rose to 21.7 ×106. He then fathered a spontaneous pregnancy. CONCLUSIONS: This is the first study to report that complete AZFc duplications are common in those infertile men with AZFc abnormalities, representing 21% of the AZFc alterations in this group. Studies only targeting AZFc deletions are underestimating the frequency of AZFc abnormalities in men with spermatogenic failure. They represent a heterogeneous group, having a variable reproductive potential. Cases should be managed on an individual basis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e394 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kian Asanad More articles by this author Mary Samplaski More articles by this author Elena Kolomeitz More articles by this author Stephen Scherer More articles by this author Ryan Yuen More articles by this author Christian Marshall More articles by this author Kirk Lo More articles by this author Ethan Grober More articles by this author Brendan Mullen More articles by this author Susan Lau More articles by this author Keith Jarvi More articles by this author Expand All Advertisement PDF downloadLoading ...

BackgroundsDespite a wide spectrum of contraceptive methods for women, the unintended pregnancy rate remains high (45% in the US), with 50% resulting in abortion. Currently, 20% of global contraceptive use is male-directed, with a wide variation among countries due to limited availability and lack of efficacy. Worldwide studies indicate that >50% of men would opt to use a reversible method, and 90% of women would rely on their partner to use a contraceptive. Additional reasons for novel male contraceptive methods to be available include the increased life expectancy, sharing the reproductive risks among partners, social issues, the lack of pharma industry involvement and the lack of opinion makers advocating for male contraception.AimThe present guidelines aim to review the status regarding male contraception, the current state of the art to support the clinical practice, recommend minimal requirements for new male contraceptive development and provide and grade updated, evidence-based recommendations from the European Society of Andrology (EAA) and the American Society of Andrology (ASA).MethodsAn expert panel of academicians appointed by the EAA and the ASA generated a consensus guideline according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system.ResultsSixty evidence-based and graded recommendations were produced on couple-centered communication, behaviors, barrier methods, semen analysis and contraceptive efficacy, physical agents, surgical methods, actions before initiating male contraception, hormonal methods, non-hormonal methods, vaccines, and social and ethical considerations.ConclusionAs gender roles transform and gender equity is established in relationships, the male contribution to family planning must be facilitated. Efficient and safe male-directed methods must be evaluated and introduced into clinical practice, preferably reversible, either hormonal or non-hormonal. From a future perspective, identifying new hormonal combinations, suitable testicular targets, and emerging vas occlusion methods will produce novel molecules and products for male contraception.

BACKGROUND:Cancer and its treatment can adversely affect male fertility. Although sperm banking is an effective fertility preservation method, there is an unmet need for information and support surrounding these issues.OBJECTIVE:This usability study evaluates a mobile health app providing male patients with cancer with credible information about the impact of cancer and its treatment on fertility and fertility preservation.METHODS:Participants were recruited by a market research firm. Eligibility criteria were men who were 18-45 years of age, identified as male, diagnosed with new or recurring cancer within 1 year, not in fertility treatment, able to read and write in English or French, and had internet access. App usage was tracked for 2 weeks. After app use, participants provided qualitative feedback about their experiences using the app as well as quantitative data regarding their sperm banking decisions, perceived change in fertility knowledge, evaluation of the app's information on the Information Assessment Method, and the app's quality on the user version of the Mobile App Rating Scale.RESULTS:The sample included 40 men aged 27-45 years. Approximately 68% (27/40) indicated that no one had previously spoken to them about the impact of cancer on fertility, and 85% (34/40) had not received information on fertility preservation. Approximately 83% (33/40) found the app's information relevant, and 85% (34/40) said that it increased their fertility knowledge. Approximately 23% (9/40) made a decision about sperm banking after using the app. Participants rated the app's quality highly, with mean scores (out of 5) of 4.14 for information, 4.06 for functionality, 3.84 for aesthetics, and 3.63 for engagement.CONCLUSIONS:The app proved to be useful for male patients with cancer, suggesting that mobile health resources could be beneficial to incorporate into clinical care to enable shared decision-making about fertility.

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.

Objective The number of couples experiencing infertility treatment has increased, as has the number of women and men experiencing infertility treatment-related stress and anxiety. Therefore, there is a need to provide information and support to both men and women facing fertility concerns. To achieve this goal, we designed a mhealth app, Infotility, that provided men and women with tailored medical, psychosocial, lifestyle, and legal information. Methods This study specifically examined how fertility factors (e.g. time in infertility treatment, parity), socio-demographic characteristics (e.g. gender, education, immigrant status), and mental health characteristics (e.g. stress, depression, anxiety, fertility-related quality of life) were related to male and female fertility patients' patterns of use of the Infotility app. Results Overall, the lifestyle section of the app was the most highly used section by both men and women. In addition, women without children and highly educated women were more likely to use Infotility. No demographic, mental health or fertility characteristics were significantly associated with app use for men. Conclusion This study shows the feasibility of a mhealth app to address the psychosocial and informational needs of fertility patients.

Male infertility presents a public health concern. As most men wish to become fathers, it is important to increase men’s awareness of infertility risk factors. We developed a mobile health application (mHealth app), Infotility XY, to promote men’s reproductive health. This study evaluates whether use of the app led to increased knowledge of infertility risk factors, and whether knowledge change was associated with participants’ sociodemographic characteristics and/or app usage. Participants were recruited between August and October 2020. Eligibility criteria included: identified as male; 18–45 years old; childless; no infertility history; able to read and write in English/French; had internet access. We assessed participants’ fertility knowledge before and after app use. App usage data were captured during the 2-week intervention period. Our sample included 49 men aged 18–45. Seventy-eight percent of participants had not previously sought fertility information. Participants viewed on average 75% of the app’s articles, and 96% of participants said the app increased their fertility knowledge. Before app use, 55% of men said they were aware of infertility risk factors, compared to 96% after app use. Men correctly identified more risk factors after app use compared to before, t(48) = 8.28, p < .001. Participants’ sociodemographic characteristics and amount of app usage were not associated with knowledge change. This study provides evidence of the feasibility of an mHealth app to improve men’s awareness of infertility risk factors. Given the positive relationship between male reproductive health and overall health, increased awareness of infertility risk factors may lead to men’s improved overall health.