Background: The significance of geographic barriers to receiving inflatable penile prosthesis (IPP) treatment is uncertain according to the existing medical literature. Aim To describe the travel patterns of men with erectile dysfunction (ED) in the United States who underwent IPP surgery. Methods: This retrospective cohort study utilized data from the 100% Medicare Standard Analytical Files. Men aged >= 65 years with an ED diagnosis who underwent IPP surgery between January 2016 and December 2021 were identified from the database. Federal Information Processing Series codes from the National Bureau of Economic Research's County Distance Database were used to determine geographic distances from patients' homes to the facilities at which surgery was performed. Outcomes: Evaluations included the proportions of men who traveled outside their county of residence or state for IPP treatment and the average distances in miles traveled. Results: Among 15 954 men with ED undergoing IPP treatment, 56.4% received care out of their county for IPP, at a mean distance of 125.6 miles (range, 3.8-4935.0). Although patients aged >= 80 years were less likely to travel outside their county as compared with men aged 65 to 69 years (48.1% vs 57.1%, P < .001), if they traveled, they were likely to travel farther (mean, 171.8 vs 117.7 miles; P < .001). South Dakota had the highest proportion of men traveling outside their county for IPP treatment (91.3%; mean, 514.2 miles), while Vermont had the highest proportion traveling outside their home state (73.7%). Clinical Implications: By unveiling disparities in access, this study will potentially lead to tailored interventions that enhance patient care and health outcomes. Strengths and Limitations: Strengths include the uniqueness in (1) evaluating the proportions of patients who travel out of their county of residence or home state for IPP treatment and (2) quantifying the average distances that patients traveled. An additional strength is the large sample size due to the retrospective design and database used. The analysis did not capture all Medicare enrollees; however, it did encompass all traditional Medicare enrollees, representing approximately half of all men in the US aged >= 65 years. Limitations include not being generalizable to entire population of the US, as the study examined only Medicare enrollees. In addition, the study period includes the pandemic, which could have affected travel patterns. Furthermore, the coding and accuracy of the data are limitations of using administrative claims data for research. Conclusion: Study findings showed that many men with Medicare and ED traveled from their home geographic location for IPP treatment.

IPP placement is gold standard for management of medication-refractory ED. Goals of intraoperative device selection include maximizing length, girth and rigidity. “Right-sizing” or “up-sizing” exist as strategies to maximize these parameters. AMS 700 LGX (Boston Scientific, USA) is the only device known to expand circumferentially and longitudinally. It is unknown whether restricting expansion in one axis (i.e. girth or length) may restrict full expansion in the opposite axis or diminish rigidity. To determine maximal length expansion for both AMS 700 LGX and CX IPPs under conditions of unrestricted and restricted girth expansion across the full spectrum of internal device pressurization. To develop a novel methodology for the reliable measurement of IPP expansion characteristics across a range of penile sizes. Custom IPP cylinder molds were designed using Autodesk Fusion 360 to emulate corpora cavernosa at fixed girth. Molds were 3D printed in polylactic acid (PLA) with variable girth diameters. Unilateral deflated IPPs were inserted into molds using proplyene glycol lubricant to prevent restriction of length expansion via material drag and damage to IPPs (Figure 1). Using an 18mm diameter mold, 21, 18, and 15cm native LGX IPPs and 18 and 15cm native CX IPPs were evaluated. Devices were pressurized from 2 to 18psi in 1psi intervals while measurements were obtained on both the constrained and unconstrained cylinders. Length of the girth constrained cylinder was measured by distal tip displacement. Girth expansion of the unrestrained cylinder was measured using laser micrometry.

Penile length and girth after insertion of an inflatable penile prosthesis (IPP) are a concern for patients and surgeons alike. Stretched penile length (SPL) has been described as a good surrogate measure of erect penile length after prosthesis placement. In addition, several surgical techniques have been described to increase penile length during prosthetic surgery; however, these techniques have never been directly compared in terms of overall length increase. Utilizing cadaveric male pelves, we aimed to 1) determine the relationship between SPL and post implant length and 2) compare two techniques for penile lengthening. Ten previously frozen male cadaveric pelvises were obtained for a surgical training lab. Anatomic measurements were conducted from the pubis to the tip of the glans and at the midshaft of the penis to determine length and girth respectively. Inflatable penile prostheses were then inserted using a standard penscrotal incision under direct supervision by fellowship trained prosthetic urologists. The finger trap and the sliding technique penile lengthening procedures were performed as previously described in 5 cases each.

Infertility is a complex and incompletely understood disease that impacts 10 to 15% of reproductive-aged couples seeking to conceive. The World Health Organization defines infertility as the failure to conceive a clinical pregnancy after 12 or more of regular unprotected sexual intercourse. It likely involves the interaction among many variables, including age, race, ethnicity, and geography, that are laid upon the foundation of genetics and chronic medical conditions and further modified by environmental factors. A plethora of contemporary epidemiologic studies have been published detailing the relationship between male infertility, medical diseases, and environmental exposures with the primary goal of better characterizing their association, identifying risk factors, and providing more effective patient counseling and subsequent treatments. In this chapter, we aim to critically analyze available data and integrate the understanding of epidemiology and male infertility in an effort to provide clear guidance to a larger audience of clinicians of various subspecialties that encounter men with reproductive challenges. This review contains 1 figure, 8 tables, and 62 references. Key Words: at-risk groups, conditions, definitions, environmental factors,epidemiology, male fertility, racial geographical, variations

Consumption of cannabis within the United States is on the rise with currently 28 states having medical marijuana and eight states have legal recreational marijuana. A government survey found that 22% of adults report using marijuana and 8% report using within the past month. Recent data suggests that cannabis may have a detrimental impact on male reproductive health. We aimed to survey and synthesize the current literate pertaining to male infertility and cannabis use. A systematic review of the literature for studies examining the effect of marijuana on male reproductive and sexual health. An exhaustive electronic search was performed using the MEDLINE and EMBASE databases through May 2017. The search was restricted to English language articles. The following keywords and MeSH terms were searched through MEDLINE: infertility, male; marijuana; cannabis; cannabinoids; endocannabinoids; semen analysis. Search strategies were adapted to other databases based upon the MEDLINE parameters. Study inclusion was independently decided by two reviewers (SR and MJR) based upon relevance to the effect of marijuana on male fertility or semen quality. Titles and abstracts were scanned for relevance (51) followed by complete article review for relevance (40). Disagreement was resolved by the corresponding author (TJW). A total of 51 articles were initially identified. Eleven articles were excluded after complete review. Of the 40 remaining, 9 examined animal models and 11 used in vitro models to study cannabinoids and their effect on sperm and cannabinoid signaling related to spermatogenesis. Nine additional articles reviewed the aforementioned original research while 7 clinical reviews simply mentioned marijuana as a putative risk factor for infertility. Only 3 articles investigated the clinical effect of marijuana on clinical fertility and semen quality. These included a cohort study consisting of 1215 men, an unmatched age referent study with 318 men, and a prospective non-randomized study of 164 men. There is limited data on the clinical effects of cannabis use and the impact on male factor infertility. The small amount of information available suggests that cannabis has a negative impact on male reproductive health. Given the current climate where marijuana is becoming increasingly legalized and the paucity of data of its effects on reproductive health, it is important future research focuses on this clinical question and that providers and societies actively engage in disseminating this information to the public.

Male infertility lies at the intersection of genetic determinants and environmental effects. Although the exact genetic mechanisms of male infertility are still unclear, the associations between male infertility and medical diseases including cancer are clear. The advent of Assisted Reproductive Technology (ART) has allowed men to bypass urologic care to achieve their family planning goals at a time when testicular germ cell tumors (TGCT) in industrialized nations are increasing and semen quality is arguably decreasing. Data suggests that male reproductive failure may be a harbinger of future urologic diseases, including testis and prostate cancer, thus emphasizing the importance of dedicated urologic evaluation and care for all male infertility patients. Advances in epigenetics, the sequencing of the human genome, and maturation of large datasets from countries with socialized medicine are heralding a new era of medicine and research. The sensitivity of germinal epithelium to changes in the external environment combined with the internal metabolic profile make germinal epithelium an excellent avenue for exploring the intersection between infertility and cancers of the male reproductive tract. This chapter will review male infertility with specific focus on epidemiologic data and biological mechanisms linking male reproductive health and cancer with specific focus on TGCT and prostate cancer (CaP). We will review the possible biologic mechanisms that may underlie this association.

ObjectiveThe semen analysis is the cornerstone of the male fertility evaluation. Semen parameters of concentration, motility, morphology, and total motile count (TMC) are important for patient counseling and treatment decision-making. Patients frequently have difficulty interpreting semen analysis results and clinic-based test result counseling can be time-consuming. In an effort to develop a patient-centered semen analysis report, we surveyed male fertility experts and obtained consensus on semen parameters that are foundational to clinical decision making.DESIGN:Materials and MethodsA web-based questionnaire was developed with intent to complete a modified Delphi process. All registered Society for the Study of Male Reproduction (SSMR) members were invited to complete the questionnaire. Survey queries were submitted using the University of Washington Catalyst platform.ResultsThe survey was completed by 16 SSMR members. When asked to rank the most important elements of a semen analysis, 28% of respondents listed TMC as the most or 2nd most important element. Motility and concentration were next in ranked importance with 22% of respondents listing these parameters among their two highest ranked. 69% stated that patients were most confused by morphology. Agglutination or fructose was not clinically useful to 81% of respondents.ConclusionsThere was considerable variability among providers regarding the relative importance of specific semen parameters. The majority of specialists agreed that patients are confused by morphology and other commonly reported parameters are not clinically useful. A patient-centered semen analysis could help patients to better understand this important aspect of their fertility evaluation. ObjectiveThe semen analysis is the cornerstone of the male fertility evaluation. Semen parameters of concentration, motility, morphology, and total motile count (TMC) are important for patient counseling and treatment decision-making. Patients frequently have difficulty interpreting semen analysis results and clinic-based test result counseling can be time-consuming. In an effort to develop a patient-centered semen analysis report, we surveyed male fertility experts and obtained consensus on semen parameters that are foundational to clinical decision making.DESIGN: The semen analysis is the cornerstone of the male fertility evaluation. Semen parameters of concentration, motility, morphology, and total motile count (TMC) are important for patient counseling and treatment decision-making. Patients frequently have difficulty interpreting semen analysis results and clinic-based test result counseling can be time-consuming. In an effort to develop a patient-centered semen analysis report, we surveyed male fertility experts and obtained consensus on semen parameters that are foundational to clinical decision making. DESIGN: Materials and MethodsA web-based questionnaire was developed with intent to complete a modified Delphi process. All registered Society for the Study of Male Reproduction (SSMR) members were invited to complete the questionnaire. Survey queries were submitted using the University of Washington Catalyst platform. A web-based questionnaire was developed with intent to complete a modified Delphi process. All registered Society for the Study of Male Reproduction (SSMR) members were invited to complete the questionnaire. Survey queries were submitted using the University of Washington Catalyst platform. ResultsThe survey was completed by 16 SSMR members. When asked to rank the most important elements of a semen analysis, 28% of respondents listed TMC as the most or 2nd most important element. Motility and concentration were next in ranked importance with 22% of respondents listing these parameters among their two highest ranked. 69% stated that patients were most confused by morphology. Agglutination or fructose was not clinically useful to 81% of respondents. The survey was completed by 16 SSMR members. When asked to rank the most important elements of a semen analysis, 28% of respondents listed TMC as the most or 2nd most important element. Motility and concentration were next in ranked importance with 22% of respondents listing these parameters among their two highest ranked. 69% stated that patients were most confused by morphology. Agglutination or fructose was not clinically useful to 81% of respondents. ConclusionsThere was considerable variability among providers regarding the relative importance of specific semen parameters. The majority of specialists agreed that patients are confused by morphology and other commonly reported parameters are not clinically useful. A patient-centered semen analysis could help patients to better understand this important aspect of their fertility evaluation. There was considerable variability among providers regarding the relative importance of specific semen parameters. The majority of specialists agreed that patients are confused by morphology and other commonly reported parameters are not clinically useful. A patient-centered semen analysis could help patients to better understand this important aspect of their fertility evaluation.

Low serum testosterone (T) is common and increasingly prevalent with increased age. Recent studies report an 'epidemic' of T prescribing and concern about unnecessary T treatment. We investigated the number of men tested for T, the prevalence of low serum T levels, and initiation of T treatment among those with low T levels in men treated at Veterans Affairs (VA) facilities in the Northwest US (VISN 20). We identified male Veterans aged 40-89 years and examined yearly proportions of men tested for T, found to have low T levels (total T < 280 ng/dL, free T < 34 pg/mL, or bioavailable T < 84 ng/dL), and subsequently treated with T from 2002 to 2011. We excluded men who had T treatment in the year prior and men with diagnoses of prostate or breast cancer. Treatment initiation was defined as the first prescription for T within a year following a low T test. From 2002 to 2011, the yearly population of eligible men in VISN 20 increased from 129 247 to 163 572. The proportion of men who had serum T tests increased from 3.2% in 2002 to 5.8% in 2011. Among the tested men, the percentage of men with low T levels increased from 35.0 to 47.3%. However, the proportion of men with low T levels who were given T treatment within a year decreased from 31.0 to 28.0%. Despite large increases in T testing, and detection of men with low T levels, there was a slight decrease in the proportion of men with low T levels who were treated with T. The decrease in T treatment during this time period contrasts with other studies and may be related to higher comorbidity in Veterans and/or VA formulary restrictions on the use of transdermal T formulations.

Retinoic acid (RA), the active metabolite of vitamin A, is required for spermatogenesis and many other biological processes. RA formation requires irreversible oxidation of retinal to RA by aldehyde dehydrogenase enzymes of the 1A family (ALDH1A). While ALDH1A1, ALDH1A2, and ALDH1A3 all form RA, the expression pattern and relative contribution of these enzymes to RA formation in the testis is unknown. In this study, novel methods to measure ALDH1A protein levels and intrinsic RA formation were used to accurately predict RA formation velocities in individual human testis samples and an association between RA formation and intratesticular RA concentrations was observed. The distinct localization of ALDH1A in the testis suggests a specific role for each enzyme in controlling RA formation. ALDH1A1 was found in Sertoli cells, while only ALDH1A2 was found in spermatogonia, spermatids, and spermatocytes. In the absence of cellular retinol binding protein (CRBP)1, ALDH1A1 was predicted to be the main contributor to intratesticular RA formation, but when CRBP1 was present, ALDH1A2 was predicted to be equally important in RA formation as ALDH1A1. This study provides a comprehensive novel methodology to evaluate RA homeostasis in human tissues and provides insight to how the individual ALDH1A enzymes mediate RA concentrations in specific cell types.

Retinoic acid (RA), the active form of vitamin A (retinol), is indispensable for maintaining many essential biological processes. RA formation depends on a complex network of enzymes. The rate limiting step is irreversible formation of RA by aldehyde dehydrogenase1A (ALDH1A1‐1A3). However, the specific roles, tissue expression, and localization of these enzymes are not well understood.While RA is necessary for spermatogenesis in animal models, the source of intratesticular RA is unknown. Sertoli cell specific ALDH1A knockouts have demonstrated intratesticular RA formation is required for male fertility. Due to the requirement for intratesticular RA formation and presence of mRNA for all three ALDH1A enzymes in the human testis, the human testis was chosen as a model of the biochemistry of RA formation.In order to model RA formation, a novel LC‐MS/MS based peptide quantification method was developed to quantify ALDH1A in a cohort of 18 men. Each ALDH1A concentration was used to predict the velocity of RA formation in each donor. The accuracy of our predictions was confirmed by measuring intrinsic RA formation and RA concentrations in the same samples. Additionally, weidentified a distinct localization pattern for ALDH1A enzymes in the human testis using immunohistochemistry.In conclusion, these novel techniques were successfully used to model RA formation in human testicular tissue. In the future, RA formation in other tissues can be investigated using the assays developed.Grant Funding Source: Supported by NIH/NICHD grant U54 HD042454 and TL1TR000422

Objective: To determine whether decreased testicular levels of enzymes necessary for retinoic acid biosynthesis were associated with male infertility, as retinoic acid is known to be necessary for spermatogenesis.Design: Observational analysis of testicular tissue samples, sperm indices, and serum hormone concentrations.Setting: Two infertility centers in Chile.Patient(s): 32 infertile men and 11 control men.Intervention(s): Measurement of the three enzymes necessary for retinoic acid biosynthesis, aldehyde dehydrogenase (ALDH) 1A1, 1A2, and 1A3, in testicular tissue by a novel liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) peptide assay.Main Outcome Measure(s): ALDH isozyme levels compared by type of infertility and correlated with testicular germ cell numbers, sperm parameters, and serum and intratesticular hormone concentrations.Result(s): Men with infertility had statistically significantly reduced levels of ALDH1A2 but not ALDH1A1 or ALDH1A3 in their testicular tissue compared with men with normal spermatogenesis. The ALDH1A2 protein levels were strongly correlated with the number of germ cells found via testicular biopsy.Conclusion(s): These findings suggest that ALDH1A2 is the enzyme involved in retinoic acid biosynthesis in human germ cells. Further study of the relationship between intratesticular ALDH1A2 and male infertility is warranted to determine whether men with infertility have a reduced ability to synthesize retinoic acid within their germ cells that could impair spermatogenesis. (C) 2014 by American Society for Reproductive Medicine.

Diabetes mellitus (DM) and erectile dysfunction (ED) are common health problems that markedly increase in prevalence and incidence with advancing age. DM is a known risk factor for developing ED; however, among men with ED it is unknown if DM alters the need for more invasive therapies. We sought to determine whether DM is associated with increased ED severity, reduced effectiveness of first-line (oral) therapies, and therefore higher utilization of second- and third-line therapies. The Inovus I3 database was queried to identify men with ED. Claims were followed for 48 months. Men with incomplete follow-up data and those diagnosed with DM after ED diagnosis were excluded from analysis. Rates of second-line (penile suppositories or injectables) and third-line (penile prostheses) ED therapies were compared between men with and without preexisting DM. Risk of progressing to second- and third-line therapies associated with DM was assessed with logistic regression and Kaplan–Meier analysis. From 1 January 2002 to 31 December 2006, 136 306 men were identified with prevalent and incident ED. Among this group, 19 236 men had DM that preceded their ED diagnosis. Men with DM were more than 50% more likely to be prescribed secondary ED treatments over the 2-year observation period, and more than twice as likely to undergo penile prosthesis surgery. Among a large population-based cohort of men with ED, those with DM are more likely to require more aggressive treatments. These data suggest that ED among men with diabetes may be less responsive to first-line treatments (oral agents), worsen more rapidly, or both.

Intratesticular retinoic acid is necessary for spermatogenesis, but the relationship between intratesticular retinoic acid and sperm quality in man has not been studied. We hypothesized that intratesticular concentrations of retinoic acid would be lower in men with abnormal semen analyses compared to men with normal semen analyses. We recruited men requiring scrotal or penile surgery in a pilot observational study examining the relationship between sperm quality and intratesticular and serum retinoic acid. Twenty-four men provided two pre-operative blood and semen samples, and underwent a testicular biopsy during surgery. Serum and tissue all-trans and 13-cis retinoic acid and reproductive hormones were measured by LC/MS/MS and radioimmunoassays, respectively. Seven men had abnormal semen analyses by at least one WHO criteria and 17 men were normal. In men with abnormal semen, the median (25th, 75th percentile) intratesticular 13-cis retinoic acid was 0.14 (0.08, 0.25) pmol/gram tissue compared with 0.26 (0.18, 0.38) pmol/gram tissue in men with normal semen (p = 0.04). There were no significant differences in intratesticular all-trans retinoic acid or serum reproductive hormones between men with normal and abnormal semen analyses. Intratesticular 13-cis retinoic acid is significantly lower in men with abnormal semen analyses compared to men with normal semen analyses. Lower intratesticular 13-cis retinoic acid concentrations may be due to decreased biosynthesis or increased metabolism in the testes. Further investigation of the relationship between intratesticular 13-cis retinoic acid and poor sperm quality is warranted to determine if this association is present in infertile men.

each sample and labeling with Cy2.Duplicate 2D-DIGE gels with sperm samples, which were dye swapped, were run to provide reliable data for statistical analysis.Image analysis was done using DeCyder software.Protein spots of at least a 1.5-fold difference in intensity were excised from the preparatory gel and identified by LC-MS.Data were analyzed using Sequest and Blast programs.RESULTS: A total of 1343 protein spots in gel 1 and 1265 spots in gel 2 were detected.The majority of spots had similar expression with 31 spots differentially expressed.Six spots were significantly decreased and 25 increased in the ROS-sample vs. the ROS+ sample.CONCLUSION: Different protective proteins against oxidative stress (OS) are expressed in ROS-vs.ROS+ samples.These differences may explain the OS pathology in male infertility.

STUDY DESIGN:Randomized trial with concurrent observational cohort. A total of 1171 patients were divided into subgroups by educational attainment: high school or less, some college, and college degree or above. OBJECTIVE:To assess the influence of education level on outcomes for treatment of lumbar disc herniation. SUMMARY OF BACKGROUND DATA:Educational attainment has been demonstrated to have an inverse relationship with pain perception, comorbidities, and mortality. METHODS:The Spine Patient Outcomes Research Trial enrolled surgical candidates (imaging-confirmed disc herniation with at least 6 weeks of persistent signs and symptoms of radiculopathy) from 13 multidisciplinary spine clinics in 11 US states. Treatments were standard open discectomy versus nonoperative treatment. Outcomes were changes from baseline for 36-Item Short Form Health Survey (SF-36), bodily pain (BP), and physical function (PF) scales and the modified Oswestry Disability Index (ODI) at 6 weeks, 3 months, 6 months, and yearly through 4 years. RESULTS:Substantial improvement was seen in all patient cohorts. Surgical outcomes did not differ by level of education. For nonoperative outcomes, however, higher levels of education were associated with significantly greater overall improvement over 4 years in BP (P = 0.007), PF (P = 0.001), and ODI (P = 0.003). At 4 years a "dose-response" type relationship was shown for BP (high school or less = 25.5, some college = 31, and college graduate or above = 36.3, P = 0.004) and results were similar for PF and ODI. The success of nonoperative treatment in the more educated cohort resulted in an attenuation of the relative benefit of surgery. CONCLUSION:Patients with higher educational attainment demonstrated significantly greater improvement with nonoperative treatment while educational attainment was not associated with surgical outcomes.

Six percent of all cancers occur in men aged 15 to 45 years. Most cancer therapies are cytotoxic and impair spermatogenesis. Sperm cryopreservation remains the cornerstone of fertility preservation for male cancer victims. Recent data suggests that a type of cancer may affect a man's semen quality; however, it is uncertain if various cancers impact post-thaw sperm survival differently. The objective of this study was to characterize sperm parameters from a thawed semen sample from men with different cancers who cryopreserved prior to onco-therapy. Retrospective review. We retrospectively evaluated the raw and test thaw semen data from men with newly diagnosed cancer at the University of Washington Male Infertility Laboratory from 1994-2009. A total of 798 semen samples were analyzed from men with the 8 most common cancers of which 477 underwent test thaw. For each raw and test thawed sample sperm concentration and motility were determined and total motile sperm counts (TMC) were calculated. Mean TMCs and changes in TMC for each cancer were compared to normal samples. The most common cancers in this study were: testicular, Hodgkin's lymphoma, myeloid and lymphoid leukemias, prostate, sarcoma, brain, and lymphocytic cancer NOS. Not surprisingly, healthy patients had the best pre-cryo and post thaw semen quality. Patients with prostate cancer had the best raw and post thaw semen quality (TMC of 155.1 and 53.2, respectively). Lymphoid leukemias demonstrated the worst raw TMC (26.8 M motile/mL), however, myeloid leukemias displayed the worst post thaw TMC (6.9 M motile/mL). All specimens showed severe reductions in TMC after cryopreservation. All cryopreserved specimens showed severe decline in the total motile sperm count post thaw. The most severe reduction was seen in myeloid leukemia group, suggesting that these patients should be counseled to provide increased numbers of specimens for fertility preservation.

OBJECTIVE: To identify modifiable, laboratory factors that may improve the yield of motile sperm following cryopreservation of ejaculated samples. DESIGN: Retrospective review, Academic Medical Center. MATERIALS AND METHODS: We performed retrospective review of laboratory data from the University of Washington Male Infertility Laboratory from 1994-2009. 1000 semen samples from 423 men that underwent cryopreservation and at least one test thaw were available. We analyzed semen analysis and cryopreservation technique variables to determine predictors of total motile sperm yield at test thaw. Variables analyzed included sperm concentration (106/mL), motility (%), sperm motility enhancement (none, pentoxifylline (PX), pentoxifylline + deoxyadenosine (PX/DOA), preparation medium (HTF, HamsF10) and freezing rate (rapid and slow). Iterative multivariate linear regression models were generated using the predictor variables. Test-thaw motility, total motile count (TMC) and the change in these parameters from the raw samples were assessed as outcomes of interest. RESULTS: The strongest predictor of sperm motility and TMC after cryopreservation is raw semen TMC. The percent recovery of TMC and % motility after test-thaw increased significantly by 24% and 4% for each quartile of improvement in raw TMC. When raw semen parameters are controlled for, PX and PX/DOA yielded significant improvements in motile sperm recovery, +76.0% (95%CI 53.3-98.6) and +73.7% (95%CI 44.9-102.5). The use of HamsF10 (compared to HTF) and rapid freezing (compared to slow) demonstrated minor improvements in motile sperm recovery, +7.1% (95%CI 3.0-11.2) and +4.6% (95%CI 1.4-7.8). CONCLUSION: Raw semen TMC is the best predictor of %motility and TMC after cryopreservation. PX and PX/DOA yielded large improvements in % motility with Hams F10 and rapid freezing technique yielding minor improvements. Sperm motility enhancement and choice of optimal buffer and freeze protocol can improve sperm survival post-freeze.