- Email: [email protected]
2289 INCREASED RISK OF CANCER AMONG AZOOSPERMIC MEN
e938
THE JOURNAL OF UROLOGY姞
weight, gestational age and other characteristics of the 7,752 male infants and determined the association between methods of conception and male reproductive disorders in the infants. We also analyzed the influence of male factor on the occurrence of these disorders. RESULTS: Ninety nine (1.3%) newborns were diagnosed with cryptorchidism, 8 (0.1%) were diagnosed with hypospadias, and 4 (0.05%) were diagnosed with both. Cryptorchidism was more common in children conceived through in vitro fertilization (IVF) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) (p ⬍ 0.05) and hypospadias was more common in children conceived through in vitro fertilization/intracytoplasmic sperm injection (p ⬍ 0.05). Children conceived through intrauterine insemination (IUI), in vitro fertilization and in vitro fertilization/intracytoplasmic sperm injection had higher rates of low birth-weight and preterm birth. Logistic regression analysis showed that low birth-weight and preterm birth were significantly associated with male reproductive disorders, whereas method of conception was not. Male factor was not significantly associated with these disorders. CONCLUSIONS: In vitro fertilization and in vitro fertilization/ intracytoplasmic sperm injection increase the risks of low birth-weight and preterm birth, resulting in increased rates of hypospadias and cryptorchidism. Male factor was not associated with reproductive disorders in male infants. Source of Funding: None
2287 PREVALENCE AND CLINICAL MEANING OF METABOLIC SYNDROME IN EUROPEAN CAUCASIAN MEN PRESENTING FOR PRIMARY COUPLE’S INFERTILITY Andrea Salonia*, Paolo Capogrosso, Marco Bianchi, Eugenio Ventimiglia, Maria Chiara Clementi, Giulia Castagna, Michele Colicchia, Luca Boeri, Cesare Regina, Alessandro Serino, Emanuele Zaffuto, Luca Villa, Ryan Matloob, Milan, Italy; Rocco Damiano, Catanzaro, Italy; Luca Carmignani, Francesco Montorsi, Milan, Italy INTRODUCTION AND OBJECTIVES: Assess prevalence of and clinical impact of metabolic syndrome (MetS) in European Caucasian men presenting for primary couple’s infertility. METHODS: Complete demographic, clinical and laboratory data from 1169 consecutive infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs ⱖ2); NCEP-ATPIII criteria were used to define MetS. Testicular volume was assessed with a Prader orchidometer. Semen analysis values were assessed based on 2010 World Health Organization (WHO) reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and MetS. RESULTS: Of all, male factor infertility and mixed infertility were found in 890 (76.1%) and 279 (23.9%) men, respectively. MetS was found in 101 (8.6%) of 1169 men. Patients with MetS were older (p⬍0.001), had a higher BMI (p⬍0.001), a greater rate of CCIⱖ1 (2:44.205; p⬍0.001), and lower testicular volumes (all p⬍0.03), as compared with those without MetS. Moreover, MetS patients had a lower serum total testosterone (tT) (p⫽0.002), a higher level of luteinizing hormone (LH) (p⫽0.001), and were hypogonadal in a higher rate (2:6.958; p⫽0.008) than patients without MetS. Conversely, no differences were found between groups in terms of follicle-stimulating hormone (FSH), inhibin B, 17 estradiol (E2) levels, and tT/E2 ratio values. Likewise, the two groups did not significantly differ in terms of semen parameters and rate of either obstructive or non-obstructive azoospermia. At multivariate logistic regression analysis serum FSH (OR: 1.36; p⬍0.001) and testicular volume (OR: 0.59; p⬍0.001) achieved independent predictor status for WHO normal semen concentration; conversely, age, CCI scores, MetS, and inhibin B values did not. No parameters predicted normal sperm progressive motility and morphology.
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
CONCLUSIONS: MetS accounts for roughly 9% in men presenting for primary couple’s infertility. Overall, while MetS patients have a lower general male health status, semen analysis values seem independent of the presence of MetS. Source of Funding: None
2288 THE RELATION BETWEEN DYSLIPIDEMIA WITH THE KLINEFELTER’S SYNDROME PATIENT Se Hwan Park*, Dae Gi Jo, Hyo Serk Lee, Jin Ho Choe, Joong Shik Lee, SEOUL, Korea, Republic of; Young Ho Kim, Korea, Republic of; Ju Tae Seo, SEOUL, Korea, Republic of INTRODUCTION AND OBJECTIVES: The prevalence rate of metabolic syndrome in hypogonadism patients is known to be increased due to changes in body composition. Klinefelter’s syndrome is a known genetic syndrome which presents with hypogonadism and there have been several studies looking into the association between Klinefelter’s syndrome and metabolic syndromes. This study is aimed at proving our hypothesis that dyslipidemia, one of the criteria of metabolic syndrome is increased in Klinefelter’s syndrome compared to control group. METHODS: We have gathered date from two groups: 55 Klinefelter’s syndrome patients who were examined at our hospital from March 2005 to May 2012 and 120 patients who underwent health screening from January 2011 to December 2011. The two groups were analyzed for height, weight, BMI, testosterone, total cholesterol, highdensity lipoprotein(HDL), low-density lipoprotein(LDL), triglyceride(TG). We performed comparisons of each variable in the two groups. RESULTS: Height and weight were significantly greater in Klinefelter’s group, but no difference was found in BMI. Testosterone level in Klinefelter’s group was significantly lower than the control group (2.4 ¡3⁄4 2.6 vs 5.2 ¡3⁄4 1.8, p⬍0.001). Compared with controls, TG in Klinefelter’s group was increase than the control group (187.9 ¡3⁄4 192.1 vs 134.9 ¡3⁄4 127.8, p⫽0.004) and HDL was significantly decrease (44.0 ¡3⁄4 9.5 vs 51.2 ¡3⁄4 22.0, p⫽0.009). LDL and cholesterol were not significantly different between the two groups. (p⫽0.076, p⫽0.256, respectively). CONCLUSIONS: Dyslipidemia indexes of the Klinefelter’s syndrome patients were found to be abnormal compared to the control group. Based on our findings, we recommend that Klinefelter’s syndrome patients who visit urology clinics for infertility counseling be screened for dyslipidemia and appropriately treated for their metabolic abnormalities. Source of Funding: None
2289 INCREASED RISK OF CANCER AMONG AZOOSPERMIC MEN Michael Eisenberg*, Stanford, CA; Paul Betts, Austin, TX; Danielle Herder, Dolores Lamb, Larry Lipshultz, Houston, TX INTRODUCTION AND OBJECTIVES: Infertile men may have a higher risk of cancer than the general population. Given the heterogeneous etiologies of male infertility, it would be useful to define the specific groups of infertile men who are at an increased risk of cancer. This study sought to determine the association between azoospermia and the development of cancer in infertile men. METHODS: A total of 2,238 men were evaluated for infertility at a single andrology clinic in Texas from 1989 to 2009 with complete records. Men were stratified based on azoospermia status. Cancer incidence was determined by data linkage to the Texas Cancer Registry. The incidence of cancer was compared to the incidence in an age-matched sample from men in the general Texas population. We also analyzed the risk of cancer in infertile men with and without azoospermia using a Cox regression model. RESULTS: Compared to the general Texas population, infertile men had a higher risk of cancer with 29 cases observed compared with
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
16.7 expected (SIR 1.7, 95% CI 1.2-2.5). When stratifying by azoospermia status, only azoospermic men had a significantly elevated risk of cancer (SIR 2.9, 95% CI 1.4-5.4). Infertile men without azoospermia had a trend toward a higher rate of cancer to the general Texas population (SIR 1.4, 95% CI 0.9-2.2). The Cox regression model revealed that azoospermic men had 2.2 fold higher risk compared to non azoospermic men (HR 2.2, 95% CI 1.0-4.8) after adjusting for age and year of evaluation. CONCLUSIONS: Men with azoospermia have an increased risk of subsequently developing cancer, suggesting a possible common etiology between azoospermia and cancer development. Source of Funding: None
2290 THE SEMEN ANALYSIS OUTCOMES OF TESTIS CANCER PATIENTS WITH AZOOSPERMIA PRIOR TO ORCHIECTOMY Patrick Teloken*, Darren Katz, Boback Berookhim, John Mulhall, New York, NY INTRODUCTION AND OBJECTIVES: Testis cancer (TC) patients are at increased risk of sub-fertility prior to any intervention. Evidence suggests that improvement in semen parameters may occur after orchiectomy (O). This analysis was undertaken to assess the effects of orchiectomy in the semen analysis of men with TC who were diagnosed with azoospermia (AZ). METHODS: A review of records of patients meeting the following criteria was conducted: (i) documented AZ prior to orchiectomy for the management of TC (ii) no prior paternity (iii) no TESE performed at time of O and (iv) semen analysis after O but prior to any further intervention. For patients with post-O AZ and with ⱕ1 million (M) sperm/ml, testis sperm extraction (TESE) was performed. Testis cancer histopathology, hormonal profile (total testosterone, TT; follicle stimulating hormone, FSH), semen and TESE data were recorded. Multivariable analysis was performed in an attempt to identify predictors of sperm return the ejaculate or retrieval on TESE after O. Factors included in the model were: patient age, serum T and FSH levels, testis volume, type of TC. RESULTS: Thirty-six patients were included. Mean age ⫽ 34⫾16 years. Mean volume of unaffected testis ⫽ 16⫾8 ml. Sixty-eight percent of men had a seminoma while the remainder had a nonseminomatous germ cell tumor (NSGCT). Mean post-O TT was 364⫾168 ng/dl and FSH 11⫾4 IU/ml. Twenty-wo (61%) patients remained AZ after O, but 14 (39%) had return of some sperm to their semen; 22% ⱕ1M/ml and 17% ⬎1M/ml (mean 4.2⫾3.6, range 1.6-8). Thirty men underwent TESE; 16/22 (73%) AZ patients had sperm found (mean vial number cryopreserved ⫽ 4); 8/8 (100%) men with near-AZ had sperm found (mean vial number 11). Mean FSH for these two TESE groups ⫽ 9 and 6 respectively (p⫽0.08). No predictors of sperm return or sperm retrieval on TESE were identified. CONCLUSIONS: More than one third of men with pre-O AZ had sperm return to their semen after O. Sperm concentration was sufficient to avoid TESE in almost 20% of men. Overall, more than 80% of patients with testicular cancer and azoospermia prior to any intervention had sperm available for banking prior to adjuvant treatment. Source of Funding: None
2291 TESTOSTERONE PRESCRIBING PATTERNS IN THE MALE INFERTILITY POPULATION Mary Samplaski*, Yasir Loai, Kirk Lo, Ethan Grober, Keith Jarvi, Toronto, Canada INTRODUCTION AND OBJECTIVES: Over the last decade there has been a gradual increase in testosterone (T) prescribing. We sought to analyze patterns of T prescribing in men presenting for infertility evaluation.
THE JOURNAL OF UROLOGY姞
e939
METHODS: Men presenting for fertility evaluation from 20082012 on T were identified via a prospective database. Data were analyzed for prevalence, prescriber, formulation, dosage and indication. RESULTS: 4400 men were evaluated for male infertility, and 56 (1.3%) were on T at presentation. Prescribers included: Endocrinologists (10, 17.9%), General Practitioners (5, 8.9%), Urologists (3, 5.3%), and independently obtained (4, 7.1%). Formulations and dosages included: Gel (26, 46.4%): most commonly 5mg every other day (QOD), range: 5mg QOD to 10mg daily; Intramuscular injection (25, 44.6%), most commonly 200mg every 2 weeks, range: 50-300mg every 2 weeks; Oral (1, 1.8%), 80mg QOD; Pellet (1, 1.7%), dose unknown; and unknown formulation and dose (5, 8.9%). Indications for T included: symptoms of hypogonadism (27, 48.2%), symptoms ⫹ low serum T (21, 37.5%), low serum T (4, 7.1%), athletic purposes (3, 5.4%), and subfertility (1, 1.8%). Co-existing conditions included: Klinefelters syndrome (8, 14.3%), history of bilateral undescended testicles (7, 12.5%), Kallmans syndrome (5, 8.9%), Sertoli only syndrome (2, 3.6%), chemotherapy induced testicular failure (2, 3.6%), prolactinoma (2, 3.6%), anejaculation (1, 1.8%), and opioid induced testicular failure (1, 1.8%). CONCLUSIONS: At our infertility center, T was not commonly used by men presenting for infertility investigation. Most men on T were being treated for appropriate conditions, with appropriate routes and dosages. Endocrinologists and General Practitioners were the most common prescribers, and educational efforts to emphasize the negative impacts of T on spermatogenesis should be focused on these groups. There are a group of men that obtain their T independently, and a group that uses T for athletic purposes. While this was a small fraction of the men in our population of infertile men, as the use of T increases, this fraction will undoubtedly grow. Source of Funding: None
2292 MEDICAL TESTOSTERONE CAUSES IATROGENIC MALE INFERTILITY - A GROWING PROBLEM Matthew Lane Purcell*, Birmingham, AL; William Parker, Kansas City, KS; Tyler Poston, Birmingham, AL; Ajay K. Nangia, Kansas City, KS; Peter N. Kolettis, Birmingham, AL INTRODUCTION AND OBJECTIVES: An increasing number of men in their reproductive years are on supplemental testosterone (T) for low T levels, decreased energy, or low libido. It is well known that testosterone can decrease sperm count. We have observed many men coming in for infertility work up have been on supplemental T. The objective of the study was to determine the prevalence of testosterone usage in an infertility practice and to see the recovery of semen parameters with treatment. METHODS: A retrospective chart review was performed for all male infertility patients for two providers from separate institutions from 1/2005 to 3/2011 (N⫽1540). Strict inclusion criteria were supplemental T usage at the time of initial visit, stopping testosterone usage, and semen analysis both while on T and after stopping. Patients who were also started on a recovery treatment (clomiphene, human chorionic gonadotropin and/or follicle stimulating hormone) at the same time as stopping the testosterone were also included. Comparisons were made based on sperm concentration before stopping testosterone and after stopping testosterone. RESULTS: 110 of the 1540 patients (7.1%) we looked at were on supplemental T. 34 patients met the inclusion criteria. 17 of 34 (50%) were started on recovery treatment. Overall, a statistically significant increase in average sperm concentration from 1.8 million/ml to 34 million/ml (p⬍0.0001) was seen after T cessation. 6 of the 34 patients (17.6%) did not have any recovery after cessation. 5 of 6 of these patients were tried on recovery treatment. Semen values were collected at an average of 97.6 days after discontinuing T. There was a significant increase in sperm concentration when the groups were stratified between those started on a recovery treatment (p⫽0.0011)
THE JOURNAL OF UROLOGY姞
weight, gestational age and other characteristics of the 7,752 male infants and determined the association between methods of conception and male reproductive disorders in the infants. We also analyzed the influence of male factor on the occurrence of these disorders. RESULTS: Ninety nine (1.3%) newborns were diagnosed with cryptorchidism, 8 (0.1%) were diagnosed with hypospadias, and 4 (0.05%) were diagnosed with both. Cryptorchidism was more common in children conceived through in vitro fertilization (IVF) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) (p ⬍ 0.05) and hypospadias was more common in children conceived through in vitro fertilization/intracytoplasmic sperm injection (p ⬍ 0.05). Children conceived through intrauterine insemination (IUI), in vitro fertilization and in vitro fertilization/intracytoplasmic sperm injection had higher rates of low birth-weight and preterm birth. Logistic regression analysis showed that low birth-weight and preterm birth were significantly associated with male reproductive disorders, whereas method of conception was not. Male factor was not significantly associated with these disorders. CONCLUSIONS: In vitro fertilization and in vitro fertilization/ intracytoplasmic sperm injection increase the risks of low birth-weight and preterm birth, resulting in increased rates of hypospadias and cryptorchidism. Male factor was not associated with reproductive disorders in male infants. Source of Funding: None
2287 PREVALENCE AND CLINICAL MEANING OF METABOLIC SYNDROME IN EUROPEAN CAUCASIAN MEN PRESENTING FOR PRIMARY COUPLE’S INFERTILITY Andrea Salonia*, Paolo Capogrosso, Marco Bianchi, Eugenio Ventimiglia, Maria Chiara Clementi, Giulia Castagna, Michele Colicchia, Luca Boeri, Cesare Regina, Alessandro Serino, Emanuele Zaffuto, Luca Villa, Ryan Matloob, Milan, Italy; Rocco Damiano, Catanzaro, Italy; Luca Carmignani, Francesco Montorsi, Milan, Italy INTRODUCTION AND OBJECTIVES: Assess prevalence of and clinical impact of metabolic syndrome (MetS) in European Caucasian men presenting for primary couple’s infertility. METHODS: Complete demographic, clinical and laboratory data from 1169 consecutive infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI; categorized 0 vs 1 vs ⱖ2); NCEP-ATPIII criteria were used to define MetS. Testicular volume was assessed with a Prader orchidometer. Semen analysis values were assessed based on 2010 World Health Organization (WHO) reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and MetS. RESULTS: Of all, male factor infertility and mixed infertility were found in 890 (76.1%) and 279 (23.9%) men, respectively. MetS was found in 101 (8.6%) of 1169 men. Patients with MetS were older (p⬍0.001), had a higher BMI (p⬍0.001), a greater rate of CCIⱖ1 (2:44.205; p⬍0.001), and lower testicular volumes (all p⬍0.03), as compared with those without MetS. Moreover, MetS patients had a lower serum total testosterone (tT) (p⫽0.002), a higher level of luteinizing hormone (LH) (p⫽0.001), and were hypogonadal in a higher rate (2:6.958; p⫽0.008) than patients without MetS. Conversely, no differences were found between groups in terms of follicle-stimulating hormone (FSH), inhibin B, 17 estradiol (E2) levels, and tT/E2 ratio values. Likewise, the two groups did not significantly differ in terms of semen parameters and rate of either obstructive or non-obstructive azoospermia. At multivariate logistic regression analysis serum FSH (OR: 1.36; p⬍0.001) and testicular volume (OR: 0.59; p⬍0.001) achieved independent predictor status for WHO normal semen concentration; conversely, age, CCI scores, MetS, and inhibin B values did not. No parameters predicted normal sperm progressive motility and morphology.
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
CONCLUSIONS: MetS accounts for roughly 9% in men presenting for primary couple’s infertility. Overall, while MetS patients have a lower general male health status, semen analysis values seem independent of the presence of MetS. Source of Funding: None
2288 THE RELATION BETWEEN DYSLIPIDEMIA WITH THE KLINEFELTER’S SYNDROME PATIENT Se Hwan Park*, Dae Gi Jo, Hyo Serk Lee, Jin Ho Choe, Joong Shik Lee, SEOUL, Korea, Republic of; Young Ho Kim, Korea, Republic of; Ju Tae Seo, SEOUL, Korea, Republic of INTRODUCTION AND OBJECTIVES: The prevalence rate of metabolic syndrome in hypogonadism patients is known to be increased due to changes in body composition. Klinefelter’s syndrome is a known genetic syndrome which presents with hypogonadism and there have been several studies looking into the association between Klinefelter’s syndrome and metabolic syndromes. This study is aimed at proving our hypothesis that dyslipidemia, one of the criteria of metabolic syndrome is increased in Klinefelter’s syndrome compared to control group. METHODS: We have gathered date from two groups: 55 Klinefelter’s syndrome patients who were examined at our hospital from March 2005 to May 2012 and 120 patients who underwent health screening from January 2011 to December 2011. The two groups were analyzed for height, weight, BMI, testosterone, total cholesterol, highdensity lipoprotein(HDL), low-density lipoprotein(LDL), triglyceride(TG). We performed comparisons of each variable in the two groups. RESULTS: Height and weight were significantly greater in Klinefelter’s group, but no difference was found in BMI. Testosterone level in Klinefelter’s group was significantly lower than the control group (2.4 ¡3⁄4 2.6 vs 5.2 ¡3⁄4 1.8, p⬍0.001). Compared with controls, TG in Klinefelter’s group was increase than the control group (187.9 ¡3⁄4 192.1 vs 134.9 ¡3⁄4 127.8, p⫽0.004) and HDL was significantly decrease (44.0 ¡3⁄4 9.5 vs 51.2 ¡3⁄4 22.0, p⫽0.009). LDL and cholesterol were not significantly different between the two groups. (p⫽0.076, p⫽0.256, respectively). CONCLUSIONS: Dyslipidemia indexes of the Klinefelter’s syndrome patients were found to be abnormal compared to the control group. Based on our findings, we recommend that Klinefelter’s syndrome patients who visit urology clinics for infertility counseling be screened for dyslipidemia and appropriately treated for their metabolic abnormalities. Source of Funding: None
2289 INCREASED RISK OF CANCER AMONG AZOOSPERMIC MEN Michael Eisenberg*, Stanford, CA; Paul Betts, Austin, TX; Danielle Herder, Dolores Lamb, Larry Lipshultz, Houston, TX INTRODUCTION AND OBJECTIVES: Infertile men may have a higher risk of cancer than the general population. Given the heterogeneous etiologies of male infertility, it would be useful to define the specific groups of infertile men who are at an increased risk of cancer. This study sought to determine the association between azoospermia and the development of cancer in infertile men. METHODS: A total of 2,238 men were evaluated for infertility at a single andrology clinic in Texas from 1989 to 2009 with complete records. Men were stratified based on azoospermia status. Cancer incidence was determined by data linkage to the Texas Cancer Registry. The incidence of cancer was compared to the incidence in an age-matched sample from men in the general Texas population. We also analyzed the risk of cancer in infertile men with and without azoospermia using a Cox regression model. RESULTS: Compared to the general Texas population, infertile men had a higher risk of cancer with 29 cases observed compared with
Vol. 189, No. 4S, Supplement, Wednesday, May 8, 2013
16.7 expected (SIR 1.7, 95% CI 1.2-2.5). When stratifying by azoospermia status, only azoospermic men had a significantly elevated risk of cancer (SIR 2.9, 95% CI 1.4-5.4). Infertile men without azoospermia had a trend toward a higher rate of cancer to the general Texas population (SIR 1.4, 95% CI 0.9-2.2). The Cox regression model revealed that azoospermic men had 2.2 fold higher risk compared to non azoospermic men (HR 2.2, 95% CI 1.0-4.8) after adjusting for age and year of evaluation. CONCLUSIONS: Men with azoospermia have an increased risk of subsequently developing cancer, suggesting a possible common etiology between azoospermia and cancer development. Source of Funding: None
2290 THE SEMEN ANALYSIS OUTCOMES OF TESTIS CANCER PATIENTS WITH AZOOSPERMIA PRIOR TO ORCHIECTOMY Patrick Teloken*, Darren Katz, Boback Berookhim, John Mulhall, New York, NY INTRODUCTION AND OBJECTIVES: Testis cancer (TC) patients are at increased risk of sub-fertility prior to any intervention. Evidence suggests that improvement in semen parameters may occur after orchiectomy (O). This analysis was undertaken to assess the effects of orchiectomy in the semen analysis of men with TC who were diagnosed with azoospermia (AZ). METHODS: A review of records of patients meeting the following criteria was conducted: (i) documented AZ prior to orchiectomy for the management of TC (ii) no prior paternity (iii) no TESE performed at time of O and (iv) semen analysis after O but prior to any further intervention. For patients with post-O AZ and with ⱕ1 million (M) sperm/ml, testis sperm extraction (TESE) was performed. Testis cancer histopathology, hormonal profile (total testosterone, TT; follicle stimulating hormone, FSH), semen and TESE data were recorded. Multivariable analysis was performed in an attempt to identify predictors of sperm return the ejaculate or retrieval on TESE after O. Factors included in the model were: patient age, serum T and FSH levels, testis volume, type of TC. RESULTS: Thirty-six patients were included. Mean age ⫽ 34⫾16 years. Mean volume of unaffected testis ⫽ 16⫾8 ml. Sixty-eight percent of men had a seminoma while the remainder had a nonseminomatous germ cell tumor (NSGCT). Mean post-O TT was 364⫾168 ng/dl and FSH 11⫾4 IU/ml. Twenty-wo (61%) patients remained AZ after O, but 14 (39%) had return of some sperm to their semen; 22% ⱕ1M/ml and 17% ⬎1M/ml (mean 4.2⫾3.6, range 1.6-8). Thirty men underwent TESE; 16/22 (73%) AZ patients had sperm found (mean vial number cryopreserved ⫽ 4); 8/8 (100%) men with near-AZ had sperm found (mean vial number 11). Mean FSH for these two TESE groups ⫽ 9 and 6 respectively (p⫽0.08). No predictors of sperm return or sperm retrieval on TESE were identified. CONCLUSIONS: More than one third of men with pre-O AZ had sperm return to their semen after O. Sperm concentration was sufficient to avoid TESE in almost 20% of men. Overall, more than 80% of patients with testicular cancer and azoospermia prior to any intervention had sperm available for banking prior to adjuvant treatment. Source of Funding: None
2291 TESTOSTERONE PRESCRIBING PATTERNS IN THE MALE INFERTILITY POPULATION Mary Samplaski*, Yasir Loai, Kirk Lo, Ethan Grober, Keith Jarvi, Toronto, Canada INTRODUCTION AND OBJECTIVES: Over the last decade there has been a gradual increase in testosterone (T) prescribing. We sought to analyze patterns of T prescribing in men presenting for infertility evaluation.
THE JOURNAL OF UROLOGY姞
e939
METHODS: Men presenting for fertility evaluation from 20082012 on T were identified via a prospective database. Data were analyzed for prevalence, prescriber, formulation, dosage and indication. RESULTS: 4400 men were evaluated for male infertility, and 56 (1.3%) were on T at presentation. Prescribers included: Endocrinologists (10, 17.9%), General Practitioners (5, 8.9%), Urologists (3, 5.3%), and independently obtained (4, 7.1%). Formulations and dosages included: Gel (26, 46.4%): most commonly 5mg every other day (QOD), range: 5mg QOD to 10mg daily; Intramuscular injection (25, 44.6%), most commonly 200mg every 2 weeks, range: 50-300mg every 2 weeks; Oral (1, 1.8%), 80mg QOD; Pellet (1, 1.7%), dose unknown; and unknown formulation and dose (5, 8.9%). Indications for T included: symptoms of hypogonadism (27, 48.2%), symptoms ⫹ low serum T (21, 37.5%), low serum T (4, 7.1%), athletic purposes (3, 5.4%), and subfertility (1, 1.8%). Co-existing conditions included: Klinefelters syndrome (8, 14.3%), history of bilateral undescended testicles (7, 12.5%), Kallmans syndrome (5, 8.9%), Sertoli only syndrome (2, 3.6%), chemotherapy induced testicular failure (2, 3.6%), prolactinoma (2, 3.6%), anejaculation (1, 1.8%), and opioid induced testicular failure (1, 1.8%). CONCLUSIONS: At our infertility center, T was not commonly used by men presenting for infertility investigation. Most men on T were being treated for appropriate conditions, with appropriate routes and dosages. Endocrinologists and General Practitioners were the most common prescribers, and educational efforts to emphasize the negative impacts of T on spermatogenesis should be focused on these groups. There are a group of men that obtain their T independently, and a group that uses T for athletic purposes. While this was a small fraction of the men in our population of infertile men, as the use of T increases, this fraction will undoubtedly grow. Source of Funding: None
2292 MEDICAL TESTOSTERONE CAUSES IATROGENIC MALE INFERTILITY - A GROWING PROBLEM Matthew Lane Purcell*, Birmingham, AL; William Parker, Kansas City, KS; Tyler Poston, Birmingham, AL; Ajay K. Nangia, Kansas City, KS; Peter N. Kolettis, Birmingham, AL INTRODUCTION AND OBJECTIVES: An increasing number of men in their reproductive years are on supplemental testosterone (T) for low T levels, decreased energy, or low libido. It is well known that testosterone can decrease sperm count. We have observed many men coming in for infertility work up have been on supplemental T. The objective of the study was to determine the prevalence of testosterone usage in an infertility practice and to see the recovery of semen parameters with treatment. METHODS: A retrospective chart review was performed for all male infertility patients for two providers from separate institutions from 1/2005 to 3/2011 (N⫽1540). Strict inclusion criteria were supplemental T usage at the time of initial visit, stopping testosterone usage, and semen analysis both while on T and after stopping. Patients who were also started on a recovery treatment (clomiphene, human chorionic gonadotropin and/or follicle stimulating hormone) at the same time as stopping the testosterone were also included. Comparisons were made based on sperm concentration before stopping testosterone and after stopping testosterone. RESULTS: 110 of the 1540 patients (7.1%) we looked at were on supplemental T. 34 patients met the inclusion criteria. 17 of 34 (50%) were started on recovery treatment. Overall, a statistically significant increase in average sperm concentration from 1.8 million/ml to 34 million/ml (p⬍0.0001) was seen after T cessation. 6 of the 34 patients (17.6%) did not have any recovery after cessation. 5 of 6 of these patients were tried on recovery treatment. Semen values were collected at an average of 97.6 days after discontinuing T. There was a significant increase in sperm concentration when the groups were stratified between those started on a recovery treatment (p⫽0.0011)