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were visited by a single urologist. Patients’ medical history, BMI, and educational status were comprehensively detailed. Comorbidities were thus scored by means of the Charlson Comorbidity Index (CCI) which REMHFWLYHO\GHWDLOVDQ\HYHQWXDOVLJQL¿FDQWKHDOWKGLVRUGHU'DWDIURP this cohort was compared with those of 174 consecutive European &DXFDVLDQPHQIHUWLOHE\GH¿QLWLRQPHDQ“6'DJHDWVXUYH\“ \U UDQJH  PHDQ Q RI IDWKHUKRRGV “ UDQJH   ZKR responded to an advertisement posted in our hospital during the period September-October 2007, and were screened for this study. Data between groups were compared using a two-sided independent T-test. Linear regression models tested the association between predictors >LQFOXGLQJDJH%0,DQGHGXFDWLRQDOVWDWXV@DQGSDWLHQW¶VKHDOWKVWDWXV as reliably scored with CCI. 5(68/76,QIHUWLOHPHQZHUHVLJQL¿FDQWO\ROGHU“YV “\US WKDQIHUWLOHPHQDWWKHDJHRIWKHLU¿UVWIDWKHUKRRG Moreover infertile men had a greater BMI (26.1±4.0 vs. 25.2±3.0 kg/ m2S  KDGDKLJKHUUDWHRIFRPRUELGLWLHV&&,“YV “S  DQGDORZHUHGXFDWLRQDOOHYHOKLJKVFKRROFROOHJH 77.6 vs. 85.6%, p=0.03) as compared with fertile men. The linear regression analysis showed that while educational status did not impact WRZDUGV&&,3  &&,OLQHDUO\LQFUHDVHGZLWKDJHLQJ3%HWD  DQG%0,S%HWD $IWHUDGMXVWLQJIRU$JH%0,DQG educational status, fertile patients were associated with a lower CCI VFRUH3 %HWD  CONCLUSIONS: These preliminary results show that being an infertile man could also account for being overall less healthy, regardless of the etiology of pure male factor infertility, as objectively scored with a internationally-validated, reliable comorbidity index. Source of Funding: None

1908 VIBRATORY EJACULATION IN 169 SPINAL CORD INJURED MEN AND HOME INSEMINATION OF THEIR PARTNERS Jens Sonksen*, Dieter Lochner-Ernst, Nancy L Brackett, Dana A Ohl, Charles M Lynne. Copenhagen, Denmark, Murnau, Germany, Miami, FL, and Ann Arbor, MI. INTRODUCTION AND OBJECTIVE: Anejaculation and impairment of semen quality are commonly found in men after spinal cord injury (SCI). Over the past several decades, clinical treatments and assisted reproductive techniques have been developed allowing SCI men to father children. However, only very few home pregnancies have been reported in the literature. The purpose of this study is to present the last 20 years’ experience from penile vibratory stimulation (PVS) and vaginal self-insemination at home in SCI men and their partners. The data originate from two European and two American centers. METHODS: Men with SCI and their healthy female partners seeking treatment for infertility were evaluated for this study. Antegrade ejaculation was induced by PVS and basic semen analysis was performed (WHO criteria). Only men who obtained antegrade ejaculation by PVS and had motile sperm in the ejaculate were included. The couples were carefully instructed to perform PVS by themselves at home. The ejaculate was collected into a nonspermicidal container. A 10-mL syringe was then used to deposit the ejaculate intravaginally. The main outcome measures were total motile sperm count, time to pregnancies, numbers of pregnancies and miscarriages. RESULTS: A total of 169 SCI men (median age 32 yrs, range 22-44) and their partners (median age 29 yrs, range 19-36) met the inclusion criteria and were included in the study. The median total motile sperm count was 31 million (range 1-426). Overall, 73 of the 169 couples (43%) achieved 99 pregnancies with delivery of 87 healthy babies (85 singletons and 1 pair of twins). There are 3 ongoing pregnancies. The median time to pregnancy was 1.2 years (range 0.1-8.2). A total of 10 miscarriages in 9 couples were noted. No complications from the PVS or home insemination procedures were reported. CONCLUSIONS: Based on the largest study of its kind to date, it is concluded that PVS combined with vaginal self-insemination may be performed as a viable, inexpensive option for assisted conception in couples in whom the SCI male partner has adequate semen parameters and the female partner is healthy. Source of Funding: None

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1909 MALE RESULTS OF THE SPARE STUDY: SURVEY FOR PRESERVATION OF ADOLESCENT REPRODUCTION Tobias S Kohler*, Sarah Chan, Amul M Shah, Laxmi A Kondapalli, Marybeth Gerrity, Teresa K Woodruff, Robert Brannigan. Chicago, IL. INTRODUCTION AND OBJECTIVE: Since the inception of ICSI, studies have demonstrated disconnect between available IHUWLOLW\SUHVHUYDWLRQ)3 WHFKQLTXHVDQGWKHLUXWLOL]DWLRQ,QWKH American Society of Clinical Oncology published FP Recommendations (ASCOR) stressing sperm cryopreservation strategies and referral to a fertility specialist if appropriate. Through SPARE, we sought to obtain nationwide, post-ASCOR FP data from pediatric oncologists. METHODS: The SPARE survey was created by our group and consists of 22 questions assessing FP attitudes and practice patterns for both pre-pubertal (age 1-12) and pubertal (13-18) cancer patients (pts) for both males and females. In addition, the survey asks about knowledge RIVSHFL¿F)3PHWKRGV$6&25DQGWKHLUXVHDQGDVVHVVHVSDUWLFLSDQW demographics. The survey was constructed and collected through the use of SurveyMonkey and launched via an oncology email list serve. RESULTS: To date, data from 49 respondents has been obtained. The majority of respondents were pediatric oncologists (>90%), DYHUDJHDJHIHPDOHDQGDI¿OLDWHGZLWKDXQLYHUVLW\SUDFWLFH (88%). Respondents strongly endorsed that male pubertal (100%) and pre-pubertal (86%) pts should be told about potential drug or radiation damage to the testicles prior to treatment. 90% felt male pubertal pts VKRXOGEHUHIHUUHGWRDIHUWLOLW\VSHFLDOLVWSUHWUHDWPHQWKRZHYHURQO\ 52% of respondents actually referred these pts > 50% of the time. The ¿JXUHEHORZOLVWVUHVXOWVWRRWKHUTXHVWLRQVRIUHVSRQGHQWVRIIHUHG sperm banking to pubertal pts most commonly within 1 week of diagnosis (84%). The biggest barriers to sperm banking reported were poor prognosis, desire for expeditious cancer treatment, cost, and parental consent. 55% of the respondents reported knowing what ICSI was. Only 45% of respondents were familiar with the 2006 ASCOR, and only 10% RIWKHWRWDOVDPSOHXWLOL]HGWKHPIRUSWGHFLVLRQV!RIWKHWLPH CONCLUSIONS: Pediatric oncologists are strongly motivated to preserve fertility in male pediatric cancer pts but barriers to semen/ testicular tissue preservation and referral to fertility specialists exist. Additional promotion of the ASCO fertility preservation recommendations LVHVVHQWLDOWRRSWLPL]HUHSURGXFWLYHKHDOWKRI\RXQJPDOHFDQFHUSWV

Source of Funding: None

1910 RECOVERY OF SPERMATOGENESIS AFTER EXOGENOUS TESTOSTERONE ADMINISTRATION Jesse N Mills*, Ethan D Grober, Mohit Khera, David M Fenig, Kumaran Sathymoorthy, Larry I Lipshultz. Houston, TX, and Toronto, ON, Canada. INTRODUCTION AND OBJECTIVE: Exogenous testosterone (T) use among men of reproductive years is becoming increasingly common. An estimated 1% of men between the ages of 18 and 45 are on testosterone replacement therapy (TRT). Exogenous administration of T impairs or halts spermatogenesis. The two most common types of T administration in the United States are via injectable and transdermal (TD) gel routes. We investigated the impact of TRT on spermatogenesis and compared the difference in time course of testicular recovery between the two types of TRT.

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METHODS: In this retrospective study, 22 men aged 25 to 54, presented to one physician (LIL) for treatment for male-factor infertility on TRT. The duration of TRT, delivery system used, hormone levels (FSH, LH, T), semen volume and sperm density, and length of time to recovery of sperm to the ejaculate were investigated. All men KDGD]RRVSHUPLDH[FHSWRQHZLWKDVSHUPGHQVLW\RIPLOOLRQP/$OO men were placed on the same regimen of HCG, 3000 units, IM, every other day and were concomitantly placed on an aromatase inhibitor to prevent gynecomastia. Semen and hormone analyses were performed after 4 weeks of treatment and every month thereafter until the semen quality became stable or a pregnancy was achieved. RESULTS: Since 2006, we have treated 22 men with nonREVWUXFWLYHD]RRVSHUPLDZLWKDKLVWRU\RI7577KHUHZHUHPHQLQ the group using injectable T and 12 men in the group using TD T. Out of these 22 men, we have so far restored sperm to the ejaculate in 20. There ZDVQRVLJQL¿FDQWGLIIHUHQFHLQDJHVEHWZHHQWKHWZRJURXSV0HQZLWK a history of injectable testosterone administration had a mean recovery time of 3.2 months. Men in the TD group had a mean recovery time of PRQWKV7KLVLVDVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFH3YDOXH  No men discontinued therapy due to adverse effects of treatment. CONCLUSIONS: TRT use is prevalent in males of reproductive age. Men using injectable TRT recover sperm sooner than men on TD TRT. This may be due to the reasons why these men initially used T. Men in the TD group were prescribed T for idiopathic hypogonadism and likely had impaired spermatogenesis at baseline. Men in the injectable group tended to be self-medicated and predictably had normal physiologic levels of T and normal spermatogenesis prior to treatment. $QDGGLWLRQDOK\SRWKHVLVLVWKDWLQMHFWDEOH7FDXVHVÀXFWXDWLQJOHYHOVRI serum T and therefore, at the T nadir, there may be intermittent increased gonadotropin release with some stimulation of spermatogenesis. Source of Funding: None

1911 OUTCOMES OF POST-CHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION ASSOCIATED-ANEJACULATION MANAGEMENT Serkan Deveci*, Keith O’Brien, John P Mulhall. New York, NY. INTRODUCTION AND OBJECTIVE: While sympathetic trunk sparing and subsequent ejaculatory ability is readily accomplished with contemporary primary retroperitoneal lymph node dissection (RPLND), post-chemotherapy (CT) RPLND is not associated with as high a success rate in this respect. This analysis aimed to assess the outcomes of management of anejaculation in men after post-CT RPLND. METHODS: A retrospective analysis of all men presenting ZLWKHMDFXODWRU\IDLOXUHDIWHUSRVW&753/1'GH¿QHGDVQRDQWHJUDGH semen production despite achievement of orgasm) was conducted. All patients were evaluated by history, physical examination and had serum androgens/gonadotropin measurement as well as a postorgasm semen analysis/urinalysis. All patients were initially treated with pseudoephedrine 60mgs QID for 2 days to assess for pharmacologic recovery of ejaculation. If alpha-agonist therapy failed the patients proceeded to electroejaculation (EEJ) and/or testis sperm extraction (TESE). Demographic, comorbidity, semen analysis and treatment data were recorded. RESULTS: 26 patients were included with a mean age of 27±9 years. All patients presented within 12 months of surgery (mean “ PRQWKV  0HDQ WRWDO WHVWRVWHURQH ZDV “ QJGO )6+ ZDV 12.8±7.2 IU/ml. On retrograde semen analysis, 15% had semen/sperm retrieved from their urine (retrograde ejaculation), while 85% had failure of emission. None of the failure of emission patients responded to pseuodephedrine, while 50% (2/4) retrograde ejaculators had antegrade ejaculation using the medication. 96% of those men who underwent EEJ had semen and/or sperm retrieved. The mean sperm concentration, forward motility and normal morphology rates were 12±22 M/ml, 36±24% and 19±34 respectively. 25% (2/4) of the retrograde ejaculators (semen but no sperm present in urine) and 23% (5/22) of failure of emission SDWLHQWV ZHUH D]RRVSHUPLF DQG DOO ZHQW RQWR 7(6(    KDG sperm retrieved on TESE. CONCLUSIONS: The majority of patients who have ejaculatory failure after post-CT RPLND have failure of emission. This condition appears not to well-treated with pharmacotherapy. However,

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50% of retrograde ejaculators respond to alpha-agonist therapy. EEJ was almost always successful. These data may allow clinicians to better counsel and treat such patients. Source of Funding: None

1912 SURVEY OF VARICOCELECTOMY: TECHNIQUES EMPLOYED BY AUA UROLOGISTS Shailen S Sehgal*, David I Chu, Brandon J Otto, Danielle N Acosta, Marc Goldstein. Philadelphia, PA, and New York, NY. INTRODUCTION AND OBJECTIVE: Varicocele is the leading correctable cause of male infertility. In this study, we assess urologists’ techniques and attitudes regarding varicocelectomy. 0(7+2'6 6XUYH\V ZHUH VHQW WR WKH ¿UVW  QDPHV LQ the 2005-2006 AUA directory. Eight questions were asked regarding varicocelectomy technique. RESULTS: Of 1044 surveys received, 266 were returned, a 25.5% yield. Of 258 urologists performing varicocelectomy, 18.22% Q   XWLOL]HG DQ RSHUDWLQJ PLFURVFRSH  Q   XVHG ORXSH PDJQL¿FDWLRQ  Q   XVHG QR PDJQL¿FDWLRQ DQG  (n=18) used laparoscopic technique. Of the 258 urologists performing varicocelectomy, 73.26% (n=189) were general urologists, 4.26% (n=11) were pediatric urologists, 3.1% (n=8) had completed a male infertility fellowship, 3.49% (n=9) were general urologists who had taken a microsurgery course, and 15.9% (n=41) had microsurgical training during residency. Of 47 urologists using an operating microscope, 87.23% (n=41) felt it improved patient outcomes/decreased morbidity, 6.38% (n=3) reported that patients requested a microsurgical approach, Q  IHOWPRUHFRQ¿GHQWXVLQJDPLFURVXUJLFDOYDULFRFHOHFWRP\ and 4.26% (n=2) sited other reasons. Of 211 not using a microscope, 32.23% (n=68) were never trained in microsurgical varicocelectomy, 48.34% (n=102) felt there was no improvement in patient outcomes/ morbidity with microsurgery, 4.27% (n=9) did not have access to an operating microscope, 9.95% (n=21) sited other reasons, and 15.17% (n=32) offered no response. CONCLUSIONS: Urologists were more likely to perform a non-microsurgical as compared to a microsurgical varicocelectomy in nearly a 4:1 ratio, however, a majority (59%) who did non-microsurgical UHSDLUVHPSOR\HGORXSHPDJQL¿FDWLRQ7KRVHSHUIRUPLQJPLFURVXUJLFDO varicocelectomy were more likely to be fellowship trained and have a larger proportion of their practice devoted to male infertility. Microsurgical varicocelectomy has been unequivocally shown to reduce recurrence and morbidity and is the approach recommended in the last 4 editions of Campbell’s Urology as well as the AUA Best Practice Guidelines. Loupe PDJQL¿FDWLRQLVEHWWHUWKDQQRQH0LFURVXUJLFDOWUDLQLQJGXULQJUHVLGHQF\ LVHVVHQWLDOWRLQFUHDVHXWLOL]DWLRQRIPLFURVXUJLFDOYDULFRFHOHFWRP\ Source of Funding: Institute for Reproductive Medicine, Weill Medical College of Cornell University.

1913 PROSPECTIVE LONGITUDINAL ANALYSIS OF THE IMPACT OF CANCER AND CHEMOTHERAPY ON MALE REPRODUCTIVE HEALTH Peter T Chan*, Cristian O’Flaherty, Barbara Hales, Bernard Robaire. Montreal, QC, Canada. INTRODUCTION AND OBJECTIVE: While the incidence of malignancies commonly affecting men in their reproductive age, such as testis cancer (TC) and Hodgkin’s lymphoma (HL), is on the rise in recent years, survival rates have also improved tremendously, allowing many cancer survivors to consider having children. The objective of the present study was to evaluate the impact of cancer and chemotherapy on the reproductive health of TC and HL survivors. METHODS: A cohort of patients with TC (n=22) and HL (n=21) who required chemotherapy was recruited prospectively. Evaluations were done pre-chemotherapy (baseline) and subsequently every 6 months for 24 months and consisted of assessing general, psychosocial, VH[XDODQGUHSURGXFWLYHKHDOWKVHUXPKRUPRQDOSUR¿OHURXWLQHVHPHQ analyses, and sperm chromatin structure assays (SCSA) to assess the DNA fragmentation index (DFI). Control groups consisted of age-