Validation of nomograms predicting semen parameters following varicocele repair

RESULTS: Of 51 consecutive patients, 47 underwent bilateral or unilateral surgical reconstruction, the other four were unable to be treated with surgical reconstruction due to pelvic vas and intratesticular obstruction. Reconstruction rate was 92.2% (47/51), patency rate and natural pregnancy rate were 89.4% (42/47) and 38.1% (16/42) respetively. The incidence of epididymal obstruction and ejaculatory duct obstruction (EDO) were 55.6% and 21.2% respectively. CONCLUSION: By using multiple advanced surgical techniques, most of aquired obstructive azoospermia could be repaired, a favorable patency and pregnancy rate can be achieved for properly selected patients. P-152 Tuesday, October 21, 2014 SALVAGE HORMONAL THERAPY AFTER FAILED MICRODISSECTION TESTICULR SPERM EXTRACTION: A MULTI-INSTITUTIONAL PROSPECTIVE STUDY. K. Shiraishi,a T. Ishikawa,b N. Watanabe,c T. Iwamoto,d H. Matsuyama.a aDepartment of Urology, Yamaguchi University, Ube, Yamaguchi, Japan; bReproduction Clinic Osaka, Osaka, Japan; cReproduction Center, Akasaka Sanno Hospital, Tokyo, Japan; d Center for Infertility and IVF, International University of Health and Welfare Hospital, Nasushiobara, Tochigi, Japan. OBJECTIVE: We have reported an hCG-based salvage hormonal therapy for men with nonobstructive azoospermia (NOA) who failed to retrieve sperms by microdissection testicular sperm extraction (microTESE) and 20% of men could retrieve sperms at the 2nd micro-TESE (Hum Reprod 2012). To validate the efficacy of the salvage hormonal therapy, a multi-institutional prospective study has been done by recruiting NOA men who could not retrieve sperms with various histologies because our prior study included a number of patients with late maturation arrest and hypospermatogenesis. DESIGN: A prospective study at reproduction centers. MATERIALS AND METHODS: NOA men who could not retrieve sperms by micro-TESE and required further treatment, excluding, chromosomal abnormalities, AZFa or b deletions, extremely small testes (less than 2 ml), prior hormonal therapy, were asked to participate in this study. hCG stimulation (5000 IU, 3 times a week) was started > 6 months after the first microTESE. After one months of the hCG therapy, patients were treated with recombinant human FSH (150 IU, 3 times a week) and hCG for the next 3 months. Three testicular samples were obtained randomly from both testes and sent for pathological diagnosis at 1st and 2nd micro-TESE. The study protocol was approved by our institution, and informed consent was obtained from all participants. RESULTS: Twenty-one men were eligible to our inclusion criteria and all the participants completed the hormonal treatment without any severe adverse effects. At the first micro-TESE, 13 and 5 patients showed Sertoli cell only or early maturation arrest, respectively. Serum testosterone significantly increased and endogenous gonadotropin secretions significantly decreased after one month of treatment. With the second microTESE, sperm were successfully obtained from two patients (9%). Patient age, testicular volume, and hormone profiles did not associated with the results of the 2nd micro-TESE, however, the testicular histologies of the two patients were late maturation arrest and hypospermatogenesis. CONCLUSION: The effectiveness of hCG-based salvage hormonal therapy preceding a second micro-TESE has been validated for limited cases. NOA men who have differentiated cells in their testes are more likely to respond to the hormonal stimulation.

P-153 Tuesday, October 21, 2014 VALIDATION OF NOMOGRAMS PREDICTING SEMEN PARAMETERS FOLLOWING VARICOCELE REPAIR. M. K. Samplaski,a C. Yu,b M. Kattan,b H. Yan,a K. C. Lo,a E. D. Grober,a A. Dabaja,c M. Goldstein,d K. Alrabeeah,d A. Zini,d K. A. Jarvi.a aMount Sinai Hospital, University of Toronto, Toronto, ON, Canada; bCleveland Clinic Foundation, Cleveland, OH; cWeill Cornell Medical College, New York, NY; dMcGill University, Montreal, QC, Canada. OBJECTIVE: We recently developed nomograms using clinical features (age, laterality and grade of varicocele) and pre-varicocele repair semen parameters, to predict semen parameters following varicocele repair. The aim of this study was to externally validate these nomograms using data from patients coming from North American institutions.

e190

ASRM Abstracts

DESIGN: Retrospective review of prospectively collected data. MATERIALS AND METHODS: Complete data from 375 patients undergoing varicocele repairs from 1 American and 2 Canadian centers was available for analysis as a validation cohort. The estimated post-repair semen parameters were generated using the previously developed nomograms and compared with the actual values in the validation cohort. The predictive accuracy was quantified by concordance correlation coefficient and Pearson’s correlation coefficients, and calibration was evaluated. RESULTS: The semen parameters after varicocele repair were overall similar between the nomogram development and validation arms, with p values for concentration (p¼0.153) being not significantly different, and total motile sperm count (TMC) being marginally different, p¼0.028. Nomograms (for sperm concentration, motility, morphology and TMC) demonstrated good model predictive performance on the validation data with respect to concordance correlation coefficient and Pearson’s correlation coefficient (Table 1), indicating good reproducibility and generalizability of the nomograms with respect to their predictive value. Model predictive performances of the validation data.

Outcome

Concordance correlation coefficient

Pearson correlation coefficient

0.709 0.549 0.668 0.490

0.729 0.690 0.704 0.586

Concentration Motility Morphology TMC

CONCLUSION: Our previously published nomograms demonstrate good model predictive performance when validated on a group of patients from different centers. Clinical factors and pre-varicocele repair semen parameters provide substantial ability to predict post-varicocele repair semen parameters. These nomograms may be used by clinicians to predict post-varicocele repair semen parameters. An online predictive tool has been developed for clinicians to better counsel their patients, and is available at: http://www.r-calc.com/calculator.aspx?calculator_id¼BIASWNPH.

P-154 Tuesday, October 21, 2014 INFLAMMATORY BOWEL DISEASE AND MALE INFERTILITY: A RETROSPECTIVE SINGLE-CENTER STUDY IN JAPAN. T. Shin, T. Iwahata, K. Suzuki, Y. Kobori, H. Okada. Department of Urology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan. OBJECTIVE: To examine the rate of inflammatory bowel disease (IBD) in the male infertile patients in Japan and to investigate whether mesalazine known as 5-aminosalicylates has any effects on fertility. DESIGN: Retrospective analysis. MATERIALS AND METHODS: After obtaining approval from the institutional review board, we analyzed the records of 1225 male infertile patients who had visited the male infertility clinic at Dokkyo Medical University Koshigaya Hospital between January 2010 and December 2012. We reviewed the cases of IBD in the medical records and evaluated the prevalence of the disease. Specifically, we examined IBD patients who ceased mesalazine during male infertility treatment, and compared the seminogram of these patients before and after discontinuation of mesalazine. We also analyzed pregnancy outcome after discontinuation. RESULTS: Of 1225 male infertile patients, 2 had Crohn’s disease and 6 had ulcerative colitis at the first visit to our clinic. Therefore, the prevalence rate of Crohn’s disease and ulcerative colitis in our male infertile patients was 163 per 100,000 men and 490 per 100,000 men, respectively. Seven patients had taken mesalazine and 6 of them subsequently stopped the medication. The mean values of sperm concentration, sperm motility, percentage of normal formed sperm, semen volume, and total motile sperm count before discontinuation were all increased after discontinuation of mesalazine. Among these parameters, the sperm motility and total motile sperm count were significantly improved (P < 0.05) after discontinuation.

Vol. 102, No. 3, Supplement, September 2014