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Predictors for sperm retrieval in microdissection sperm extraction for non-obstructive azoospermia
formulations. 42 (48.3%) used cutaneous testosterone gels, while 23 (26.4%) used testosterone injections. 49 (56.3%) respondents found their patients to be satisfied ‘‘most times’’ and 30 (34.5%) said their patients are ‘‘almost always’’ satisfied with Testopel therapy. When Testopel therapy was discontinued, cost was cited as the most common reason. CONCLUSIONS: Testopel implantation appears to be a highly successful therapy for the treatment of hypogonadism. This study categorizes common practices that have yet to be standardized. Based on this specialty society questionnaire, management of hypogonadism may require 10 or more pellets in the majority of cases. P-549 Wednesday, October 21, 2015 PREDICTORS FOR SPERM RETRIEVAL IN MICRODISSECTION SPERM EXTRACTION FOR NON-OBSTRUCTIVE AZOOSPERMIA. T. Ishikawa, K. Yamaguchi, Y. Takaya, R. Nishiyama, K. Kitaya, H. Matsubayashi. Reproduction Clinic Osaka, Osaka, Japan. OBJECTIVE: Recently, the most popular treatment in patients with nonobstructive azoospermia (NOA) has been micro TESE with subsequent assisted fertilization by intracytoplasmic sperm injection (ICSI). With the spread of ICSI, the presence of a minimum number of spermatozoa is required for fertilization. Micro TESE and ICSI cycles expose the couple to an emotional and financial burden, so it would be beneficial to predict the success of sperm retrieval using noninvasive parameters before attempted procedure. The aim of this study is to assess the predictors of sperm retrieval by micro TESE in NOA patients. DESIGN: A retrospective study. MATERIALS AND METHODS: A total of 1323 micro TESE attempts were done in 1275 men with confirmed cryptozoospermia and NOA to recover spermatozoa for ICSI between January 2006 and March 2015 by a single surgeon. Micro TESE was used in which seminiferous tubule are directly examined throughout the testicle using an operating microscope and selectively biopsied for all of the NOA patients. We analyzed sperm retrieval rate (SRR) of the patients with NOA. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), testicular volume, age at micro TESE, chromosomal analysis, AZF microdeletions analysis, and past history were examined as predictive factors for sperm recovery. Chromosomal analysis was performed on all patients on cultured lymphocytes from peripheral blood. RESULTS: Testicular sperm were successfully retrieved by micro-TESE in 560 of 1323 (42.5%). No correlation was found between serum FSH, LH, and T level with the success of sperm retrieval. Testicular volume and patient age also did not affect the SRR for micro-TESE. Good candidates of sperm retrieval by micro TESE were cryptozoospermia (114/120: 95.0%), AZFc microdeletion (22/28:78.6%), associated with cryptorchidism (50/69: 72.5%), and non-mosaic Klinefelter syndrome (77/144: 53.5%). Worse candidates of sperm retrieval were AZFa or b microdeletions (0/ 10:0%), 46XY male with NOA without past history (180/643: 28.0%), and after chemotherapy (25/70: 35.7%). CONCLUSIONS: A prognostic parameter for successful sperm retrieval in TESE seems to be decisive for male fertility. FSH is not able to resolve spermatogenesis on an individual tubule level, and, therefore, they should not be used as predictors of sperm recovery. We conclude that at the present time there are no absolute predictors of sperm yield for micro TESE. However, we could predict good candidates for micro TESE by past history and genetic analysis.
P-550 Wednesday, October 21, 2015 THE RELATIONSHIP BETWEEN A MAN’S SOMATIC HEALTH S. Li,b B. Behr,c AND ART OUTCOMES. M. Eisenberg,a S. Nakajima,a V. L. Baker.d aUrology, Stanford University, Stanford, CA; b Stanford University, Palo Alto, CA; cStanford Fertility and Reproductive Medicine Cente, Pali alto, CA; dStanford University, Stanford, CA. OBJECTIVE: As medical comorbidity and medication use increases, semen quality declines. However, less is known about how a man’s somatic health may impact the outcomes of assisted reproductive techniques. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: After IRB approval, we identified couples undergoing assisted reproductive technology (ART) cycles at our center from 2004 until 2014. We only fresh IVF cycles utilizing fresh ejaculated sperm from the male partner. We recorded patient and partner demographic characteristics. The cohort was linked to administrative data to obtain infor-
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mation on the male partners’ comorbidities identified using ICD-9-CM codes and limited to men evaluated within the health care system. Cycle outcomes were queried from our clinical database. We calculated fertilization rate, clinical pregnancy rate, miscarriage rate, implantation rate, live birth rate, and singleton birth weight. Regression models were adjusted for male and female covariates. RESULTS: In all, we identified 772 men who had outpatient data available. Those men underwent 1,503 fresh ART cycles - 702 were IVF only and 801 utilized ICSI. Overall, the mean age of the man was 39.6 and 37.7 for his female partner. 67 % of men had at least one medical diagnosis. 96% of men had a CCI of 0. After stratifying by organ system, differences were noted for ART outcomes based on any male diagnosis. Men with neurologic diseases had a lower live birth rate (15% vs 23%, p¼0.02) while men with endocrine diseases had a higher implantation rate (73% vs 62%, p¼0.02). The associations were similar for unadjusted and adjusted models. When examining singleton birth weights after all forms of ART, men with diseases of the nervous system (3270g vs 2990g, p<0.01) and respiratory system (3260g vs 3000g, p<0.01) had significantly smaller children. In addition, after examining singleton births conceived after IVF alone, men with respiratory (3280g vs 2900g, p<0.01) and genitourinary diseases (3250g vs 2720g, p<0.01) had smaller children compared to men without such diagnoses. CONCLUSIONS: Men with diseases of the nervous, respiratory, and genitourinary system had children with significantly lower singleton birth weights compared to men without such diagnoses. However, the current report identified a modest relationship between a man’s health and other IVF outcomes. As these are potentially modifiable factors, further research should determine whether treatment for men’s health conditions may improve or impair IVF outcomes. Supported by: ASRM Young Investigators Award. P-551 Wednesday, October 21, 2015 EFFICACY AND TOLERABILITY OF ANASTROZOLE IN THE TREATMENT OF OVERWEIGHT OR OBESE, SUBFERTILE MALES. T. Shah,a B. Patel,a D. Shin.b aUrology, Rutgers New Jersey Medical School, Newark, NJ; bUrology, Hackensack University Medical Center, Hackensack, NJ. OBJECTIVE: Elevated body mass index has been shown to be negatively correlated with total testosterone (TT) and bioavailable testosterone (BT) levels and semen parameters in infertile males. Anastrozole, a non-steroidal aromatase enzyme competitive inhibitor, is used in the empiric treatment of subfertile males to increase endogenous testosterone levels and improve sperm concentration. We sought to study the efficacy and tolerability of anastrozole for treatment of subfertile males who are overweight (BMI 25-29.9 kg/m2) or obese (BMI R 30 kg/m2). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Thirty-two subfertile men with BMI R 25 kg/m2 were treated with anastrozole between 2008 and 2014. FSH (follicle stimulating hormone), LH (luteinizing hormone), TT, BT, E (estradiol), and PSA (prostate specific antigen) levels were recorded at baseline and measured at 1, 3 and 5 months during therapy. Semen analysis was recorded at baseline and measured at 5 months follow-up during therapy. Pregnancy status was recorded when available. Paired t-test analysis was used to compare pre- and post-treatment biochemical and semen parameters. RESULTS: The study included 32 men, mean age 36.51.3 years (SEM). After 5 months of anastrozole therapy, FSH, LH, TT, BT, E and sperm concentration increased significantly (p<0.05). Baseline vs. 5 months Post-Anastrozole Therapy.
Parameter FSH (mIU/mL) LH (mIU/mL) TT (ng/dL) BT (ng/dL) E (pg/mL) PSA (ng/mL) Sperm Concentration (M/mL) Total Motile Count (M)
Baseline
5 Months
P-value
5.74 0.7 4.0 0.4 268.3 11.9 165.4 7.7 32.1 2.75 0.64 0.09 15.7 3.6 23.9 5.7
9.2 1.2 5.9 0.5 426.9 23.9 277.9 16.3 21.5 2.7 0.79 0.11 31.0 6.7 39.2 8.9
<0.05 <0.01 <0.01 <0.01 <0.01 0.30 <0.05 0.15
Of the 32 men on anastrozole therapy, one (3.1%) reported minor headaches, one (3.1%) reported mild malaise and one (3.1%) had elevated liver
Vol. 104, No. 3, Supplement, September 2015
P-550 Wednesday, October 21, 2015 THE RELATIONSHIP BETWEEN A MAN’S SOMATIC HEALTH S. Li,b B. Behr,c AND ART OUTCOMES. M. Eisenberg,a S. Nakajima,a V. L. Baker.d aUrology, Stanford University, Stanford, CA; b Stanford University, Palo Alto, CA; cStanford Fertility and Reproductive Medicine Cente, Pali alto, CA; dStanford University, Stanford, CA. OBJECTIVE: As medical comorbidity and medication use increases, semen quality declines. However, less is known about how a man’s somatic health may impact the outcomes of assisted reproductive techniques. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: After IRB approval, we identified couples undergoing assisted reproductive technology (ART) cycles at our center from 2004 until 2014. We only fresh IVF cycles utilizing fresh ejaculated sperm from the male partner. We recorded patient and partner demographic characteristics. The cohort was linked to administrative data to obtain infor-
e294
ASRM Abstracts
mation on the male partners’ comorbidities identified using ICD-9-CM codes and limited to men evaluated within the health care system. Cycle outcomes were queried from our clinical database. We calculated fertilization rate, clinical pregnancy rate, miscarriage rate, implantation rate, live birth rate, and singleton birth weight. Regression models were adjusted for male and female covariates. RESULTS: In all, we identified 772 men who had outpatient data available. Those men underwent 1,503 fresh ART cycles - 702 were IVF only and 801 utilized ICSI. Overall, the mean age of the man was 39.6 and 37.7 for his female partner. 67 % of men had at least one medical diagnosis. 96% of men had a CCI of 0. After stratifying by organ system, differences were noted for ART outcomes based on any male diagnosis. Men with neurologic diseases had a lower live birth rate (15% vs 23%, p¼0.02) while men with endocrine diseases had a higher implantation rate (73% vs 62%, p¼0.02). The associations were similar for unadjusted and adjusted models. When examining singleton birth weights after all forms of ART, men with diseases of the nervous system (3270g vs 2990g, p<0.01) and respiratory system (3260g vs 3000g, p<0.01) had significantly smaller children. In addition, after examining singleton births conceived after IVF alone, men with respiratory (3280g vs 2900g, p<0.01) and genitourinary diseases (3250g vs 2720g, p<0.01) had smaller children compared to men without such diagnoses. CONCLUSIONS: Men with diseases of the nervous, respiratory, and genitourinary system had children with significantly lower singleton birth weights compared to men without such diagnoses. However, the current report identified a modest relationship between a man’s health and other IVF outcomes. As these are potentially modifiable factors, further research should determine whether treatment for men’s health conditions may improve or impair IVF outcomes. Supported by: ASRM Young Investigators Award. P-551 Wednesday, October 21, 2015 EFFICACY AND TOLERABILITY OF ANASTROZOLE IN THE TREATMENT OF OVERWEIGHT OR OBESE, SUBFERTILE MALES. T. Shah,a B. Patel,a D. Shin.b aUrology, Rutgers New Jersey Medical School, Newark, NJ; bUrology, Hackensack University Medical Center, Hackensack, NJ. OBJECTIVE: Elevated body mass index has been shown to be negatively correlated with total testosterone (TT) and bioavailable testosterone (BT) levels and semen parameters in infertile males. Anastrozole, a non-steroidal aromatase enzyme competitive inhibitor, is used in the empiric treatment of subfertile males to increase endogenous testosterone levels and improve sperm concentration. We sought to study the efficacy and tolerability of anastrozole for treatment of subfertile males who are overweight (BMI 25-29.9 kg/m2) or obese (BMI R 30 kg/m2). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Thirty-two subfertile men with BMI R 25 kg/m2 were treated with anastrozole between 2008 and 2014. FSH (follicle stimulating hormone), LH (luteinizing hormone), TT, BT, E (estradiol), and PSA (prostate specific antigen) levels were recorded at baseline and measured at 1, 3 and 5 months during therapy. Semen analysis was recorded at baseline and measured at 5 months follow-up during therapy. Pregnancy status was recorded when available. Paired t-test analysis was used to compare pre- and post-treatment biochemical and semen parameters. RESULTS: The study included 32 men, mean age 36.51.3 years (SEM). After 5 months of anastrozole therapy, FSH, LH, TT, BT, E and sperm concentration increased significantly (p<0.05). Baseline vs. 5 months Post-Anastrozole Therapy.
Parameter FSH (mIU/mL) LH (mIU/mL) TT (ng/dL) BT (ng/dL) E (pg/mL) PSA (ng/mL) Sperm Concentration (M/mL) Total Motile Count (M)
Baseline
5 Months
P-value
5.74 0.7 4.0 0.4 268.3 11.9 165.4 7.7 32.1 2.75 0.64 0.09 15.7 3.6 23.9 5.7
9.2 1.2 5.9 0.5 426.9 23.9 277.9 16.3 21.5 2.7 0.79 0.11 31.0 6.7 39.2 8.9
<0.05 <0.01 <0.01 <0.01 <0.01 0.30 <0.05 0.15
Of the 32 men on anastrozole therapy, one (3.1%) reported minor headaches, one (3.1%) reported mild malaise and one (3.1%) had elevated liver
Vol. 104, No. 3, Supplement, September 2015