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Repeat microsurgical reconstruction after failed initial vasectomy reversal
fragment in the promoter region (-453 to +36) of the MAEL gene was sequenced by using five pairs of primers to analyze a total of 33 CpG positions. Of the 33 CpG position, 30 showed significantly higher % methylation in hypospermatogenesis group, and significantly reverse correlations was found between each CpG % methylation and MAEL transcript levels. For individual sequencing segment (S1-S5), only S1 and S2 showed significantly higher methylation index (MtI, mean of % methylation at all CpG positions) in HS, and both segments reversely correlated with MAEL transcript levels. Targeted methylation of S2 in H358 cells resulted in decreased expression of MAEL. CONCLUSIONS: Our study provides evidence that MAEL gene participates in the epigenetic regulation of human spermatogenesis. Specific CpG sites in the promoter region are associated with the low expression levels of MAEL. Because MAEL has been shown to play an important role in the piRNA-mediated defense mechanism of the mammalian germline from retrotransposons, epigenetic dysregulation of MAEL should contribute to one of the causes of male infertility. Supported by: This work was supported by the Ministry of Science and Technology of Taiwan (100-2314-B-006-017). P-495 Wednesday, October 19, 2016 REPEAT MICROSURGICAL RECONSTRUCTION AFTER FAILED INITIAL VASECTOMY REVERSAL. P. V. Bach,a B. B. Najari,a F. Neto,a A. Ayangbesan,a A. V. Gottesdiener,a M. Goldstein.b aUrology, Weill Cornell Medical College, New York, NY; bMale Reproductive Medicine, and Urology, Weill Cornell Medical College, New York Presbyteri, New York, NY. OBJECTIVE: Repeat vasectomy reversals are common, accounting for up to 15% of vasectomy reversals performed. While patency rates of up to 99% have been described by our group for unselected vasovasostomies, repeat reversals represent a more difficult cohort to manage surgically and may have lower patency rates. We aim to characterize the patency rates in men with history of one or more failed vasectomy reversals undergoing repeat microsurgical reconstruction. DESIGN: Retrospective case series. MATERIALS AND METHODS: We reviewed a database of 754 vasectomy reversals done by a single surgeon (M.G.) and identified 116 cases (15%) with a history of one or more failed vasectomy reversals. We included all cases in which unilateral and bilateral vasovasostomies or vasoepididymostomies were performed and post-operative semen analyses were available. Patency was defined as the presence of motile sperm in the ejaculate at six months post-operatively. Statistical analyses were done using chisquared test and t-test. RESULTS: Mean patient age was 43.8 6.5 years old with a median obstructive interval of 11.0 years (IQR 5.0 years). 99 patients (85%) had undergone a single failed vasectomy reversal while 17 patients (15%) had undergone two or more failed vasectomy reversals. 61 men (53%) underwent bilateral vasovasostomy, 28 men (24%) underwent bilateral vasoepididymostomy, and 27 men (23%) underwent unilateral vasovasostomy with contralateral vasoepididymostomy. Overall patency rate was 82%, but was significantly higher for those undergoing unilateral/bilateral vasovasostomy compared to unilateral/bilateral vasoepididymostomy or unilateral vasovastomy and contralateral vasoepididymostomy (Table 1). The type of repair required was significantly associated with obstructive interval, with those requiring at least one vasoepididymostomy presenting after longer obstructive intervals (Table 1).
CONCLUSIONS: Microsurgical vasal reconstruction in men with history of failed vasectomy reversal is a technically challenging situation that results in lower patency rates than those reported for unselected vasovasostomies and requires vasoepididymostomy in nearly 50% of cases. Taken together, to maximize the potential for patency in these men, only urologists adept at vasoepididymostomy should attempt repeat microsurgical reconstruction. Supported by: The project was supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. This project was alsosupported by grant number T32HS00066 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
P-496 Wednesday, October 19, 2016 VARIABILITY OF MALE FERTILITY NUTRICEUTICALS: SUPPLEMENT ANALYSIS, COST AND QUALITY CONTROL. S. Pana S. C. Honig.b aUrology, Yale New Haven Hospital, New Haven, CT; bUrology, Yale University, New Haven, CT. OBJECTIVE: A large percentage of male infertility patients take supplements for improvement of semen quality. Formulation of supplements, costs, and third-party quality assurance vary considerably. The purpose of this study is to evaluate the composition of each supplement in various commercial products as compared to published data of known efficacy. Secondary endpoints in evaluation include cost and independent testing agency of quality control. DESIGN: Review of ‘‘pro’’ fertility products available on the market and analysis of active ingredients in accordance to the most up to date meta-analysis of efficacy. MATERIALS AND METHODS: 9 supplements were selected that target male factor infertility. Supplements were selected from products that had exhibit booths at the 2015 American Society of Reproductive Medicine meeting, as well as others listed on a Google search of ‘‘Male Infertility supplements’’. Each product was reviewed based on information provided in package insert or listed proprietary info. Criteria used for reasonable supplementation were based on review article summaries of published evidence deemed to be of the highest quality (Cochrane review 2014, review articles Ko et al 2012, Zini et al 2011). RESULTS: Table attached shows supplements identified to have some published efficacy. Due to the paucity of well conducted randomized controlled studies, the antioxidants included were also based on the authors’ review of data. (Please see uploaded excel file for table) CONCLUSIONS: Use of nutritional supplements in male factor infertility is certainly perplexing. It is difficult to ascertain dosages of supplements that may improve male infertility. Percentage of individual supplements vary widely between available products, and some products may have more of one antioxidant and none of another. There are no recommended daily allowances of individual antioxidants optimized for male factor infertility. As such, amounts of vitamin C, E, Carnitine, zinc, selenium, and coenzyme Q10 vary greatly between different available supplements. Costs and testing agency quality assurance differed as well. Physicians should be aware of these variability before they endorse the use of specific commercial regimens.
Patency rates, types of repeat microsurgical reconstruction, and obstructive intervals
Patency rates for different types of repeat microsurgical reconstructions Median obstructive intervals (years) for different types of microsurgical reconstruction Median obstructive intervals (years) and patency
FERTILITY & STERILITYÒ
Unilateral or bilateral vasovasostomy
55/61 (90%)
p¼0.035
Unilateral vasovasostomy and contralateral vasoepididymostomy Unilateral or bilateral vasoepididymostomy Unilateral or bilateral vasovasostomy
22/27 (82%) 19/28 (68%) 9 (IQR 9)
p¼0.013
Unilateral vasovasostomy and contralateral vasoepididymostomy Unilateral or bilateral vasoepididymostomy Patent Not patent
11 (IQR 6) 13 (IQR 7) 11 (IQR 8) 13 (IQR 10)
p¼0.058
e293
CONCLUSIONS: Microsurgical vasal reconstruction in men with history of failed vasectomy reversal is a technically challenging situation that results in lower patency rates than those reported for unselected vasovasostomies and requires vasoepididymostomy in nearly 50% of cases. Taken together, to maximize the potential for patency in these men, only urologists adept at vasoepididymostomy should attempt repeat microsurgical reconstruction. Supported by: The project was supported by The Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. This project was alsosupported by grant number T32HS00066 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.
P-496 Wednesday, October 19, 2016 VARIABILITY OF MALE FERTILITY NUTRICEUTICALS: SUPPLEMENT ANALYSIS, COST AND QUALITY CONTROL. S. Pana S. C. Honig.b aUrology, Yale New Haven Hospital, New Haven, CT; bUrology, Yale University, New Haven, CT. OBJECTIVE: A large percentage of male infertility patients take supplements for improvement of semen quality. Formulation of supplements, costs, and third-party quality assurance vary considerably. The purpose of this study is to evaluate the composition of each supplement in various commercial products as compared to published data of known efficacy. Secondary endpoints in evaluation include cost and independent testing agency of quality control. DESIGN: Review of ‘‘pro’’ fertility products available on the market and analysis of active ingredients in accordance to the most up to date meta-analysis of efficacy. MATERIALS AND METHODS: 9 supplements were selected that target male factor infertility. Supplements were selected from products that had exhibit booths at the 2015 American Society of Reproductive Medicine meeting, as well as others listed on a Google search of ‘‘Male Infertility supplements’’. Each product was reviewed based on information provided in package insert or listed proprietary info. Criteria used for reasonable supplementation were based on review article summaries of published evidence deemed to be of the highest quality (Cochrane review 2014, review articles Ko et al 2012, Zini et al 2011). RESULTS: Table attached shows supplements identified to have some published efficacy. Due to the paucity of well conducted randomized controlled studies, the antioxidants included were also based on the authors’ review of data. (Please see uploaded excel file for table) CONCLUSIONS: Use of nutritional supplements in male factor infertility is certainly perplexing. It is difficult to ascertain dosages of supplements that may improve male infertility. Percentage of individual supplements vary widely between available products, and some products may have more of one antioxidant and none of another. There are no recommended daily allowances of individual antioxidants optimized for male factor infertility. As such, amounts of vitamin C, E, Carnitine, zinc, selenium, and coenzyme Q10 vary greatly between different available supplements. Costs and testing agency quality assurance differed as well. Physicians should be aware of these variability before they endorse the use of specific commercial regimens.
Patency rates, types of repeat microsurgical reconstruction, and obstructive intervals
Patency rates for different types of repeat microsurgical reconstructions Median obstructive intervals (years) for different types of microsurgical reconstruction Median obstructive intervals (years) and patency
FERTILITY & STERILITYÒ
Unilateral or bilateral vasovasostomy
55/61 (90%)
p¼0.035
Unilateral vasovasostomy and contralateral vasoepididymostomy Unilateral or bilateral vasoepididymostomy Unilateral or bilateral vasovasostomy
22/27 (82%) 19/28 (68%) 9 (IQR 9)
p¼0.013
Unilateral vasovasostomy and contralateral vasoepididymostomy Unilateral or bilateral vasoepididymostomy Patent Not patent
11 (IQR 6) 13 (IQR 7) 11 (IQR 8) 13 (IQR 10)
p¼0.058
e293