Infertility/andrology: 78% cite inadequate exposure to subspecialty

A review of surgically acquired sperm for assisted reproductive technology and a multicenter study analyzing surgical sperm retrieval rates in men with non-mosaic Klinefelter’s syndrome undergoing micro-TESE were among other AUA 2018 take-homes in infertility/andrology. The take-home were presented by Lawrence Jenkins, MD, MBA, of the Ohio State University, Columbus.

• Among the findings of a survey of andrology/male infertility subspecialty exposure during U.S.-based residency training: 86% thought andrology/male infertility subspecialty exposure is an important part of the urology residency, 78% cited inadequate exposure to the subspecialty throughout training, and 78% stated they would not feel confident getting their own fertility care at their home institution due to concerns over competency.
• Subclinical varicoceles showed improvements after repair that were similar to those of clinical varicoceles.
• It takes approximately 3 to 6 months after varicocelectomy for the most significant improvement in semen parameters to be seen. Up to 33% of men with total motile sperm count <2 million were upgraded to natural conception range of total motile sperm count >9 million following varicocele repair.
• In men undergoing microsurgical varicocelectomy, mean TUNEL and SCSA values both decreased significantly following repair. The percentage of patients with abnormal TUNEL and SCSA values decreased significantly. Among couples undergoing in vitro fertilization (IVF), the pregnancy rate was 71% and live birth rate was 40%. Pregnancy rates were improved in men whose sperm DNA fragmentation moved from abnormal to normal. Of the couples achieving pregnancy, only the mean difference in TUNEL was significant.
• A review of surgically acquired sperm for assisted reproductive technology found the percentage of cycles using surgically retrieved sperm increased between 2004 and 2015. Pregnancy and perinatal outcomes were similar for treatments using surgical retrieval of sperm and ejaculated sperm among couples undergoing IVF/intracytoplasmic sperm injection (ICSI) for treatment of male factor infertility.
• ICSI outcomes using testicular sperm are not significantly better than ICSI using ejaculated sperm in couples with high sperm DNA fragmentation and prior ICSI failures.
• A multicenter study analyzing surgical sperm retrieval rates in men with non-mosaic Klinefelter’s syndrome undergoing microsurgical testicular sperm extraction (micro-TESE) found that sperm retrieval rate was about 21%. No factor was found to be predictive of successful micro-TESE.
• A retrospective, multicenter, international cohort of 1,200 ICSI cycles with donor eggs found no significant association between advanced paternal age and embryo aneuploidy.
• The proportion of sperm with low or high levels of DNA damage provides discriminatory information for male infertility diagnosis and treatment outcomes.
• Among 1,500 men who underwent genetic evaluation, 4% had microdeletions of the Y chromosome and the most common Y-chromosome abnormality was the AZFc region (75% of patients). No patients had sperm concentrations higher than 0.5 million/mL, and it was recommended to reduce the threshold for testing to that mark in order increase specificity and reduce costs without affecting sensitivity.
• A retrospective review of charts at a downtown-based tertiary referral fertility clinic servicing greater Chicago identified a clear racial discrepancy of male patients who sought reproductive care.