Providing a post-vasectomy semen analysis cup at the time of vasectomy rather than post-operatively improves compliance.

Background: Post-vasectomy semen analysis (PVSA) completion rates after vasectomy are poor, and minimizing the need for an additional in-person visit may improve compliance. We hypothesized that providing PVSA specimen cup at time of vasectomy instead of at a postoperative appointment might be associated with higher PVSA completion rates. Methods: We performed a retrospective cohort study with historical control using medical records of all patients seen by a single provider for vasectomy consultation between October 2016 and June 2022. All patients who underwent vasectomy were included. Patients who underwent vasectomy prior to 05/01/2020 had PVSA specimen cup given at postoperative appointment two weeks following vasectomy, and those who underwent vasectomy after 05/01/2020 were given PVSA specimen cup at time of vasectomy. PVSA completion, demographic, and clinical outcomes data were collected. Logistic regressions were used to investigate associations between PVSA completion rates and timing of PVSA specimen cup provision. Results: There were no significant differences among study cohorts across all patient demographics analyzed, including age, body mass index (BMI), age of primary partner, presence of children, and history of prior genitourinary infection. A total of 491 patients were seen for vasectomy consultation between October 2016 and June 2022; among these patients, 370 underwent vasectomy. Of these, 173 (46.8%) patients underwent vasectomy prior to 05/01/2020 and were given PVSA specimen cup at postoperative visit; 197 (53.2%) patients underwent vasectomy after 05/01/2020 and were given PVSA specimen cup at vasectomy. Providing PVSA specimen cup at time of vasectomy was associated with higher odds of PVSA completion than providing PVSA specimen cup at postoperative visit [62.4% vs. 49.7%; odds ratio (OR) =1.68; 95% confidence interval (CI): 1.11, 2.55]. Adjusting for all identified confounders excludes 35 (9.5%) patients without a primary partner and shows no statistically significant association in cup timing [adjusted OR (aOR) =1.53; 95% CI: 0.98, 2.39]. Adjusting for all identified confounders except age of primary partner revealed timing of specimen cup provision at time of vasectomy was associated with higher odds of PVSA completion (aOR =1.64; 95% CI: 1.08, 2.52). Conclusions: PVSA specimen cup provision at time of vasectomy versus at postoperative appointment is associated with higher rates of PVSA completion in this retrospective cohort study.

No Detectable Association Between Virtual Setting for Vasectomy Consultation and Vasectomy Completion Rate.

INTRODUCTION: The COVID-19 pandemic has fueled widespread incorporation of telehealth into urology practices. Vasectomy consultation via telehealth is convenient and improves access to care for male contraception. However, it does not allow for physical examination, inherently leading to possible day-of-procedure cancellations due to unforeseen anatomic concerns. This study aimed to compare vasectomy completion rates between patients undergoing virtual vs in-person consultation. METHODS: All patients seen by a single provider at NYU Langone Health for vasectomy consultation between October 2016 and June 2022 were included in the study. Most patients seen before March 2020 had in-person consultations, whereas the majority of patients seen afterwards had virtual consultations without option for in-person visit due to the emergence of COVID-19. All patients seen virtually were examined in a consult room prior to being prepped for the vasectomy in the procedure room. Visit type, demographic information, and clinical outcomes data were collected for all patients. A chi-square test was used to compare the rate of vasectomy completion between those with in-person and virtual consultation. Analysis was performed using R, version 4.0.5. RESULTS: Four hundred ninety-one patients were seen by a single provider for vasectomy consultation between October 2016 and June 2022. One hundred ninety-seven (40.1%) consultations were performed virtually and 294 (59.9%) consultations were performed in person. Three hundred seventy (75.4%) of all patients seen for consultation (both virtual and in person) ultimately underwent vasectomy. There was no evidence of difference in rate of completing vasectomy after virtual (75.6%) and in-person (75.2%) consultation (P = .91). Two of the 197 (1%) patients who consulted virtually had their vasectomy procedures cancelled on the day of the procedure based on their preoperative exam; one because of abnormal epididymal sensitivity after prior scrotal infection, the other because of a history of orchiopexy that the patient was not aware of until the surgeon started inquiring about scrotal scars present. CONCLUSIONS: Despite the lack of physical examination, virtual vasectomy consultation is both feasible and effective, with rates of vasectomy completion comparable to traditional in-person consultation.

Are Infertile Men Less Healthy Than Fertile Men? An Analysis of the National Survey for Family Growth.

OBJECTIVE: To characterize the general health status of infertile men in the United States using a nationally representative sample of men. METHODS: Using the National Survey for Family Growth from 2011 to 2017, infertile subgroups were created using a range of inclusion criteria. Univariate and multivariate analyses were conducted comparing these men to fertile men. RESULTS: Using population estimates, 6.5 million men with reduced fertility potential were compared to 26 million fertile men. After controlling for demographic and healthcare utilization factors, these groups did not have significantly different rates of key medical co-morbidities, including cancer, obesity, and overall disability. Looking at the subset of men who had received a specific infertility diagnosis, estimated as a population of nearly 600,000 men, this pattern held, in that there were no significant differences in the rates of medical co-morbidities. Notably, the rate of male infertility evaluation among potentially infertile men was only 50%. These findings also persisted after a propensity-matched analysis. CONCLUSION: In this cohort, there was no significant relationship between infertility and specific medical co-morbidities. We must consider the influence of sample selection as we continue to investigate the relationship between medical co-morbidities and reduced fertility potential. Given the persistent low rates of infertility evaluation, even among men who seek medical advice to conceive, we must continue to search for ways to characterize the infertile male population while simultaneously working to improve access.

How do we counsel men with obstructive azoospermia due to CF mutations?-a review of treatment options and outcomes.

Obstructive azoospermia (OA) is a rare cause of male infertility, with Congenital Bilateral Absence of The Vas Deferens (CBAVD) being a major cause. A wealth of literature has established an irrefutable link between CFTR mutations and CBAVD, with CBAVD affecting almost all men with cystic fibrosis (CF) disease and a significant portion of men that are CFTR mutation carriers. In the past two decades, assisted reproductive technologies have made the prospect of fathering children a viable possibility in this subset of men, using a combination of sperm extraction techniques and intracystoplasmic sperm injection (ICSI). In order to assess techniques for sperm retrieval, as well as reproductive outcomes, a systemic search of the MEDLINE database was conducted for all articles pertaining to management options for CBAVD, and also all reports describing outcomes of these procedures in the CBAVD population. Both epididymal and testicular sperm extraction (TESE) are viable options for men with CBAVD, and though rigorous data are lacking, live birth rates range from 8% to 50% in most small retrospective series and subset analyses. In addition, there does not appear to be significant differences in the rate of live birth or complications and miscarriages between the various techniques, though further investigation into other factors that limit reproductive potential of men with CFTR mutations and CBAVD is warranted.

Evaluating the unevaluated: a secondary analysis of the National Survey for Family Growth (NSFG) examining infertile women who did not access care.

PURPOSE: To characterize the demographic differences between infertile/sub-fertile women who utilized infertility services vs. those that do not. METHODS: A retrospective analysis of cross-sectional data obtained during the 2011-2013, 2013-2015, and 2015-2017 cycles of National Survey for Family Growth from interviews administered in home for randomly selected participants by a National Center of Health Statistics (NCHS) surveyor was used to analyze married, divorced, or women with long-term partners who reported difficulty having biological children (sub-fertile/infertile women). Demographic differences such as formal marital status, education, race, and religion were compared between women who presented for infertility care vs. those that did not. The primary outcome measure was presenting for infertility evaluation and subsequently utilizing infertility services. Healthcare utilization trends such as having a usual place of care and insurance status were also included as exposures of interest in the analysis. RESULTS: Of the 12,456 women included in the analysis 1770 (15.3%) had used infertility services and 1011 (8.3%) said it would be difficult for them to have a child but had not accessed infertility services. On univariate analysis, compared to women who used infertility services, untreated women had lower average household incomes (295.3 vs. 229.8% of the federal poverty line respectively). Untreated women also had lower levels of education and were more likely to be divorced or never have married. In terms of health status, unevaluated women were less likely to have a usual place for healthcare (87.3%) as compared to women presenting for fertility care (91.9%) (p = 0.004). When examining insurance status, 23.3% of unevaluated women were uninsured as compared to 8.3% of evaluated women. On multivariate analysis, infertile women without insurance were at 0.37 odds of utilizing infertility care compared to women with insurance. CONCLUSIONS: Demographic factors are associated with the utilization of infertility care. Insurance status is a significant predictor of whether or not infertile women will access treatment. Data from the three most recent NSFG surveys along with prior analyses demonstrate the need for expanded insurance coverage in order to address the socioeconomic disparities between infertile women who are accessing services vs. those that are not.

Vasectomy in Men without Children: Demographics and Family Planning Attitudes from the National Survey for Family Growth.

INTRODUCTION: To investigate the ethically challenging scenario of a childless man requesting a vasectomy, we compared vasectomy reversal rates and family planning attitudes in men who underwent vasectomy with and without fathering a child. METHODS: We performed an analysis of the 2002 to 2006, 2006 to 2010, 2011 to 2013, 2013 to 2015 and 2015 to 2017 waves of the National Survey for Family Growth, a nationally representative survey of family planning in the United States. We compared demographic information and family planning attitudes among men who had undergone vasectomy with and without having children. RESULTS: Of the 29,192 men surveyed 1,043 (3.6%) reported undergoing a vasectomy. Of the men reporting vasectomy, 4.4% (95% CI 3.2-6.0) underwent the procedure without having had children. Compared to men with children, men without children were less likely to have ever been married and were more likely to not identify with any religion. Whereas 1.2% (95% CI 0.5-2.4) of men with children underwent vasectomy reversal during the followup, 0% of men without children underwent reversal. CONCLUSIONS: Men who undergo vasectomy without having children constitute a small but distinct population of men. During 7-year followup after vasectomy, men who have not fathered children do not express higher rates of postvasectomy regret.

Men Who Have Undergone Vasectomy are Healthier Than Non-sterilized Fertile Men: An Analysis of the Nation Survey for Family Growth.

OBJECTIVE: To evaluate the health status of men who have undergone vasectomy versus nonsterilized fertile men. METHODS: Using the National Survey for Family Growth from 2002 to 2017, univariate and multivariate analyses were performed on demographic and health data, including health status and health care utilization. RESULTS: Men who have undergone vasectomy are more likely to be older, healthier, have more children, identify as non-Hispanic white, be married, have a higher level of education, earn a higher mean household income, and were more likely to be privately insured than non-sterilized fertile men. On multivariate analysis, men who underwent vasectomy had a better health status despite being older. CONCLUSION: There are significant socioeconomic and health differences between men who elect vasectomy and non-sterilized fertile men. These differences should be considered when considering using sterilized men as a proxy for proven fertile men in epidemiological studies.

Access to infertility services: characterizing potentially infertile men in the United States with the use of the National Survey for Family Growth.

OBJECTIVE: To characterize the population of subfertile and infertile men in the United States who lack access to infertility services. DESIGN: Analysis of the 2011-2013, 2013-2015, and 2015-2017 waves of the National Survey for Family Growth (NSFG) dataset. SETTING: Not applicable. PATIENT(S): Noninstitutionalized civilian men, ages 15-45 years, who were married or lived with a woman and had not undergone a vasectomy. INTERVENTION: Not applicable. MAIN OUTCOME MEASURE(S): Access to infertility services. RESULT(S): Compared with people who had used infertility services, unevaluated men who self-reported as infertile or subfertile were younger, had lower household incomes, were less educated, and were less likely to be married. Unevaluated infertile men were less likely to have a regular place where they received health care, were more likely to be uninsured, and had a poorer perception of their personal health. On multivariable logistic regression analysis, average household income, marital status, education level, and current insurance status remained significant. CONCLUSION(S): Infertile men who had not used infertility services were less educated, were less likely to have been married, and had a lower household income and private insurance rate compared with men who had used infertility services. These demographic and health care utilization differences can help inform public policy related to fertility.

Kallman syndrome and central non-obstructive azoospermia.

The understanding of male factors of infertility has grown exponentially in the past ten years. While clear guidelines for obstructive azoospermia have been developed, management of non-obstructive azoospermia has lagged. Specifically, management of Kallmann Syndrome and central non-obstructive azoospermia has been limited by a lack of understanding of the molecular pathogenesis and investigational trials exploring the best option for management and fertility in these patients. This review aims to summarize our current understanding of the causes of central hypogonadotropic hypogonadism with a focus on genetic etiologies while also discussing options that endocrinologists and urologists can utilize to successfully treat this group of infertile men.

Fertility Preservation in Male to Female Transgender Patients.

Gender dysphoria, or the incongruence between gender identification and sex assigned at birth with associated discomfort or distress, manifests in transgender patients, whose multifaceted care includes puberty suppression, cross-sex hormonal therapy, and gender-affirming surgery. Discussion of fertility preservation (FP) is paramount because many treatments compromise future fertility, and although transgender patients demonstrate desire for children, use of FP remains low for a plethora of reasons. In transgender women, established FP options include ejaculated sperm cryopreservation, electroejaculation, or testicular sperm extraction. Further research is needed regarding reproductive health and FP in transgender patients.

Changes in practice patterns in male infertility cases in the United States: the trend toward subspecialization.

OBJECTIVE: To assess changes in the practice patterns of urologists performing male infertility procedures (vasal reconstruction, sperm retrieval, varicocelectomy) from 2004 to 2015 in the United States. DESIGN: Examination of self-reported procedural volumes from urologists undergoing certification and recertification using case log data provided by the American Board of Urology. The study period was stratified into early (2004-2007) and recent (2012-2015) time periods. SETTING: Not applicable. PATIENT(S): None. INTERVENTION(S): None. MAIN OUTCOMES MEASURE(S): Temporal variations in male infertility practice patterns among different urologic subspecialties between the early and recent time periods. RESULT(S): The overall proportion of total male infertility procedures performed by andrologists significantly increased between the early and recent groups (23% to 26%). This growth was driven by a significant increase in the proportion of varicocele repairs being performed by andrologists between the early and recent periods (19% to 25%). Most notably, an assessment of total number of male infertility procedures performed by newly certifying urologists showed that there was a significant increase in the overall proportion of all male infertility procedures being performed by recently trained andrologists (24% to 35%). This significant increase was seen individually among all three types of male infertility procedures. CONCLUSION(S): With the increased trend in urologists obtaining fellowship training, male infertility surgical volume is beginning to shift from general urologists to subspecialized andrologists.