(075) ANDROLOGIST PREFERENCES FOR SPERM EXTRACTION IN CONGENITAL BILATERAL ABSENCE OF VAS DEFERENS (CBAVD)
Authors: Passarelli R , Islam R , Velez D 
Published: December 2024

Introduction

Prior research suggests the possibility of varying levels of fertilization rates between testicular and epididymal sperm. Given the lack of consensus in the literature regarding which sperm provides superior fertility outcomes, the sperm extraction technique preferences utilized most often by reproductive urologists’(RU) has not been studied.

Objective

We aim to assess RU sperm extraction technique preferences for patients with congenital bilateral absence of the vas deferens (CBAVD) and/or cystic fibrosis (CF). We hypothesized that heterogeneity persists among RUs performing sperm extraction for CBAVD/CF patients, suggesting that further research into optimal retrieval options is warranted.

Methods

A survey was sent to all registered Society for the Study of Male Reproduction (SSMR) members to assess infertility care in the following situation: “A 30-year old male presents with his 28-year old wife for infertility evaluation. On exam he has CBAVD, with bilateral testicular volume of 24 cc and normal epididymal head bilaterally, no varicocele. His wife's evaluation is normal. You send him for a CFTR panel, which is positive for homozygous delta F 508 mutation.” Responses were collected and recorded. Descriptive and comparative statistics using chi square analyses were performed.

Results

We received 51 survey responses of which 39.2% elected for testicular extraction, 29.4% epididymal and 31.4% a combination. More than half (56.9%) would perform the extraction in the office, while 41.2% would utilize a operating room/surgery center and 2.0% an alternative location. There was not a significant difference on chi square analysis between extraction technique and location. There were 35 respondents (68.6%) who would perform extraction with onsite Andrology lab, of these 31.4% would perform epididymal extraction, 37.2% testicular, and 31.4% possible combination. Out of the 12 respondents who did not utilize an onsite Andrology lab, 25.0% target epididymal sperm, 41.7% testicular, and 33.3% possible combination. On chi square analysis there was no significant difference between presence of Andrology lab and extraction preference. Fertility labs would be collected by 90.2% of participants. If the CF panel was negative for mutation (CBAVD), 80.4% of respondents would not change their technique. For a post-vasectomy patient who refused reversal, 70.6% would not change their practice.

Conclusions

The results of this survey reveals an array of preferred sperm extraction techniques for men with obstructive azoospermia due to CF and CBAVD. There were no differences in extraction technique in relation to location of procedure or access to an Andrology lab. Most respondents would not change their approach for non-CF/CBAVD obstructive azoospermia patients but there was more heterogeneity in preferences for the post-vasectomy patient desiring assisted reproductive technology in lieu of reversal. We propose these differences are due to epididymal procedures eliminating future vasectomy reversal versus epididymal extractions in CF men not yielding quality sperm. We present this variety in sperm extraction preferences as a suggestive index that further discussion and research into optimal retrieval options is prudent.

Disclosure

No.