O-222 The impact of psychological counselling on decision-making of sperm donation among the couples with nonobstructive azoospermia after unsuccessful microdissection testicular sperm extraction
Authors: Koizumi T , Iwahata T , Okada H , Osaka A , Sugimoto K 
Published: July 2024

Abstract

Study question
Is nonobstructive azoospermia (NOA) couples with psychological counselling likely to choose sperm donation after unsuccessful microdissection testicular sperm extraction (MD-TESE)?

Summary answer
Couples with psychological counselling were significantly 2.9 times likely to choose sperm donation than couples without psychological counselling by Cox proportional hazard regression analysis.

What is known already
For NOA, although MD-TESE and intracytoplasmic sperm injection offer the only chance to become biological parenthood, 70% of NOA cannot get sperm by MD-TESE, and they have to end treatment and seek another life course. When diagnosing NOA, almost all male patients (88.9%) have severe depressive symptoms (Bak, 2012). Germany, England, Australia, and New Zealand have shown that psychological counselling for ending treatment and decision making in alternative life courses, such as sperm donation, is theoretically recommended in their guidelines (BKiD 2014; BICA 2015; ANZICA 2018). However, no study has yet examined the efficacy of psychological care.

Study design, size, duration
This was a retrospective cohort study. The sample size calculation estimated a total of 90 couples. The couples who experienced unsuccessful MD-TESE at a university hospital from August 1, 2020, to September 30, 2021, were observed to receive psychological counselling and a reference to another hospital for sperm donation treatment for 300 days after MD-TESE.

Participants/materials, setting, methods
Participants: The 88 NOA couples after unsuccessful MD-TESE in a university hospital between August 2020 and September 2021. Methods: After unsuccessful MD-TESE, doctors recommended psychological counseling for all couples; 44 couples (counselling group) received psychological counselling, whereas 44 couples (non-counselling group) did not. Intervention: Semi-structured single-session psychological counselling was conducted for the counselling group. This includes psychological care for grieving unsuccessful treatment, giving up their biological children, and deciding what life course they choose.

Main results and the role of chance
The reference ratio to the sperm donation hospital was 50% for the counselling group and 18.2% for the non-counselling group (χ2(1)= 9.913, p=.002, φ=.336). The average duration from MD-TESE to the reference was 103.8 days for the counselling group whereas 80.1 days for the non-counselling group, which was not statistically significant. Analyzing the cumulative non-referral rate using the Kaplan-Meier estimation method, the counseling group was more likely to have a decline in the cumulative non-referral rate than the non-counseling group. The log-rank test result was significant (χ2(1) = 8.284, p = .004). The Cox proportional hazard regression with covariates of male chromosomal abnormality, the period of infertility, and females’ age, shows that the counseling group are significantly more likely to make the referral letter earlier than the non-counseling group (adjust hazard ratio, 2.931; 95%Cl, 1.271-6.758). When unsuccessful MD-TESE, NOA couples with semi-structured psychological counselling can recover from loss and grief and can consider and decide on sperm donation treatment urgently compared to non-counselling couples.

Limitations, reasons for caution
We calculated an appropriate sample size from the results and found that at least 45 persons were needed in each group. Therefore, it is necessary to conduct future studies with sufficient sample sizes.

Wider implications of the findings
Couples with NOA after unsuccessful MD-TESE may recover from loss and grief, and may consider and decide their future life-course urgently through semi-structured psychological counseling for grieving unsuccessful treatment, giving up their biological children, and deciding what life courses they choose.

Trial registration number
UMIN000053508