Faculty Bibliography

Characterizing the chemical composition of semen can provide valuable insights into the exposome and environmental factors that directly affect seminal and overall health. In this study, we compared molecular profiles of 45 donated semen samples from general population New York City participants and examined the correlation between the chemical profiles in semen and fertility parameters, i.e., sperm concentration, sperm motility, sperm morphology, and semen volume. Samples were prepared using a protein precipitation procedure and analyzed using liquid chromatography (LC) coupled to high-resolution mass spectrometry (HRMS). Non-targeted analysis (NTA) revealed 18 chemicals not previously reported in human exposome studies, with 3-hydroxyoctanedioic acid, a cosmetic additive, emerging as a plausible candidate found to be at higher levels in cases vs controls (p < 0.01) and associated with adverse sperm motility and morphology. Four level 1 identified compounds were found to have associations with semen health parameters; dibutyl phthalate and 2-aminophenol negatively impacted motility, 4-nitrophenol was associated with low morphology, while palmitic acid was found to be associated with both low morphology and low volume. This study aims to utilize NTA to understand the association of contaminants of emerging concern (CECs) along with a full chemical profile to find trends separating poor and normal semen health parameters from each other chemically. Our results suggest that the collective effects of many CECs could adversely affect semen quality.

BACKGROUND/UNASSIGNED:Many barriers prevent transgender women (TW) from fertility preservation (FP) prior to initiating gender-affirming hormones. The decision to move forward with gender affirming bottom surgery presents the last opportunity for these patients to preserve their ability to have genetically related children. However, oftentimes these patients will have azoospermia even after stopping their hormone therapy for an extended period due to the negative effects of these hormones on fertility. The objective of this case report is to investigate a novel method of FP in TW on longstanding gender-affirming hormone therapy who present with azoospermia on conventional semen analysis. CASE DESCRIPTION/UNASSIGNED:Three TW on gender-affirming hormone therapy for between 6-21 years presented for FP prior to gender affirming vaginoplasty with simultaneous orchiectomy. All three patients had azoospermia on conventional semen analysis. Extended sperm search and microfreeze (ESSM) was conducted on semen samples. Results, including sperm count, number of vitrified sperm, and number of SpermVDs, were obtained. Conventional testicular sperm extraction (TESE) was also performed on two of the patients. Two out of three patients successfully retrieved and cryopreserved sperm after ESSM procedure. One patient had a successful ESSM despite not having any sperm on testicular tissue analysis. CONCLUSIONS/UNASSIGNED:The findings from this case study underscore the potential use for ESSM as a tool for FP in TW who have undergone multiple years of hormonal therapy and have unsuccessful semen analyses and testicular extractions. Future studies with larger cohorts are necessary to validate the efficacy of ESSM and explore its potential application as a standard practice in transgender healthcare, particularly for those who cannot completely cease hormone therapy.

BACKGROUND/UNASSIGNED: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/UNASSIGNED: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/UNASSIGNED: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/UNASSIGNED: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.

INTRODUCTION/BACKGROUND: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:= .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.

Varicoceles are an abnormal dilation of the pampiniform plexus within the spermatic cord that can impair spermatogenesis and testosterone production in the testes through a variety of theorized mechanisms. Nearly 15% of the male population is affected by varicocele, though most men are entirely asymptomatic. Among men presenting with infertility, the incidence of varicocele has been observed to be as high as 35-40%. Varicoceles are the most commonly identified abnormalities in men presenting with infertility, and, when associated with abnormal semen parameters, present the urologist with an opportunity for intervention. Serum testosterone levels have been demonstrated to be lower on average among patients with varicoceles and data have suggested that varicocelectomy improves mean serum testosterone levels postrepair. Nonetheless, there are no current guideline indications for varicocelectomy for men with symptomatic hypogonadism, and it is not yet known whether the reported improvement in serum testosterone with surgical intervention is clinically meaningful. In this review, we discuss the most up-to-date literature on the mechanisms by which varicoceles are purported to impair both spermatogenesis and testosterone production as well as the effect of varicocelectomy on serum testosterone levels.

PURPOSE/OBJECTIVE:To determine whether sociodemographic differences exist among female patients accessing fertility services post-cancer diagnosis in a representative sample of the United States population. METHODS:All women ages 15-45 with a history of cancer who responded to the National Survey for Family Growth (NSFG) from 2011 to 2017 were included. The population was then stratified into 2 groups, defined as those who did and did not seek infertility services. The demographic characteristics of age, legal marital status, education, race, religion, insurance status, access to healthcare, and self-perceived health were compared between the two groups. The primary outcome measure was the utilization of fertility services. The complex sample analysis using the provided sample weights required by the NSFG survey design was used. RESULTS:Five hundred forty-five women reported a history of cancer and were included in this study. Forty-three (7.89%) pursued fertility services after their cancer diagnosis. Using the NSFG sample weights, this equates to a population of 161,500.7 female cancer survivors in the USA who did utilize fertility services and 1,811,955.3 women who did not. Using multivariable analysis, household income, marital status, and race were significantly associated with women utilizing fertility services following a cancer diagnosis. CONCLUSIONS:In this nationally representative cohort of reproductive age women diagnosed with cancer, there are marital, socioeconomic, and racial differences between those who utilized fertility services and those who did not. This difference did not appear to be due to insurance coverage, access to healthcare, or perceived health status.

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. CONCLUSIONS: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.