Faculty Bibliography

Purpose: To evaluate the technical success, clinical efficacy, and safety of gonadal vein embolization in men presenting with symptomatic varicoceles. Materials: A retrospective study of 83 consecutive male patients who had varicocele embolization between January 2008 and December 2018 was conducted. 39 patients (mean age, 33.8 years; range, 18-70 years) met the inclusion criteria of symptomatic varicocele (scrotal pain and/or heaviness) and had complete clinical records. The primary outcome was symptomatic improvement. Secondary outcomes were technical success rate defined as successful catheterization and embolization of the gonadal vein(s) and adverse events.
Result(s): Of the 39 patients, 33 (84.6%) presented had scrotal pain, 3 (7.7%) had heaviness, and 3 (7.7%) had pain and heaviness. Nine (23.1%) had prior varicocelectomy. 32 patients had complete preprocedural ultrasound; of those 12 (37.5%) had testicular asymmetry, 22 (68.8%) had left varicocele, 1 (3.1%) had right varicocele, and 9 (28.1%) had bilateral varicoceles. Procedural approach was transfemoral in 34 (87.2%) and transjugular in 5 (12.8%) patients. Only symptomatic sides were treated; of the 39 patients, 8 (20.5%) had bilateral, 1 (2.6%) had right, and 30 (76.9%) had left embolization. Embolic agents used were coils + Sodium tetradecyl sulfate (STS) in 3 (7.7%), coils + n-Butyl cyanoacrylate (n-BCA) glue in 8 (20.5%), n-BCA glue alone in 20 (51.3%), and a combination of different embolization material in the remainder of the patients (STS, vascular plugs, n-BCA, Gelfoam, and/or coils). The mean time to follow-up was 8.3 months. The overall technical success rate was 94.9%; of those, 28 (75.7%) indicated an improvement in their preprocedural symptoms. In patients with symptomatic improvement, the recurrence rate was 7.1%, with a mean time to recurrence of 7.5 months. There were no recorded complications. Conclusion(s): GVE is safe, has high technical success rate, and is effective in improving scrotal pain and heaviness

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.

Objective: Epidemiologic studies have found that a greater degree of comorbidity is associated with worse fertility potential. However, these findings are largely based on retrospective studies of men interacting with the health care system. Our objective was to evaluate the association of fertility and health status in men in the United States using a nationally representative survey.
Design(s): We compared the demographics, healthcare utilization, and overall health status of fertile and infertile men in the National Survey for Family Growth (NSFG).
Material(s) and Method(s): We performed an analysis of the male 2011-2017 cycles of the NSFG, a nationally representative survey of family planning. Infertile men were defined as men who had ever used infertility services or men who self-reported as non-surgically sterile. Men who reported completed pregnancies were considered fertile.
Result(s): Of the 13,861 men surveyed, 1,071 men were infertile, and 5,661 men were known to be fertile. Projecting to the national population, this translates to 5,205,771 infertile men and a 26,577,702 fertile men. Of the total population of sexually active men aged 15-49, roughly 8.5% (95%CI: 7.8-9.3) of men were infertile. Compared to known fertile men, infertile men had significant demographic and healthcare utilization differences (Table). Infertile men were wealthier, better educated, more likely to be white, more likely to be married, and more likely to have private insurance. Importantly, infertile men and fertile men had similar overall health status. On multivariate analysis, differences in income, marital status, and usual healthcare place remained significant.
Conclusion(s): While infertile men do have significant demographic and healthcare utilization differences compared to fertile men, the overall health status of both infertile and fertile men appear similar. [Figure presented]
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OBJECTIVE: Epidemiologic studies have found that a greater degree of comorbidity is associated with worse fertility potential. However, these findings are largely based on retrospective studies of men interacting with the health care system. Our objective was to evaluate the association of fertility and health status in men in the United States using a nationally representative survey. DESIGN: We compared the demographics, healthcare utilization, and overall health status of fertile and infertile men in the National Survey for Family Growth (NSFG). MATERIALS AND METHODS: We performed an analysis of the male 2011-2017 cycles of the NSFG, a nationally representative survey of family planning. Infertile men were defined as men who had ever used infertility services or men who self-reported as non-surgically sterile. Men who reported completed pregnancies were considered fertile.
RESULT(S): Of the 13,861 men surveyed, 1,071 men were infertile, and 5,661 men were known to be fertile. Projecting to the national population, this translates to 5,205,771 infertile men and a 26,577,702 fertile men. Of the total population of sexually active men aged 15-49, roughly 8.5% (95%CI: 7.8-9.3) of men were infertile. Compared to known fertile men, infertile men had significant demographic and healthcare utilization differences (Table). Infertile men were wealthier, better educated, more likely to be white, more likely to be married, and more likely to have private insurance. Importantly, infertile men and fertile men had similar overall health status. On multivariate analysis, differences in income, marital status, and usual healthcare place remained significant.
CONCLUSION(S): While infertile men do have significant demographic and healthcare utilization differences compared to fertile men, the overall health status of both infertile and fertile men appear similar