Reproductive urologic consultation in subfertile men: predictors of establishing care and patient perceptions after abnormal semen testing.

OBJECTIVE: To evaluate the predictors of establishing care with a reproductive urologist (RU) among men with abnormal semen analyses (SAs) ordered by nonurologists and examine patient perceptions of abnormal SAs in the absence of RU consultation. DESIGN: Retrospective cohort study with cross-sectional survey. SETTING: Large, integrated academic healthcare system during 2002-2019. PATIENT(S): We identified adult men undergoing initial SAs with nonurologists who had abnormalities. Patients with index SAs during 2002-2018 were included for the analysis of RU consultation. Men tested in 2019 were recruited for cross-sectional survey. INTERVENTION(S): Cross-sectional survey. MAIN OUTCOME MEASURE(S): RU consultation and accurate perception of abnormal SAs. RESULT(S): A total of 2,283 men had abnormal SAs ordered by nonurologists, among whom 20.5% underwent RU consultation. Mixed-effect logistic regression modeling identified oligospermia as the strongest predictor of RU care (odds ratio, 3.08; 95% confidence interval, 2.43-3.90) with a significant provider-level random intercept. We observed substantial provider-level heterogeneity among nonurologists with provider-specific rates of RU evaluation ranging from 3.7% to 35.8%. We contacted 310 men who did not undergo RU consultation with a 27.2% survey response rate. Of respondents, 6.7% reported receiving an RU referral. Among men with abnormal SAs not evaluated by RU, 22.7% appropriately perceived an abnormal SA. CONCLUSION(S): In men with abnormal SAs diagnosed by nonurologists, the rate of RU consultation was low and associated with substantial provider-level variation among ordering providers. Patients without RU consultation reported inaccurate perceptions of their SA. Multidisciplinary efforts are needed to ensure that subfertile men receive appropriate RU evaluation.

The effect of sleep on male reproductive system: A protocol for systematic review and meta analysis.

BACKGROUND: the purpose of this study was to evaluate the effects of sleep deprivation on semen analyses, hormone levels and testicular histopathology in men. METHODS: this review will be included in a qualified case-control study. The search strategy will be implemented in PubMed, Embase, Web of science, Cochrane library, China National knowledge Infrastructure database, Wanfang Database, and the Cochrane library. We will solicit both English and Chinese case-control studies published from its beginning to July 31, 2020. The 2 examiners will independently screen, select research, extract data and evaluate quality. We use Revman5.3 software to generate funnel map, heterogeneity assessment, data analysis, subgroup analysis and sensitivity analysis. RESULTS: in the current meta-analysis, we will provide some more practical and targeted results for the study of the effects of sleep on the male reproductive system, and sum up the main limitations of previous studies. CONCLUSION: this study will provide new evidence for the effect of sleep on male reproductive system.

Sexual Relationship Power and Semen Exposure Among Female Patients at a Sexually Transmitted Infection Clinic in Kingston, Jamaica.

Women's power in sexual relationships is thought to be an important predictor of condom use. However, research on correlates of condom use often relies on participant reporting of behavior, which has questionable validity. We evaluated the association between scores from the modified Sexual Relationship Power Scale (SRPS-M) and biological detection of semen exposure in a prospective study of adult women attending a sexually transmitted infection clinic in Kingston, Jamaica with cervicitis or abnormal vaginal discharge in 2010-2011. At enrollment, women were counseled to avoid sex while on treatment and were asked to return in 6 days for a follow-up visit. At both study visits, women were administered a questionnaire and had vaginal swabs collected to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure. We found no significant association at enrollment or follow-up between SRPS-M scores and semen exposure, as measured with either self-reported data or PSA positivity. Semen biomarkers could be used to develop and validate new scales on relationship power and self-efficacy related to condom use.

Male attitude towards masturbating: an impediment to infertility evaluation and sperm parameters.

Male attitude about masturbation may influence early diagnosis and treatment of infertility and may be of particular burden in developing countries. We sought to explore attitude about masturbating and examine comfort/discomfort with masturbating and sexual history, pregnancy history and sperm quality in men investigating fertility potential. The study consisted of 83 male volunteers, 23-61 years, attending a fertility management unit in Kingston, Jamaica. Comfort with masturbation was assessed by a self-administered questionnaire. Participants also completed the unit's standard intake form for infertility investigations and produced a semen sample. T-tests, Mann-Whitney U-test and chi-square were used to compare differences in comfort level with outcome variables. We found 59% were comfortable masturbating although requiring external stimulation to produce a sample (48%); 6% (n = 5) failed to produce a sample after repeated attempts. A higher percentage of men uncomfortable with masturbating reported sexual problems (P < 0.05) and spending a longer time trying to have a baby (P < 0.05). Semen quality was not associated with masturbating comfort. Producing a sample by masturbation is standard for many assisted conception treatments. As comfort with masturbating may influence delay in infertility investigations and fertility outcome, efforts to improve men's comfort level with semen production should be considered in pre-treatment fertility counselling.

Barriers to use of semen analysis in the adolescent with a varicocele: Survey of patient, parental, and practitioner attitudes.

BACKGROUND: The American Society for Reproductive Medicine Practice Committee recommends obtaining a semen analysis (SA) in pediatric patients presenting with a varicocele in the absence of significant testicular atrophy. Among infertile adults with a varicocele, surgery is indicated in the presence of abnormal semen analysis regardless of testicular atrophy. Despite these two statements, semen analysis is not widely utilized by pediatric urologists in the USA managing a patient with a varicocele. OBJECTIVE: We explored the attitudes of patients, parents, and practitioners toward SA to identify potential barriers to the use of SA in the evaluation of the adolescent varicocele. STUDY DESIGN: We conducted a survey of Society for Pediatric Urology members regarding their management of adolescent varicoceles, with focus on the utilization of SA. The survey consisted of 14 multiple choice questions and two open-ended questions regarding use of SA in practice, barriers to its use, indications for varicocelectomy, and demographics. We also surveyed patients presenting for initial evaluation of a varicocele, as well as their parents, regarding their knowledge about SA and their attitude towards obtaining it. Statistical analysis was performed (p < 0.05 significant). RESULTS: The practitioner survey response rate was 53% (168). Only 13.1% routinely incorporated SA in their practice, with 48% of all responders having some degree of discomfort asking for a SA. Of practitioners who cited discomfort, 90% never order a SA for patients with varicoceles. From the 46% of physicians who ordered a SA, we noted significant practice variability (see Figure). The patient/parent survey demonstrated that this population was uncomfortable with the notion of obtaining a SA, with most patients/parents citing lack of knowledge about SA as the main barrier. Patient and parent knowledge was found to correlate. DISCUSSION: This study uniquely addresses an issue that has not been discussed in the adolescent varicocele literature to date. It can increase awareness of the option of incorporating SA data in management of the adolescent who presents with a varicocele. CONCLUSION: Recognizing and then breaking through the barriers to obtaining a SA, would improve patient care, providing a direct assessment of the impact of a varicocele on fertility potential and thus best determining which patients require surveillance versus surgical intervention. This study suggested that the barriers to SA are surmountable.

Reduced Postvasectomy Semen Analysis Testing With the Implementation of Special Clearance Parameters.

OBJECTIVE: To determine the applicability of postvasectomy special clearance parameters (<100,000 nonmotile sperm/mL on semen analysis) suggested by the American Urological Association and to define the associated cost savings with avoidance of further testing. MATERIALS AND METHODS: We retrospectively reviewed the cohort of men undergoing vasectomy from December 2009 to August 2012 at a single institution. Patient demographics and postvasectomy semen analysis (PVSA) results were collected for clearance parameter comparisons. RESULTS: During the study period, 230 patients underwent vasectomy with a mean ± SD age of 36.4 ± 6.5 years. Among the cohort, 83.5% were married and 95.2% had one or more children. The initial PVSA was completed by 111 (48.3%) patients at a mean of 17.8 weeks (range 4-45) following vasectomy. Sperm was identified on initial PVSA in 40 patients (36.0%); 1 patient was found to have motile sperm. Of 39 patients, 38 (97.4%) with nonmotile sperm on PVSA could be cleared to cease other contraceptives based on the most recent clearance guidelines. For those completing an initial PVSA, postvasectomy clearance increased from 64.0% to 98.2% representing a potential cost savings of $2356 in repeat semen testing. CONCLUSION: Postvasectomy contraceptive clearance can be greatly increased when rare nonmotile sperm parameters are included although postvasectomy semen testing compliance remains poor.

Association of state and trait anxiety to semen quality of in vitro fertilization patients: a controlled study.

OBJECTIVE: To investigate the relationship between semen quality and state/trait anxiety in patients enrolled in an in vitro fertilization (IVF) program and in control subjects. DESIGN: Cross-sectional study. SETTING: Centre for Reproductive Medicine and Biology, European Hospital, Rome. PATIENT(S): Ninety-four first-attempt IVF patients and 85 age-matched, random subjects recruited in the period July 2006 through March 2008. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Behavioral features of stress, including state and trait anxiety, self-perceived impact of physical disturbance on everyday activities, ethanol consumption, cigarette smoking, and semen parameters such as semen volume, sperm concentration, total count, motility, morphology, and DNA fragmentation. RESULT(S): Increased levels of both state and trait anxiety were associated with lower semen volume, sperm concentration and count, reduced sperm motility, and increased sperm DNA fragmentation of IVF patients, thus influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained in the controls. CONCLUSION(S): Our data confirm previous observations with state anxiety and show that trait anxiety also is negatively associated with male fertility.

Socio-psycho-behavioural factors associated with male semen quality in China: results from 1346 healthy men in Chongqing.

BACKGROUND: Human semen quality in China has decreased in the last few decades. A previous study found that 61.1% of healthy males in Chongqing City in Southwest China had abnormal semen parameters values according to 1999 World Health Organization criteria. OBJECTIVE: This cross-sectional study explored the associations between socio-psycho-behavioural factors and semen quality in Chongqing City. METHODS: The study participants comprised 1346 eligible healthy men who were examined and researched in respect to 15 socio-psycho-behavioural factors. RESULTS: Men from a higher occupational class had better semen volume (ß coefficient 1.18, p=0.034), while men who often wore underwear made from man-made fibres had a lower percentage of morphologically normal sperm (ß coefficient 0.82, p=0.001). As regards psychological stress, men with less stress had an increased total sperm count and percentage of morphologically normal sperm (ß coefficient 1.19 and 1.25 respectively, p=0.02 and 0.04 respectively). The other 12 factors examined in the study demonstrated no significant association with semen quality in Chongqing. CONCLUSIONS: Semen quality can be impacted by socio-psycho-behavioural factors (occupational class, psychological stress and wearing man-made fibre underwear). A health programme that deals directly with psychological health and healthy lifestyle, and the implementation of policies that address social factors for men may play a part in the improvement of male reproductive health in China.

Monitoring fertility (semen analysis) by cancer survivors who banked sperm prior to cancer treatment.

STUDY QUESTION: What medical and psychological variables predict why men with banked sperm do not return for semen analysis after their cancer treatment has ended? SUMMARY ANSWER: Men who decline the offer of semen analysis are less likely to have reported adverse side effects during cancer treatment, and have a more negative experience of banking sperm and a more negative attitude towards disposal of their stored semen than those who attend. WHAT IS KNOWN ALREADY: Previous authors have noted that male cancer survivors seem reluctant to have their fertility tested after their treatment has ended. Moreover, the utilization rates of banked sperm are very low (<10%) and the majority of samples are kept for many years without being used. STUDY DESIGN, SIZE AND DURATION: A cross-sectional study of 499 cancer survivors who were sent a questionnaire about their views on sperm banking, fertility and post-treatment semen analysis between April 2008 and December 2010. PARTICIPANTS AND SETTING: Men (aged 18-55 years) who had banked sperm in Sheffield and Nottingham (UK) prior to gonadotoxic treatment for cancer more than 5 years previously. MAIN RESULTS AND THE ROLE OF CHANCE: Completed questionnaires were received from 193 men (38.7% response rate) whose samples had been banked for 9.18 ± 3.70 years (range = 4.94-26.21) and whose current age was 35.08 ± 7.08 years (range = 21.58-54.34; mean ± SD). One-third (35.8%) had never attended for semen analysis. In multivariate analysis, the odds of not attending for semen analysis were significantly greater among men who did not experience adverse treatment side effects [odds ratio (OR) = 5.72, 95% confidence interval (CI) = 2.10-15.56], who reported a more negative experience of banking sperm (OR = 1.82, 95% CI = 1.17-2.82) and a more negative attitude to disposal of their stored semen (OR = 1.56, 95% CI = 1.01-2.42). LIMITATIONS AND REASONS FOR CAUTION: Only 38.7% of those eligible agreed to take part. We do not know the characteristics of men who declined to take part, if they agreed to attend semen analysis without completing the questionnaire or whether they had chosen to have semen analysis performed elsewhere (e.g. private sector). Some of the measures used (e.g. experience of banking sperm) relied on men's recall of events many years previously. WIDER IMPLICATIONS OF THE FINDINGS: New strategies are required to encourage these men to engage with fertility monitoring programmes if sperm banks are to be used cost-effectively and men are to be given appropriate fertility advice. STUDY FUNDING AND COMPETING INTERESTS: This paper was supported by funding from Cancer Research-UK to C.E., A.A.P. and R.R. (C481/A8141). The views expressed are those of the authors. No competing interests declared.

Knowledge and perceived risks in couples undergoing genetic testing after recurrent miscarriage or for poor semen quality.

Couples with recurrent miscarriage (RM) and men with poor semen quality may undergo genetic testing as part of the diagnostic work-up. This study explored their knowledge and perception of genetic testing, evaluated psychological wellbeing and identified associated variables. A prospective questionnaire study was conducted in seven clinical genetics centres and referring gynaecological departments in couples with RM or poor semen quality. Questionnaires were completed before disclosure of genetic test results. Main outcome measures were knowledge, perceived risk, anxiety and depression. Of 439 participants, 256 were not aware genetic testing was part of the diagnostic work-up. One-third (36% RM, 33% poor semen quality) indicated they had not received information about the genetic test from their doctor. Perceived risk of receiving an abnormal genetic test result was higher than objective risk. Anxiety was highly correlated with perceived risk. Women with RM were more anxious than women in the poor semen quality group or men (P<0.01). These couples undergoing genetic testing have a suboptimal understanding of the nature of testing, overestimate the risks of receiving an abnormal result and some show high levels of anxiety. The results of this study can be used to improve patient counselling before genetic testing.

Semen quality in fertile men in relation to psychosocial stress.

OBJECTIVE: To examine the association between stressful life events and semen parameters. DESIGN: Cross-sectional analysis in a pregnancy cohort study. SETTING: Prenatal clinics in five U.S. cities. PATIENT(S): Fertile men (n = 744) in the Study for Future Families, a cohort study of pregnant women and their partners. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Sperm concentration, percent motile, and percent normal morphology and classification above/below World Health Organization (WHO) cutoffs for semen quality. RESULT(S): After adjusting for confounders, men reporting 2+ recent stressful life events had an increased risk of being classified below WHO thresholds for "normal" defined by concentration, motility, and morphology criteria compared with men reporting <2 stressful life events (odds ratio [OR] = 2.06; 95% confidence interval [CI], 1.18, 3.61; OR = 1.54; 95% CI, 1.04, 2.29; OR = 1.93; 95% CI, 1.02, 3.66 for concentration, motility and morphology, respectively). Men experiencing 2+ stressful life events had lower sperm concentration (log scale, beta = -0.25; 95% CI, -0.38, -0.11) and lower percent motile sperm (beta = -1.95; 95% CI, -3.98, 0.07), but percent normal morphology was less affected. CONCLUSION(S): These results suggest that stressful life events may be associated with decreased semen quality in fertile men. The experience of psychosocial stress may be a modifiable factor in the development of idiopathic infertility.

Variation of semen parameters in healthy medical students due to exam stress.

AIM: This study was aimed at investigating semen parameters that vary most in samples of healthy donors undergoing stressful examination period. METHODS: Samples were left to liquefy in an incubator at 37 degrees C, 5% CO2 for 30 minutes before volume was measured. Concentration and motility parameters were measured by means of computer assisted semen analysis (CASA) using Sperm Class Analyzer (Microptic S.L, Madrid, Spain). RESULTS: Sperm concentration was significantly decreased in samples donated close to the exam period as well as samples donated during the exam period when compared to samples donated at the beginning of the semester. CONCLUSION: Stress levels of donors might prove to be clinically relevant and important when designing experiment protocols.