PD58-08 FNA MAPPING-GUIDED SPERM RETRIEVAL VS. UPFRONT MICROTESE IN NON-OBSTRUCTIVE AZOOSPERMIA: A COMPARISON OF SPERM RETRIEVAL, PREGNANCY AND LIVE BIRTH RATES FROM A HIGH VOLUME FERTILITY CENTER

Abstract

You have accessJournal of UrologyInfertility: Therapy II (PD58)1 Apr 2020PD58-08 FNA MAPPING-GUIDED SPERM RETRIEVAL VS. UPFRONT MICROTESE IN NON-OBSTRUCTIVE AZOOSPERMIA: A COMPARISON OF SPERM RETRIEVAL, PREGNANCY AND LIVE BIRTH RATES FROM A HIGH VOLUME FERTILITY CENTER Akash A. Kapadia*, Marah Hehemann, David Ball, Robert D. McClure, Kevin Ostrowski, and Thomas J. Walsh Akash A. Kapadia*Akash A. Kapadia* More articles by this author , Marah HehemannMarah Hehemann More articles by this author , David BallDavid Ball More articles by this author , Robert D. McClureRobert D. McClure More articles by this author , Kevin OstrowskiKevin Ostrowski More articles by this author , and Thomas J. WalshThomas J. Walsh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000968.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Up to 50% of men with non-obstructive azoospermia (NOA) experience sperm retrieval (SR) failure even with microTESE. No clear predictors of SR have been established that may obviate invasive, costly surgery in men (microTESE) and their female partners (oocyte retrieval). Testicular fine needle aspiration mapping (FNAM) is an office procedure that provides highly accurate data on spermatogenesis. No study has directly compared outcomes of FNAM-guided SR to upfront microTESE. The primary outcomes are SR, pregnancy, and livebirth rates using upfront FNAM vs upfront microTESE from 3 providers with different practice patterns at a single high-volume fertility center. Our secondary objective is to describe utilization rates of SR techniques guided by FNAM. METHODS: We performed a review of males at our clinic diagnosed with NOA from 2009-2019. Treatment pathways were delineated: A) FNAM-guided SR, B) upfront microTESE. Corresponding female partners’ records were reviewed for pregnancy and livebirth data. χ2 analyses were performed for SR, pregnancy and livebirth rates. RESULTS: Of 96 men with NOA, 60 underwent FNAM (Group A), and 36 had upfront microTESE (Group B) based on surgeon and patient preferences. In Group A, 34/60 (56.7%) patients had FNA maps positive for spermatogenesis. Of these, 19/34 (55.9%) had diffuse hypospermatogenesis, and 15/34 (44.1%) had focal hypospermatogenesis. 31/34 (91.1%) underwent SR, 3 declined further treatment. 18/31 (58.1%) had FNA-targeted TESA/E, and 13/31 (41.9%) had microTESE. SR was successful in 30 of 31 men (96.7%). Overall SR rate was 52.6% and 58.3% in groups A and B, respectively, resulting in no statistical difference (p = 0.59). Group A had pregnancy and livebirth rates of 33.3% and 28.1%, respectively. Group B had pregnancy and livebirth rates of 33.3% each. χ2 analysis revealed no statistical difference for both pregnancy (p = 1.0) and livebirth rates (p = 0.6). CONCLUSIONS: Rates of SR, pregnancy and livebirth are similar in the two groups. With FNAM, a majority of men with NOA were treated with minimally invasive, office-based SR. Upfront FNAM allowed for accurate counseling regarding SR success. Further in-depth cost analysis is needed to determine improved cost-efficiency with FNAM. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1202-e1203 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akash A. Kapadia* More articles by this author Marah Hehemann More articles by this author David Ball More articles by this author Robert D. McClure More articles by this author Kevin Ostrowski More articles by this author Thomas J. Walsh More articles by this author Expand All Advertisement PDF downloadLoading ...