Reproductive Urologist Preferences for Sperm Extraction in Congenital Bilateral Absence of the Vas Deferens.

OBJECTIVE

To assess reproductive urologists' sperm extraction preferences for patients with congenital bilateral absence of the vas deferens (CBAVD) and CBAVD with cystic fibrosis (CF).

METHODS

A survey was sent to the Society for the Study of Male Reproduction: "A 30-year old male presents with his 28-year-old wife for infertility evaluation. On exam he has CBAVD, with bilateral testicular volume of 24 cc and normal epididymal head bilaterally, no varicocele. His wife's evaluation is normal. You send him for a cystic fibrosis transmembrane conductance regulator panel, which is positive for homozygous delta F 508 mutation." Responses were collected, and descriptive and comparative statistics using Χ2 analyses were performed.

RESULTS

We received 51 survey responses: 39.2% elected for testicular extraction, 29.4% epididymal, and 31.4% a combination. Office was more common (56.9%) versus 41.2% would perform in the operating room; 68.6% would perform extraction with onsite andrology lab. On Χ2 analysis, there was no significant difference between onsite lab and extraction preference. Fertility labs would be collected by 90.2%. For a postvasectomy patient who chose sperm retrieval over reversal, 70.6% would not change their practice.

CONCLUSION

There is an array of sperm extraction techniques in CF, which often can be managed similarly to a non-CF patient with obstructive azoospermia. Technique preference is unrelated to procedure location or andrology lab access. As there are many options for this population, further research is needed on outcomes and resource utilization in assisted reproductive technology for these patients to define clinical guidelines and improve access to care.