Abstracts from the New England Section of the AUA 2020: A Virtual Experience

NE AUA 2020 Abstracts 46 The Effect of Body Mass Index on Clomiphene Citrate Therapy Outcomes for Hypogonadal Men Alexander Plochocki, MD, MPH 1 ,Alexander Erbella, MD 2 , Erin Burns, RN 3 , Susan Parks, CMA 3 , Nicole Rossetti, RN 3 , Matthew Wosnitzer, MD 3 1 University of Vermont Medical Center, Burlington, VT; 2 Florida State University College of Medicine / Tallahassee Memorial Healthcare, Tallahassee, FL; 3 Yale New Haven Health, Northeast Medical Group, Fairfield, CT Introduction: Standard exogenous testosterone replacement therapy may lead to fertility decline or azoospermia, as they suppress the natural hypothalamus-pituitary-gonadal (HPG) axis necessary for endogenous testosterone production and spermatogenesis. For menwith future fertility interest or male factor infertility, clomiphene citrate (CC) provides a fertility-sparing treatment option, by increasing endogenous testosterone production. Materials&Methods: Inasinglemale infertilityclinic,ourstudyretrospectivelycompared 100 consecutive men who were diagnosed with hypogonadism and treated by a single urologist with clomiphene citrate (CC) starting at 25 mg every other day and titrated to eugonadal total testosterone (TT) up to a maximal dose of 50mg daily. Increase in TT from baseline after three months of treatment measured treatment effectiveness. Additional outcomes were measured with change in prostate specific antigen (PSA), estradiol, and hematocrit (HCT) from baseline after three months of treatment. Results: All BMI groups experienced an increase in TT (Figure 1), but patients with a normal BMI exhibited a greater increase in TT (p < 0.01). There was a minimal and non- significant change in PSA (p = 0.37), estradiol (p = 0.59), and HCT (p = 0.13). Results are summarized in Table 1. Conclusions: CC increases TT less in overweight, obese, and morbidly obese men, while exhibiting minimal change in PSA, estradiol, or HCT in all BMI groups. Our study’s findings suggest that CCmay be a more effective treatment for hypogonadism in normal- weighted men compared to overweight and obese men. Novel Mobile-Enabled Point-of-Care Testing for Comprehensive Male Fertility Assessment Reza Amin, PhD 1 , Jared Bieniek, MD 2 , Evelyn Neuber, PhD 3 1 QR Fertile, Farmington, CT; 2 Hartford Healthcare, Hartford, CT; 3 Center for Advanced Reproductive Services, Farmington, CT Introduction: Semen analysis remains the gold standard for male fertility testing. The current standard is for men to visit a laboratory and either deliver a fresh semen sample or collect a sample on site for analysis. This process, however, is uncomfortable for most men, time-consuming, and costly. We have developed a mobile-enabled paper-based device for home-basedmale fertility testing of sperm concentration, semen pH, and semen fructose concentration; allowing men to make their initial male fertility assessments in the comfort of their homes. Here we present validation data for our novel home male fertility colorimetric testing assay. Materials &Methods: The testing device comprises a reservoir for sample loading, sample delivery microfluidic channels, and a paper layer pre-loaded with colorimetric reagents. Sperm count is quantified bymeasuring the colorimetric change of yellow tetrazoliumdye to purple formazan by metabolically active sperms. The color change in each assay region is imaged and analyzed using a mobile phone application. Human semen samples were obtained from a local fertility clinic (Farmington, CT) and applied to our device without any sample preparation. Measured semen parameters were compared to standard semen analysis results by trained andrologists. Results: Previous sensitivity testing of eight different sperm concentrations (utilizing ten semen samples) was performed to create a calibration curve with (R 2 = 0.97). Using the established calibration, the sperm concentration of seven new semen samples was evaluated in comparison to standard lab-based testing and a mean absolute error of 12M spermwas obtained. The pH sensitivity is increased bymultiplexing of three pH indicators and their calibration curves have been determined and further tested in five semen samples with a mean absolute error of 0.45. The colorimetric fructose assay has been calibrated for concentrations ranging from 0 to 4 mg/mL (R 2 = 0.98). Conclusions: Our preliminary clinical validation demonstrates the practicality of the proposed at-home diagnostic platform as a screening tool for male fertility assessment. Further testing is needed to define the sensitivity of the assays and user-friendliness of the platform. Furthermore, additional semen parameters, such as DNA fragmentation, are being targeted for future iterations of the platform. 45 21 Scientific Session V: ED/Infertility