One-tenth of sperm retrievals performed by gynecologists

A recent study is questioning some of the current trends in sperm retrieval practices in private U.S. clinics that treat infertile couples.

California researchers investigated provider sperm retrieval practice patterns at American infertility clinics and found that sperm retrievals were performed by gynecologists in 9.4% of private fertility clinics. The authors point out that these are providers for whom male anatomy is not part of their training. They also found that the majority of these gynecologists performed sperm retrievals under IV sedation.

They write that this practice may be driven by finances or patient convenience. However, it is an area that may need better oversight.

“Male infertility can be a harbinger of many other diseases,” said study investigator Nima Nassiri, MD, resident at the Institute of Urology, Keck USC School of Medicine, Los Angeles, who worked on the study with Mary Samplaski, MD, and colleagues.

For the study, private-practice fertility clinics were phoned and queried regarding their sperm retrieval practice patterns. At least two community clinics were contacted in each state and no academic centers were included. In states with multiple large cities, several clinics in different cities were contacted. The authors examined the type of physician performing sperm retrievals, the type of anesthesia used, and total costs.

A total of 225 infertility clinics were contacted and 90.2% of clinics (203/225) responded to the queries. The authors found that an on-staff urologist was not present at any clinic that was queried. An on-staff gynecologist performed surgical sperm retrieval at 9.4% of the clinics (19 out of 203). A urologist who was “partnered” with the infertility clinic performed the procedure at the clinic as needed at 11.8% of the clinics (24 out of 203).

The study showed that 18.7% of the clinics (38 out of 203) did not offer surgical sperm retrieval. However, they had a referral pattern established with a local urologist, who did the sperm retrieval off site and had the sample transported to the clinic.

When the authors looked at those clinics where gynecologists performed surgical sperm retrieval, they found that anesthesia use varied widely, with 1.52.6% routinely using IV anesthesia, 2.10.5% offering local or IV anesthesia, 3.5.3% using local anesthesia alone, and 4.31.6% not knowing about anesthesia use.

Next: Most use general anesthesiaMost use general anesthesia

“Most of the gynecologists are using general anesthesia, which increases costs and risks. We found 92% offered general anesthesia and 77% routinely used it. Generally, we do it under local anesthesia,” Dr. Nassiri told Urology Times.

The cities/states that reported to have gynecologists perform sperm retrievals were in virtually every geographic region in the U.S. They included: Northport, AL; Pasadena, CA; Parker, CO; Newark, DE; Miami and Pensacola, FL; Lexington, KY; Lafayette, LA; Henderson, NV; Albuquerque, NM; Charlotte and Winston-Salem, NC; Sylvania, OH; Tulsa, OK; Portland and Eugene, OR; Greenville, SC; Beaumont, TX; and Kirkland, WA.

Dr. Nassiri said surgical sperm retrieval has traditionally been performed by reproductive urologists. However, a growing number of reproductive gynecologists are performing these procedures and this may be occurring for a variety of reasons. The researchers contend that this trend needs to be more closely scrutinized, since they found that costs for a gynecologist to perform sperm retrieval ranged from $1,000 to $10,000.

“That a big difference. I think this is a great preliminary study. It gives us good insight into community practice patterns. There is a best practice statement from the AUA, but I don’t think it specifically says patients should go to a reproductive urologist. I think anyone who is evaluating male infertility should have a background in doing a full workup,” said Dr. Nassiri.

The findings were presented at the 2019 AUA annual meeting in Chicago and subsequently published in Urology (2019; 133:116-20).