(704) Psychological Impact of Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Results From a Randomized Clinical Trial

Introduction Surgical sperm retrieval is used in men with non-obstructive azoospermia (NOA) to achieve biological parenthood. Meanwhile, the mental health impact of the treatment is poorly understood. Objective To evaluate mental health outcomes in men with NOA undergoing surgical sperm retrieval and to examine whether surgical results influence psychological well-being. Methods Psychological assessment was done in men participating in a randomized trial (ethical approval H-16033784) comparing microdissection testicular sperm extraction to multi-pass testicular sperm aspi-ration, receiving their sperm retrieval results one day postoperatively. The Hospital Anxiety and De-pression Scale (HADS-A and HADS-D), the Perceived Stress Scale (PSS), and the 12-Item Short Form Health Survey (SF-12 physical and mental component PCS/MCS) were administered at baseline, two days postoperatively, and 90 days postoperatively. Changes in scores were analyzed using linear mixed-effects models. Results 100 men with a median age (IQR) of 33 (7) years underwent surgical sperm retrieval. Complete response rate was ≥82% across all questionnaires and the mean response rate was >92% across all time points. Spermatozoa were retrieved in 36 men. No differences were seen between groups in any of the questionnaires at baseline or 90 days. Men without successfully retrieved sperm had a higher HADS-D (2.27; 95% CI 1.01 to 3.52; p<0.001) and a lower PCS (-3.79; 95% CI -6.9 to -0.69; p<0.05) two days post-surgery, than men with retrieved sperm. In the overall cohort, HADS-D increased by 1.04 (95% CI 0.73–1.9; p<0.01), PSS rose by 1.68 (95% CI 0.43–2.93; p<0.05), and PCS declined by –6.59 (95% CI 8.43 to -4.75; p<0.001) two days after surgery, with no significant changes in HADS-A or MCS. By 90 days, scores had returned to baseline (Table 1). When spermatozoa were retrieved, PCS fell at two days (–5.61; 95% CI -8.52 to -2.7; p<0.001) but normalized by 90 days; other scores remained stable (Table 1). Without retrieval, HADS-D rose by 2.1 (95% CI 1.4–2.8; p<0.001), PSS by 2.58 (95% CI 1.06–4.09; p<0.01), and PCS dropped by –7.57 (95% CI -9.83 to -5.31; p<0.001), at two days after surgery. The remaining scores did not change significantly and at 90 days, all scores were comparable to baseline (Table 1). Comparisons of score changes showed that men without retrieved sperm had greater increases in depressive symptoms from baseline to 2 days (2.17; 95% CI 0.99–3.35; p<0.001) and in perceived stress from baseline to 90 days (2.95; 95% CI 0.4–5.5; p<0.05) post-surgery. Conclusions Men with NOA reported mental health comparable to the general population but experienced transient psychological and physical strain around the time of surgical sperm retrieval, particularly in men with negative sperm retrieval. This highlights the importance of mental health assessment in men with NOA. Disclosure No