(703) Impact of Surgery and Sperm Retrieval Outcomes on Erectile Function in Men with Non-Obstructive Azoospermia: Results from a Randomized Clinical Trial

Introduction The emotional and physical burden associated with infertility and surgical intervention has been sug-gested to impact sexual well-being, including erectile function. However, evidence regarding postop-erative changes in erectile function including the potential influence of sperm retrieval outcomes re-mains limited. Objective To evaluate erectile function before and after surgery in men with NOA undergoing surgical sperm retrieval and to examine whether surgical results influence erectile function. Methods Men participating in a randomized clinical trial (ethical approval H-16033784) comparing microdis-section testicular sperm extraction to multi-pass testicular sperm aspiration completed the Interna-tional Index of Erectile Function 5 questionnaire (IIEF-5) at baseline, 2 days post-surgery and 90 days post-surgery, knowing their sperm retrieval result before the 2-day assessment. Adjusted mean IIEF-5 scores were estimated from a linear mixed-effects model accounting for repeated measures and then compared between and within each surgical result group. Results A total of 100 men with a median (IQR) age of 33 years (7) underwent surgical sperm retrieval. Complete response rate (all time points) for IIEF-5 was 85% and the average response rate across all three time points was 93.3%. Spermatozoa were successfully retrieved in 36/100 men. The median (IQR) IIEF-5 score across all men with NOA was 24 (4) at baseline, 24 (3) on the sec-ond postoperative day and 25 (3) on day 90 post-surgery. Differences in IIEF-5 scores between men with and without retrieved sperm were -0.39 (95%CI -1.61 to 0.83; p = 0.527) at baseline, -0.17 (95% CI -1.41 to 1.06; p = 0.779) at 2 days post-surgery and -0.14 (95%CI -1.39 to 1.10; p = 0.822) at 90 days post-surgery and thus not clinically or statistically significant. From baseline to the second postoperative day, the mean change in IIEF-5 was 0.03 (95% CI -0.44 to 0.5; p = 0.987) in men without successful sperm retrieval and 0.25 (95% CI -0.37 to 0.87; p = 0.670) in men with successful sperm retrieval. At 90 days, the corresponding changes were 0.11 (95% CI -0.37 to 0.59; p = 0.880) and 0.36 (95% CI -0.27 to 0.99; p = 0.459), respectively. Analyzing the interaction between time and surgical outcome revealed that changes in IIEF-5 scores in the two groups did not differ statistically significantly, with a difference in change of -0.22 (95% CI -0.99 to 0.57; p=0.583) at 2 days and -0.25 (95% CI -1.04 to 0.55; p=0.537) at 90 days. Conclusions Men with NOA showed unimpaired erectile function at baseline. IIEF scores and changes in IIEF scores over time were not affected by the outcome of the procedure. These reassuring data can be useful in shared decision-making regarding sperm retrieval and pre-operative counselling. Disclosure No