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?:abstract
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Objective: With the rapid expansion of telehealth use during COVID-19, it remains unknown how video visits are being used to evaluate male infertility particularly when patients are not able to undergo a physical exam We sought to assess what diagnoses were seen and which tests were pursued as part of the new patient evaluation Herein we summarize a single institution’s experience with video visits for male infertility during COVID-19 Design: Retrospective case series of patients with male infertility managed via video visits Materials and Methods: We identified video visits completed at our institution between March 23, 2020 and April 29, 2020 for male infertility We included new patients visits and return visits for men 18 years of age or older completed by two andrology-trained urologists We collected and categorized scheduled visit type;visit completion rate;patient demographic and referral information;primary diagnoses;and laboratory and imaging tests ordered for new patient evaluations Results: There were 51 scheduled video visits with 21 (41 2%) new patient and 30 (58 8%) established patient encounters Eight (15 7%) video visits were cancelled—7 re-scheduled and 1 converted to a telephone encounter due to technical issues—and 6 (11 8%) were no-shows The median age was 32 years (range 22 – 48) and most patients were referred by their primary care provider or their partner’s reproductive endocrinologist (53% and 18%, respectively) For the 38 completed video visits, primary diagnoses included 11 (29%) idiopathic cases, 11 (29%) endocrinologic derangements, and 9 (24%) cases had anatomic contributors to infertility such as varicocele, previous vasectomy or ejaculatory duct obstruction Additional diagnoses included genetic abnormalities (5%), concurrent partner evaluation (3%), sperm DNA integrity concerns (3%), active infection with pyospermia (3%), and post-operative hematoma (3%) Of the 17 completed new patient visits, most were diagnosed with idiopathic 6 (35%) or anatomic (24%) conditions Only 4 new patients (24%) had previously undergone an examination by a urologist Eleven new patients (65%) required additional hormonal testing, 5 (29%) required another semen analysis, and 5 (29%) had scrotal ultrasound ordered due to inability to perform a physical exam due to limited use of outpatient clinics during COVID-19 Three (18%) required genetic testing, 2 (12%) a pituitary MRI, and 1 (6%) required DNA fragmentation testing Conclusions: Due to COVID-19, use of video visit has expanded to include new patient, male infertility evaluations The most commonly ordered tests for these men included additional hormonal testing, additional semen analyses, and scrotal ultrasounds While the physical exam is a crucial aspect of the infertility work-up, this series suggests that video visits could help ensure that a complete evaluation takes place even before a man undergoes a physical exam in clinic
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