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1921 SIGNIFICANCE OF ANTI-CHLAMYDIA TRACHOMATIS IGM ANTIBODY IN INFERTILE OR SUBFERTILE MEN: IMPACT OF ANTIMICROBIAL THERAPY ON SEMEN PARAMETERS
Vol. 183, No. 4, Supplement, Wednesday, June 2, 2010
Infertility: Therapy/Evaluation Moderated Poster 57 Wednesday, June 2, 2010
10:30 AM-12:30 PM
1920
THE JOURNAL OF UROLOGY姞
e747
rise in the TMSC of antibody-positive asthenozoospermic males (127.8x106 vs. 203.9x106, n⫽73, p⬍0.001) and antibody-borderline asthenozoospermic males (106.2x106 vs. 162.1x106, n⫽56, p⫽0.015). CONCLUSIONS: The prevalence of anti-Chlamydia trachomatis IgM antibody in adult males could be higher than expected. Appropriate antimicrobial therapy in patients with anti-chlamydial antibody improves TMSC. Therefore, it may be prudent to screen subfertile men for Chlamydia trachomatis-mediated genitourinary tract infections. Source of Funding: None
ISOLATED TERATOSPERMIA DOES NOT APPEAR TO PREDICT CLINICAL PREGANCY FOLLOWING IN VITRO FERTILIZATION OR IN VITRO FERTILIZATION WITH INTRACYTOPLASMIC SPERM INJECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
1922
James Hotaling*, Seattle, WA; James Smith, Mitchell Rosen, San Francisco, CA; Thomas Walsh, Seattle, WA
James F. Smith*, Michael Eisenberg, Shana Millstein, Robert Nachtigall, Natalia Sadetsky, Patricia Katz, San Francisco, CA
INTRODUCTION AND OBJECTIVES: Current data is conflicting with regard to the role of sperm morphology in predicting assisted reproductive technology (ART) pregnancy outcomes. We performed a systematic review and meta-analysis to provide a concise statement regarding the specific impact of isolated teratospermia on clinical pregnancy after IVF and ICSI. METHODS: We conducted a systematic review and metaanalysis of data from the literature from years 1970 to 2009 using teratospermia and fertilization or IVF or in vitro fertilization as the keywords. For data extraction isolated, severe teratospermia was defined by strict Kruger criteria as less than 5% normal forms and otherwise normal semen parameters (WHO). Outcome was defined as clinical pregnancy per number of treatment cycles. Odds ratios (ORs) were used as the measure of risk and were calculated using the random effects model. RESULTS: A total of 31 studies were identified and five met inclusion criteria. Isolated teratospermia did not lead to a significantly decreased chance of pregnancy with ART. The Odds Ratio (OR) for IVF success with teratospermia compared to non-teratospermic controls was 1.03 with a 95% Confidence Interval (CI) of 0.90-1.21. OR for successful pregnancy with IVF-ICSI was 0.94 (95% CI 0.63-1.42). CONCLUSIONS: Isolated severe teratospermia does not appear to predict decreased pregnancy rates in IVF alone or IVF-ICSI.
INTRODUCTION AND OBJECTIVES: While various estimates of fertility care costs have been made, most are based upon resource utilization or billing estimates rather than actual out-of-pocket expense to an individual. This study documents the total out-of-pocket cost of fertility care among a prospective cohort of infertile couples followed for 18 months. METHODS: Fertility outcomes and key demographic and medical data were determined through questionnaires, interviews, and medical record abstraction. The infertility cohort was assembled from 8 community and academic reproductive endocrinology clinics. Interviews were conducted at enrollment, and at 4, 10, and 18 months. Cost diaries with entries for the out-of-pocket costs of provider visits, medications, transportation, and “other” (e.g. adoption, legal fees, cryopreservation, psychological support, and child care) were completed by 371 participants. RESULTS: The mean out-of-pocket cost was $9,592 (median $4,112, range 0-$73,180) among all participants. Provider visits were the largest expense (mean $6,504, range 0-$57,620), followed by medications (mean $1,670, range 0-$19,452), and “other” (mean $1,414, range 0-$60,439). Transportation costs were minimal. Couples using no cycle-based treatment spent the least ($1,534) followed by those using medications for ovarian stimulation without IUI ($2,008), IUI with or without ovarian stimulation ($3,302), IUI followed by IVF ($16,042), and IVF alone ($16,550). Couples with isolated male factor infertility ($10,731) and combined male and female factors spent the most ($13,012) compared to female factor only ($8,435) and no identifiable infertility factors ($2,512). Insurance coverage was associated with lower out-of-pocket fertility expenses ($8,479 vs. $10,540); however, this difference did not achieve statistical significance. CONCLUSIONS: The out-of-pocket cost of fertility care is related to the complexity of the treatments utilized, and to a lesser degree, the infertility diagnosis. Combined male and female factor generated the highest expenses followed by isolated male factor alone and female factor alone. Insurance coverage ameliorated this expense slightly but not to a significant degree. These data provide useful information to guide clinicians and patients in assessing the costs of different infertility treatment options.
Source of Funding: None
1921 SIGNIFICANCE OF ANTI-CHLAMYDIA TRACHOMATIS IGM ANTIBODY IN INFERTILE OR SUBFERTILE MEN: IMPACT OF ANTIMICROBIAL THERAPY ON SEMEN PARAMETERS Jin Ho Choe*, Hana Yoon, Joong Shik Lee, Young Min Joo, Ju Tae Seo, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Chlamydia infection in the genitourinary tract is associated with male infertility and subfertility. We sought to estimate the prevalence of anti-chlamydial antibodies in infertile men and examined the effect of antimicrobial therapy on their sperm parameters. METHODS: Males who visited a fertility clinic (n⫽2,196) were screened for serum anti-Chlamydia trachomatis IgM antibody and subjected to computer-assisted semen analysis. Patients who were positive for the antibody or had borderline levels received one single 1,000 mg dose of oral azithromycin. Total motile sperm counts (TMSCs; semen volume x sperm count x percentage of motile sperm x 106) were compared before and after treatment. TMSC changes in patients with initial asthenozoospermia (⬍50% motility) were also assessed. RESULTS: The anti-chlamydial antibody prevalence was 21.6% (474/2,196; positive in 12.8% and borderline in 8.8%). TMSC before and after treatment was evaluated in 198 patients, of whom 129 initially exhibited asthenozoospermia. After treatment, the TMSC rose significantly in antibody-positive patients (215.7x106 vs. 255.6x106, n⫽123, p⫽0.008) and antibody-borderline patients (145.8x106 vs. 184.9x106, n⫽75, p⫽0.049). After treatment, there was also a marked
OUT-OF-POCKET FERTILITY COSTS: DATA FROM A PROSPECTIVE INFERTILITY COHORT IN THE UNITED STATES
Source of Funding: Grant HD37074 from the National Institute for Child Health and Human Development (NICHD/NIH)
1923 MORBID OBESE MEN PRESENT POOR SPERM QUALITY AND WHILE HORMONAL AND SEXUAL FUNCTIONS IMPROVE IT IS NOT REVERSED AFTER GASTRIC BYPASS – A LONG TERM FOLLOW UP Leonardo O. Reis*, Ricardo D Saade, Elintom A Chaim, Laurione C Oliveira, Adriano Fregonesi, Ubirajara Ferreira, Campinas, Brazil INTRODUCTION AND OBJECTIVES: The effects of weight loss on sexual function, hormones and mostly on fertility have not been well studied. We evaluate the impact of lifestyle modifications and gastric bypass in this context focusing sperm quality.
Infertility: Therapy/Evaluation Moderated Poster 57 Wednesday, June 2, 2010
10:30 AM-12:30 PM
1920
THE JOURNAL OF UROLOGY姞
e747
rise in the TMSC of antibody-positive asthenozoospermic males (127.8x106 vs. 203.9x106, n⫽73, p⬍0.001) and antibody-borderline asthenozoospermic males (106.2x106 vs. 162.1x106, n⫽56, p⫽0.015). CONCLUSIONS: The prevalence of anti-Chlamydia trachomatis IgM antibody in adult males could be higher than expected. Appropriate antimicrobial therapy in patients with anti-chlamydial antibody improves TMSC. Therefore, it may be prudent to screen subfertile men for Chlamydia trachomatis-mediated genitourinary tract infections. Source of Funding: None
ISOLATED TERATOSPERMIA DOES NOT APPEAR TO PREDICT CLINICAL PREGANCY FOLLOWING IN VITRO FERTILIZATION OR IN VITRO FERTILIZATION WITH INTRACYTOPLASMIC SPERM INJECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
1922
James Hotaling*, Seattle, WA; James Smith, Mitchell Rosen, San Francisco, CA; Thomas Walsh, Seattle, WA
James F. Smith*, Michael Eisenberg, Shana Millstein, Robert Nachtigall, Natalia Sadetsky, Patricia Katz, San Francisco, CA
INTRODUCTION AND OBJECTIVES: Current data is conflicting with regard to the role of sperm morphology in predicting assisted reproductive technology (ART) pregnancy outcomes. We performed a systematic review and meta-analysis to provide a concise statement regarding the specific impact of isolated teratospermia on clinical pregnancy after IVF and ICSI. METHODS: We conducted a systematic review and metaanalysis of data from the literature from years 1970 to 2009 using teratospermia and fertilization or IVF or in vitro fertilization as the keywords. For data extraction isolated, severe teratospermia was defined by strict Kruger criteria as less than 5% normal forms and otherwise normal semen parameters (WHO). Outcome was defined as clinical pregnancy per number of treatment cycles. Odds ratios (ORs) were used as the measure of risk and were calculated using the random effects model. RESULTS: A total of 31 studies were identified and five met inclusion criteria. Isolated teratospermia did not lead to a significantly decreased chance of pregnancy with ART. The Odds Ratio (OR) for IVF success with teratospermia compared to non-teratospermic controls was 1.03 with a 95% Confidence Interval (CI) of 0.90-1.21. OR for successful pregnancy with IVF-ICSI was 0.94 (95% CI 0.63-1.42). CONCLUSIONS: Isolated severe teratospermia does not appear to predict decreased pregnancy rates in IVF alone or IVF-ICSI.
INTRODUCTION AND OBJECTIVES: While various estimates of fertility care costs have been made, most are based upon resource utilization or billing estimates rather than actual out-of-pocket expense to an individual. This study documents the total out-of-pocket cost of fertility care among a prospective cohort of infertile couples followed for 18 months. METHODS: Fertility outcomes and key demographic and medical data were determined through questionnaires, interviews, and medical record abstraction. The infertility cohort was assembled from 8 community and academic reproductive endocrinology clinics. Interviews were conducted at enrollment, and at 4, 10, and 18 months. Cost diaries with entries for the out-of-pocket costs of provider visits, medications, transportation, and “other” (e.g. adoption, legal fees, cryopreservation, psychological support, and child care) were completed by 371 participants. RESULTS: The mean out-of-pocket cost was $9,592 (median $4,112, range 0-$73,180) among all participants. Provider visits were the largest expense (mean $6,504, range 0-$57,620), followed by medications (mean $1,670, range 0-$19,452), and “other” (mean $1,414, range 0-$60,439). Transportation costs were minimal. Couples using no cycle-based treatment spent the least ($1,534) followed by those using medications for ovarian stimulation without IUI ($2,008), IUI with or without ovarian stimulation ($3,302), IUI followed by IVF ($16,042), and IVF alone ($16,550). Couples with isolated male factor infertility ($10,731) and combined male and female factors spent the most ($13,012) compared to female factor only ($8,435) and no identifiable infertility factors ($2,512). Insurance coverage was associated with lower out-of-pocket fertility expenses ($8,479 vs. $10,540); however, this difference did not achieve statistical significance. CONCLUSIONS: The out-of-pocket cost of fertility care is related to the complexity of the treatments utilized, and to a lesser degree, the infertility diagnosis. Combined male and female factor generated the highest expenses followed by isolated male factor alone and female factor alone. Insurance coverage ameliorated this expense slightly but not to a significant degree. These data provide useful information to guide clinicians and patients in assessing the costs of different infertility treatment options.
Source of Funding: None
1921 SIGNIFICANCE OF ANTI-CHLAMYDIA TRACHOMATIS IGM ANTIBODY IN INFERTILE OR SUBFERTILE MEN: IMPACT OF ANTIMICROBIAL THERAPY ON SEMEN PARAMETERS Jin Ho Choe*, Hana Yoon, Joong Shik Lee, Young Min Joo, Ju Tae Seo, Seoul, Korea, Republic of INTRODUCTION AND OBJECTIVES: Chlamydia infection in the genitourinary tract is associated with male infertility and subfertility. We sought to estimate the prevalence of anti-chlamydial antibodies in infertile men and examined the effect of antimicrobial therapy on their sperm parameters. METHODS: Males who visited a fertility clinic (n⫽2,196) were screened for serum anti-Chlamydia trachomatis IgM antibody and subjected to computer-assisted semen analysis. Patients who were positive for the antibody or had borderline levels received one single 1,000 mg dose of oral azithromycin. Total motile sperm counts (TMSCs; semen volume x sperm count x percentage of motile sperm x 106) were compared before and after treatment. TMSC changes in patients with initial asthenozoospermia (⬍50% motility) were also assessed. RESULTS: The anti-chlamydial antibody prevalence was 21.6% (474/2,196; positive in 12.8% and borderline in 8.8%). TMSC before and after treatment was evaluated in 198 patients, of whom 129 initially exhibited asthenozoospermia. After treatment, the TMSC rose significantly in antibody-positive patients (215.7x106 vs. 255.6x106, n⫽123, p⫽0.008) and antibody-borderline patients (145.8x106 vs. 184.9x106, n⫽75, p⫽0.049). After treatment, there was also a marked
OUT-OF-POCKET FERTILITY COSTS: DATA FROM A PROSPECTIVE INFERTILITY COHORT IN THE UNITED STATES
Source of Funding: Grant HD37074 from the National Institute for Child Health and Human Development (NICHD/NIH)
1923 MORBID OBESE MEN PRESENT POOR SPERM QUALITY AND WHILE HORMONAL AND SEXUAL FUNCTIONS IMPROVE IT IS NOT REVERSED AFTER GASTRIC BYPASS – A LONG TERM FOLLOW UP Leonardo O. Reis*, Ricardo D Saade, Elintom A Chaim, Laurione C Oliveira, Adriano Fregonesi, Ubirajara Ferreira, Campinas, Brazil INTRODUCTION AND OBJECTIVES: The effects of weight loss on sexual function, hormones and mostly on fertility have not been well studied. We evaluate the impact of lifestyle modifications and gastric bypass in this context focusing sperm quality.