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2275 PREDICTIVE FACTORS OF INTRAUTERINE INSEMINATION SUCCESS: SPERM MORPHOLOGY ACCORDING TO THE NEW WORLD HEALTH ORGANIZATION LABORATORY MANUAL
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THE JOURNAL OF UROLOGY姞
2275 PREDICTIVE FACTORS OF INTRAUTERINE INSEMINATION SUCCESS: SPERM MORPHOLOGY ACCORDING TO THE NEW WORLD HEALTH ORGANIZATION LABORATORY MANUAL Edson Borges Jr., Amanda Setti, Rita Figueira, Daniela Braga, Assumpto Iaconelli Jr., Sa˜o Paulo, Brazil; Fabio Pasqualotto*, Caxias do Sul, Brazil INTRODUCTION AND OBJECTIVES: Despite intrauterine insemination (IUI) often has been used as a treatment for male factor infertility, seminal characteristics indicative of IUI success have not been defined clearly. Recently, the 5th World Health Organization (WHO) data described lower reference limits for the number of morphologically normal spermatozoa. The aim of our study was to assess the likelihood of IUI success as a function of the sperm morphology according to the new reference values defined by the recently published WHO guideline. METHODS: We performed a retrospective study among 300 couples that completed their first IUI cycle, using father’s fresh sperm as a result of cervical infertility, relative male factor infertility, anovulation or unexplained infertility. Pregnancy rates were compared between the patients characterized as having normal and abnormal sperm morphology values according to the previous and the recent WHO reference values and the number of inseminated motile sperm was compared between the patients who did and did not achieve a pregnancy. RESULTS: The overall pregnancy rate was 12.3%. Women older than 35 years showed a lower pregnancy rate as compared to women younger than 35 years (6.5% vs 18.2%, p⫽ 0.017). The presence of two or more preovulatory follicles on the day of hCG administration resulted in higher pregnancy rate when compared to cases in which only one preovulatory follicle was present (18.6% vs 8.2%, p⫽ 0.011). There were no significant differences between the mean total number of inseminated sperm (26.4⫾21.7 vs 34.86⫾33.12, p⫽ 0.1237) and the mean number of inseminated motile sperm (22.3⫾18.6 vs 27.0⫾24.5, p⫽ 0.3156) between the patients who did and did not achieve a pregnancy. The number of inseminated motile sperm ⱖ 1x106 M/mL positively influenced pregnancy occurrence (OD: 1.47; CI: 0.88 –3.14, p ⫽0.027). Pregnancy rates did not differed neither when the male partners were characterized as having normal or abnormal sperm morphology according to the previous WHO reference values (9.8% vs 11.6%, p⫽ 0.6584), nor when the male partners were characterized as having normal or abnormal sperm morphology according to the recent WHO reference values (9.4% vs 11.3%, p⫽ 0.7469). Finally, normal sperm morphology had no influence on pregnancy rate (OD: 1.05; CI: 0.56 –3.02, p⫽ 0.936). CONCLUSIONS: Our results suggest that even after the establishment of new reference values for semen parameters, sperm morphological normalcy still does not have any predictive value on IUI outcomes.
Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011
oncofertility program at our institution in 2005 with expedited fertility preservation clinical care (2005) and a patient navigator (2006). We assess this program’s impact by comparing the frequency of SCP and the characteristics of patients before and after the program’s implementation. METHODS: While increased efforts began in 2004, a formalized oncofertility program was inaugurated in 2005. The electronic data warehouse (EDW) was used to identify men with cancer (excluding skin) in their reproductive years between ages 18 –55. The frequency of these men who underwent SCP was compared before and after the initiation of our formalized program. In addition, we compared the clinical characteristics of men who elected and refused SCP. RESULTS: Since 2002, 10,129 men of reproductive age were treated for a testicular, brain, blood, bone/soft tissue, head and neck, or gastrointestinal malignancy at our institution. After initiation of the program a significantly increased number of these men underwent SCP (Figure 1). The greatest increase in the frequency of SCP after program initiation occurred in men with head and neck (4.3⫻), brain (3.6⫻), blood (1.95⫻) and testicular (1.3⫻) cancers. Men who banked sperm were significantly younger (32.9⫾8.3 vs. 41.7⫾9.7yrs; p⬍0.001) and more likely to be married. CONCLUSIONS: A formalized oncofertility program markedly increases the utilization of SCP. While the majority of men were in their 20’s and 30’s, men in their 40’s and 50’s also chose SCP. Men choosing SCP were younger and more frequently married than those declining SCP. With increased awareness and the implementation of streamlined clinical care, fertility preservation services were utilized with significantly increased frequency by men with all types of cancer assessed at our institution.
Source of Funding: None
Source of Funding: None
2277 2276 HOW DOES ESTABLISHMENT OF A FORMAL INSTITUTIONAL FERTILITY PRESERVATION PROGRAM IMPACT UTILIZATION AND PATIENT CHARACTERISTICS? Brian T. Helfand*, Kunj R. Sheth, Vidit Sharma, Kristin Smith, Jason C. Hedges, Chicago, IL; Tobias S. Kohler, Springfield, IL; Teresa K. Woodruff, Robert E. Brannigan, Chicago, IL INTRODUCTION AND OBJECTIVES: The survival rates among young men with cancer have steadily increased in part due to more effective cancer treatments. However, many men face the possibility of infertility as a result of the disease itself and/or associated treatments including chemotherapy and radiation. While many of these men have the opportunity to undergo sperm cryopreservation (SCP) prior to initiating oncologic therapy, many do not due to lack of information and/or unavailability of services. We initiated a formalized
CLINICAL CHARACTERISTICS OF MEN WITH IDIOPATHIC NONOBSTRUCTIVE AZOOSPERMIA Peter Stahl*, Jennifer Reifsnyder, Wayland Hsiao, Peter Schlegel, New York, NY INTRODUCTION AND OBJECTIVES: Men without an identifiable cause for impaired sperm production comprise a large proportion of patients with nonobstructive azoospermia (NOA). We described the clinical characteristics of these patients, which have not previously been reported. METHODS: A total of 1070 microdissection TESE (mTESE) attempts were done in 872 men with NOA from 1999 –2010. NOA was labeled idiopathic for men with a 46XY karyotype, no Y chromosome microdeletions, and no history of cryptorchidism, gonadotoxin exposure, hypogonadotropic hypogonadism, orchitis, or significant testicular trauma. Clinical characteristics and mTESE outcome of patients with
THE JOURNAL OF UROLOGY姞
2275 PREDICTIVE FACTORS OF INTRAUTERINE INSEMINATION SUCCESS: SPERM MORPHOLOGY ACCORDING TO THE NEW WORLD HEALTH ORGANIZATION LABORATORY MANUAL Edson Borges Jr., Amanda Setti, Rita Figueira, Daniela Braga, Assumpto Iaconelli Jr., Sa˜o Paulo, Brazil; Fabio Pasqualotto*, Caxias do Sul, Brazil INTRODUCTION AND OBJECTIVES: Despite intrauterine insemination (IUI) often has been used as a treatment for male factor infertility, seminal characteristics indicative of IUI success have not been defined clearly. Recently, the 5th World Health Organization (WHO) data described lower reference limits for the number of morphologically normal spermatozoa. The aim of our study was to assess the likelihood of IUI success as a function of the sperm morphology according to the new reference values defined by the recently published WHO guideline. METHODS: We performed a retrospective study among 300 couples that completed their first IUI cycle, using father’s fresh sperm as a result of cervical infertility, relative male factor infertility, anovulation or unexplained infertility. Pregnancy rates were compared between the patients characterized as having normal and abnormal sperm morphology values according to the previous and the recent WHO reference values and the number of inseminated motile sperm was compared between the patients who did and did not achieve a pregnancy. RESULTS: The overall pregnancy rate was 12.3%. Women older than 35 years showed a lower pregnancy rate as compared to women younger than 35 years (6.5% vs 18.2%, p⫽ 0.017). The presence of two or more preovulatory follicles on the day of hCG administration resulted in higher pregnancy rate when compared to cases in which only one preovulatory follicle was present (18.6% vs 8.2%, p⫽ 0.011). There were no significant differences between the mean total number of inseminated sperm (26.4⫾21.7 vs 34.86⫾33.12, p⫽ 0.1237) and the mean number of inseminated motile sperm (22.3⫾18.6 vs 27.0⫾24.5, p⫽ 0.3156) between the patients who did and did not achieve a pregnancy. The number of inseminated motile sperm ⱖ 1x106 M/mL positively influenced pregnancy occurrence (OD: 1.47; CI: 0.88 –3.14, p ⫽0.027). Pregnancy rates did not differed neither when the male partners were characterized as having normal or abnormal sperm morphology according to the previous WHO reference values (9.8% vs 11.6%, p⫽ 0.6584), nor when the male partners were characterized as having normal or abnormal sperm morphology according to the recent WHO reference values (9.4% vs 11.3%, p⫽ 0.7469). Finally, normal sperm morphology had no influence on pregnancy rate (OD: 1.05; CI: 0.56 –3.02, p⫽ 0.936). CONCLUSIONS: Our results suggest that even after the establishment of new reference values for semen parameters, sperm morphological normalcy still does not have any predictive value on IUI outcomes.
Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011
oncofertility program at our institution in 2005 with expedited fertility preservation clinical care (2005) and a patient navigator (2006). We assess this program’s impact by comparing the frequency of SCP and the characteristics of patients before and after the program’s implementation. METHODS: While increased efforts began in 2004, a formalized oncofertility program was inaugurated in 2005. The electronic data warehouse (EDW) was used to identify men with cancer (excluding skin) in their reproductive years between ages 18 –55. The frequency of these men who underwent SCP was compared before and after the initiation of our formalized program. In addition, we compared the clinical characteristics of men who elected and refused SCP. RESULTS: Since 2002, 10,129 men of reproductive age were treated for a testicular, brain, blood, bone/soft tissue, head and neck, or gastrointestinal malignancy at our institution. After initiation of the program a significantly increased number of these men underwent SCP (Figure 1). The greatest increase in the frequency of SCP after program initiation occurred in men with head and neck (4.3⫻), brain (3.6⫻), blood (1.95⫻) and testicular (1.3⫻) cancers. Men who banked sperm were significantly younger (32.9⫾8.3 vs. 41.7⫾9.7yrs; p⬍0.001) and more likely to be married. CONCLUSIONS: A formalized oncofertility program markedly increases the utilization of SCP. While the majority of men were in their 20’s and 30’s, men in their 40’s and 50’s also chose SCP. Men choosing SCP were younger and more frequently married than those declining SCP. With increased awareness and the implementation of streamlined clinical care, fertility preservation services were utilized with significantly increased frequency by men with all types of cancer assessed at our institution.
Source of Funding: None
Source of Funding: None
2277 2276 HOW DOES ESTABLISHMENT OF A FORMAL INSTITUTIONAL FERTILITY PRESERVATION PROGRAM IMPACT UTILIZATION AND PATIENT CHARACTERISTICS? Brian T. Helfand*, Kunj R. Sheth, Vidit Sharma, Kristin Smith, Jason C. Hedges, Chicago, IL; Tobias S. Kohler, Springfield, IL; Teresa K. Woodruff, Robert E. Brannigan, Chicago, IL INTRODUCTION AND OBJECTIVES: The survival rates among young men with cancer have steadily increased in part due to more effective cancer treatments. However, many men face the possibility of infertility as a result of the disease itself and/or associated treatments including chemotherapy and radiation. While many of these men have the opportunity to undergo sperm cryopreservation (SCP) prior to initiating oncologic therapy, many do not due to lack of information and/or unavailability of services. We initiated a formalized
CLINICAL CHARACTERISTICS OF MEN WITH IDIOPATHIC NONOBSTRUCTIVE AZOOSPERMIA Peter Stahl*, Jennifer Reifsnyder, Wayland Hsiao, Peter Schlegel, New York, NY INTRODUCTION AND OBJECTIVES: Men without an identifiable cause for impaired sperm production comprise a large proportion of patients with nonobstructive azoospermia (NOA). We described the clinical characteristics of these patients, which have not previously been reported. METHODS: A total of 1070 microdissection TESE (mTESE) attempts were done in 872 men with NOA from 1999 –2010. NOA was labeled idiopathic for men with a 46XY karyotype, no Y chromosome microdeletions, and no history of cryptorchidism, gonadotoxin exposure, hypogonadotropic hypogonadism, orchitis, or significant testicular trauma. Clinical characteristics and mTESE outcome of patients with