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Can a successful testicular sperm recovery be predicted in 47,XXY klinefelter patients?
total tail swelling response, and also for specific swelling patterns developed. Swelling patterns were described as those spermatozoa exhibiting maximal (⬎ 50% tail length swelling) or minimal (⬍ 50% tail length swelling) swelling of the tail region with or without associated sperm motility. Results: In the HOS solution, the most predominant patterns were maximal swelling/non-motile (increased from 37⫾6.2% at 0 min, to 54⫾8.1% after 30 min of exposure), and minimal swelling/immotile (decreased from 20.7⫾8.1% at 0 min, to 13⫾3.2% after 30 min of exposure). In the H-SSS solution, the most predominant swelling patterns were minimal swelling/ immotile (decreased from 49⫾3.7% at 0 min, to 34⫾3.4% after 30 min of exposure) and minimal swelling/motile (increased from 25.0⫾5.7% at 0 min, to 39⫾5.5% after 30 min of exposure). The tendency of the minimal swelling/non-motile pattern was to decrease during incubation, while the swelling motile pattern tended to increased with incubation. In the control sample, motility and spontaneous sperm swelling remained stable throughout the incubation period. Conclusion: The results obtained in this study provide additional evidence to support the role of protein supplementation to delay the swelling response, which permits the development of swelling patterns in a nonabrupt manner. The findings suggest that spermatozoa exhibiting the minimal tail swelling patterns are better fit for regulating their internal environment due to a higher membrane activity, which must be necessary to respond to the hypoosmotic stress as evidenced in this study. The evaluation of the behavior and the various tail swelling patterns developed may lead to improving the criteria for evaluating the swelling response, its clinical application in cases of intracytoplasmic sperm injection and its relationship to other sperm qualitative characteristics.
factor infertility, or when previous IVF treatment resulted in unexpected fertilization failure, the routine use of ICSI will maximize fertilization rates and the yield of good-quality embryos.
P-253
WITHDRAWN
P-252 Value of split intracytoplasmic sperm injection/insemination for mild male factor infertility. Michael P. Steinkampf, Karen R. Hammond, Phillip A. Kretzer. Univ of Alabama at Birmingham, Birmingham, AL. Objective: Intracytoplasmic sperm injection (ICSI) is a widely used adjunct to in vitro fertilization (IVF) for male-factor infertility when fertilization failure is suspected, but the specific sperm parameters in which ICSI should be performed are not clear. The purpose of this study was to assess the value of the allocation of some eggs to ICSI and others to conventional insemination (“split ICSI/insemination”) in IVF cycles in which semen parameters are mildly abnormal, or when complete fertilization failure has occurred in a previous IVF cycle in patients with normal semen parameters. Design: Retrospective study in an academic reproductive technology program. Materials and Methods: IVF cases performed between September 1, 1996 and March 31, 2003 in which split ICSI/insemination was performed were reviewed. During this time period, split ICSI/insemination was offered to infertile couples enrolled for IVF when the total motile sperm count was between 10 million and 20 million (“mild male factor”), or when complete fertilization failure had been encountered in a previous IVF cycle despite a normal semen analysis. Ovarian stimulation and egg retrieval were performed in the standard fashion, and oocytes were randomly assigned to either ICSI or conventional insemination, using a concentration of 105 motile sperm/mL. For each patient, rates of fertilization and cleavage, and the embryo quality on day 3 after egg retrieval were compared between the two oocyte cohorts. Results: A total of 21 split ICSI/insemination cycles were performed in women 29 to 40 years of age (mean 33.7). Eighteen cycles had been performed because of mild male factor infertility, and three cycles because of previous unexpected fertilization failure. A mean of 18.4 eggs were retrieved per patient (range 5-36). There were no differences between ICSI and insemination oocyte goups with respect to total number of eggs allocated (ICSI: 9.5, INS: 8.4; P⫽0.61) or number of mature eggs allocated (ICSI: 8.4, INS: 6.5; P⫽0.13). Fertilization occurred in both oocyte groups in 10 patients, and in the ICSI group only in 11 patients. Oocytes randomized to ICSI yielded a higher fertilization rate per mature egg (ICSI: 74.3%, INS⫽18.0%; P⬍0.0001), and the percentage of mature eggs that ultimately yielded an 8-cell embryo three days after egg retrieval was substantially higher with ICSI (ICSI⫽14.1%, INS⫽8.5%; P⫽0.036). There was no difference in the cleavage rates of fertilized eggs obtained in either group (ICSI⫽95.5%, INS⫽89.8%; P⫽0.12). Conclusion: Our data suggest that in infertile couples with mild male-
S206
Abstracts
P-254 Can a successful testicular sperm recovery be predicted in 47,XXY Klinefelter patients? Vale´ rie Vernaeve, Catherine Staessen, Greta Verheyen, Andre´ Van Steirteghem, Paul Devroey, Herman Tournaye. Dutchspeaking Brussels Free Univ (Vrije Univ Brussel), Brussels, Belgium. Objective: To assess the availability of predictive factors for successful sperm retrieval in 47,XXY Klinefelter patients. Design: Retrospective, consecutive case series. Materials and Methods: We performed sperm recovery procedures in 50 non-mozaic Klinefelter patients who did not receive androgen substitution therapy. The predictive power of clinical parameters such as age, largest testicular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivity index for successful testicular sperm retrieval was analyzed using the receiver operating characteristics (ROC) curve analysis. Results: In 24 out of these 50 patients (48%) testicular spermatozoa were recovered. The mean FSH and testosterone values in patients with sperm was 31.2 IU/L and 3.1 ng/ml vs. 40.4 IU/L and 3.2 ng/ml in patients without sperm. The mean testicular volume of the largest testis in patients with sperm found was 4.2 ml vs. 3.6 ml in patients with no sperm found. The best discriminating age was 31 years (sensitivity 75.0%, specificity 61.5%) with
Vol. 80, Suppl. 3, September 2003
an area under the ROC curve (AUC) of 0.67. The best discriminating FSH value was 33.2 IU/L (sensitivity 68.2%, specificity 70.8%) with an AUC of 0.68. The best discriminating testosterone value was 2.2 ng/ml (sensitivity 70.6%, specificity 43.5%) with an AUC of 0.51. The best discriminating FSH/LH ratio was 1.4 (sensitivity 47.1%, specificity 82.6%) with an AUC of 0.59. The best discriminating androgen sensitivity index (LH x testosterone) was 76.8 (sensitivity 87.5%, specificity 40.9%) with an AUC of 0.61. Ninety-four percent of the men in whom sperm was found had a normal facial hair pattern compared to 93% in whom no sperm was recovered (NS). Seventeen percent of the men with successful testicular sperm extraction had gynecomastia compared to 31% of the men with failed testicular sperm extraction (NS). Conclusion: As in the general population of men with non-obstructive azoospermia, there are currently no factors predicting successful sperm retrieval in this subpopulation of patients with non-mozaic Klinefelter syndrome.
Design: Retrospective study. Materials and Methods: Chemical pregnancy losses after IVF/ET from January 1, 2003, and April 1, 2003, were studied for the frequency of abnormal sperm quality. Sperm quality was measured as the percentage of fragmented DNA (DFI) in the SDIa. Results: Among 56 chemical pregnancy losses, 28 male partners had SDIa performed. DFI⬎25% was present in 13 men (46%) and ⬍25% in 15 men (54%). When these values were compared with results of 68 men undergoing IVF/ET who did not have chemical pregnancy losses, 17 (25%) had DFI ⬎25% and 51 (75%) had DFI ⬍25%. The differences were significant (P⬍0.05). The odds ratio was 2.6 with the 95% confidence interval of 1.1-6.5. Conclusion: Chemical pregnancy loss is associated with elevated DFI measured in the SDIa. Couples experiencing chemical pregnancy losses should have an SDIa performed. P-257
P-255 Pregnany outcome after IVF/ET among couples who have elevated DNA fragmentation determined by the sperm DNA integrity assay (SDIa™). Carolyn B. Coulam, Peter Alhering, Herman Rodriguez, Levent Keskintepe, Geoffrey Sher, Roumen Roussev. Sher Institute for Reproductive Medicine/RPL and Millenova Immunology Lab, Chicago, IL; Sher Institute for Reproductive Medicine, St. Louis, MO; Sher Institute for Reproductive Medicine, Las Vegas, NV; RPL and Millenova Immunology Lab, Chicago, IL. Objective: To determine pregnancy outcomes of couples undergoing in vitro fertilization (IVF) and embryo transer (ET) in whom the male partners have elevated DNA fragmentation index (DFI) measured by the SDIa™. Design: Prospective observational study with retrospective analysis. Materials and Methods: Two hundred ten couples undergoing IVF/ET at the Sher Institutes for Reproductive Medicine in whom the male partner had SDIa™ performed served as the study patients. Before insemination, morphologically normal and motile spermatozoa selection was done by Percoll gradient and then swim up. All oocytes collected at the time of retrieval were inseminated with a single spermatozoon by intracytoplasmic sperm injection (ICSI). Pregnancy outcomes were documented as ongoing pregnancy, early pregnancy loss and not pregnant. An ongoing pregnancy was a pregnancy demonstrating normal embryonic size and heart rate at 8 weeks gestation. Early pregnancy loss included chemical pregnancy losses and clinical pfregnancy losses prior to 8 weeks gestation. An elevated DFI measured by SDIa™ was DFI greater than 25%. The frequency of ongoing pregnancies, early pregnancy losses and no pregnancies after IVF/ET with ICSI were compared between those couples with DFI ⬎25% and those ⬍25%. Results: Among the 210 couples, 101 (48%) had ongoing pregnancies, 30 (14%) had early pregnancy losses and 79 (38%) were not pregnant after IVF/ET with ICSI. Sixty (29%) of the male partners had DFI ⬎25% and 150 (71%) had DFI ⬍25%. Among 60 couples in whom the male partner had DFI ⬎25%, 29 (48%) had a ongoing pregnancy, 14 (24%) had an early pregnancy loss and 17 (28%) were not pregnant. These values compared with those in whom the 150 male partners had DFI ⬍25% as follows: ongoing pregnancy 74 (49%), early pregnancy loss 16 (11%) and not pregnant 60 (40%). No differences in pregnany rates were noted when DFI ⬎25% (P⫽0.3). However, a significant difference in early pregnancy loss rates were observed when DFI ⬎25% was compared with DFI ⬍25% (P⬍0.01). The odds ratio was 2.916 (95% conficence interval 1.264-6.729). Conclusion: DFI ⬎25% measured by the SDIa™ does not affect pregnancy rates after IVF/ET with ICSI but does predict early pregnancy loss. P-256 Elevated sperm fragmentation index measured by the sperm DNA integrity assay (SDIa) is associated with chemical pregnancy losses after IVF/ET. Carolyn B. Coulam, Roumen G. Roussev. Sher Institute for Reproductive Medicine/RPL and Millenova Immunology Lab, Chicago, IL; Millenova Immunology Lab, Chicago, IL. Objective: To evaluate the contribution of sperm quality to chemical pregnancy loss rates after in vitro fertilization (IVF) and embryo transfer (ET).
FERTILITY & STERILITY威
Erectile dysfunction: Seminal characteristics of men undergoing infertility treatment using viagra. Panayiotis M. Zavos, Michel Abou-Abdallah, Khalied Kaskar, Panayota N. Zarmakoupis-Zavos. Andrology Institute of America/Kentucky Ctr for Reproductive Medicine & IVF, Lexington, KY; Clin Dr. Rizk, Beirut, Lebanon. Objective: Erectile dysfunction (ED) is the inability to attain and maintain penile erection sufficient to permit satisfactory intercourse and afflicts approximately 10% of the adult US men. This is more and more evident in men that are asked to produce seminal specimens on demand for infertility evaluation and treatments. Recently, sildenafil citrate (Viagra(r)) has been considered as an effective treatment for erectile dysfunction (ED). Initial studies have shown that when Viagra(r) is administered to men with ED, it can bring about erection and subsequent ejaculation. It has also been recommended for use to treat temporary erectile dysfunction due to stress on the day of in vitro fertilization (IVF). The objective of this study was to evaluate the quantitative and qualitative characteristics of ejaculates in men of reproductive age with ED undergoing infertility evaluation and their suitability for intrauterine insemination (IUI) or other forms of Assisted Reproductive Technologies (ART’s). Design: Prospective study. Materials and Methods: A total of 3 patients with ED received Viagra(r) and produced a total of 18 ejaculates for evaluation and sperm preparation for IUI. Each ejaculate was produced at intercourse via the use of the Male Factor Pak. Seminal specimens were assessed and processed via the ZSC-II method for IUI. Each processed specimen was evaluated for its appropriateness for IUI. Results: Sperm quantitative and qualitative measurements after production at intercourse were within normal range (WHO standards) and when specimens were processed for IUI, the sperm quantity and quality was adequate to cause adequate conception. The results are shown in the table below.
Conclusion: The results in the current study show for the first time, that not only does sildenafil citrate help males with erectile dysfunction but it also reports the seminal characteristics of ejaculates produced at intercourse, along with semen preparation for use in subsequent intrauterine inseminations or ART’s. Sperm obtained after administering sildenafil citrate showed normal values according to WHO criteria. Not only were the sperm of good quality, but also a high motile fraction could be isolated for intrauterine insemination using the ZSC-II technology. It appears that Viagra(r) can be an effective tool for the treatment of reproductive age ED males undergoing infertility workup or treatment in an IUI or ART program. The ejaculates produced and the processed specimens for IUI were of adequate quality to establish a pregnancy in the treated couples. P-258 Repeated testicular sperm aspiration may provide good results in male infertility management. Mauro Bibancos de Rosa, Lia M. Rossi, Patrı´cia
S207
factor infertility, or when previous IVF treatment resulted in unexpected fertilization failure, the routine use of ICSI will maximize fertilization rates and the yield of good-quality embryos.
P-253
WITHDRAWN
P-252 Value of split intracytoplasmic sperm injection/insemination for mild male factor infertility. Michael P. Steinkampf, Karen R. Hammond, Phillip A. Kretzer. Univ of Alabama at Birmingham, Birmingham, AL. Objective: Intracytoplasmic sperm injection (ICSI) is a widely used adjunct to in vitro fertilization (IVF) for male-factor infertility when fertilization failure is suspected, but the specific sperm parameters in which ICSI should be performed are not clear. The purpose of this study was to assess the value of the allocation of some eggs to ICSI and others to conventional insemination (“split ICSI/insemination”) in IVF cycles in which semen parameters are mildly abnormal, or when complete fertilization failure has occurred in a previous IVF cycle in patients with normal semen parameters. Design: Retrospective study in an academic reproductive technology program. Materials and Methods: IVF cases performed between September 1, 1996 and March 31, 2003 in which split ICSI/insemination was performed were reviewed. During this time period, split ICSI/insemination was offered to infertile couples enrolled for IVF when the total motile sperm count was between 10 million and 20 million (“mild male factor”), or when complete fertilization failure had been encountered in a previous IVF cycle despite a normal semen analysis. Ovarian stimulation and egg retrieval were performed in the standard fashion, and oocytes were randomly assigned to either ICSI or conventional insemination, using a concentration of 105 motile sperm/mL. For each patient, rates of fertilization and cleavage, and the embryo quality on day 3 after egg retrieval were compared between the two oocyte cohorts. Results: A total of 21 split ICSI/insemination cycles were performed in women 29 to 40 years of age (mean 33.7). Eighteen cycles had been performed because of mild male factor infertility, and three cycles because of previous unexpected fertilization failure. A mean of 18.4 eggs were retrieved per patient (range 5-36). There were no differences between ICSI and insemination oocyte goups with respect to total number of eggs allocated (ICSI: 9.5, INS: 8.4; P⫽0.61) or number of mature eggs allocated (ICSI: 8.4, INS: 6.5; P⫽0.13). Fertilization occurred in both oocyte groups in 10 patients, and in the ICSI group only in 11 patients. Oocytes randomized to ICSI yielded a higher fertilization rate per mature egg (ICSI: 74.3%, INS⫽18.0%; P⬍0.0001), and the percentage of mature eggs that ultimately yielded an 8-cell embryo three days after egg retrieval was substantially higher with ICSI (ICSI⫽14.1%, INS⫽8.5%; P⫽0.036). There was no difference in the cleavage rates of fertilized eggs obtained in either group (ICSI⫽95.5%, INS⫽89.8%; P⫽0.12). Conclusion: Our data suggest that in infertile couples with mild male-
S206
Abstracts
P-254 Can a successful testicular sperm recovery be predicted in 47,XXY Klinefelter patients? Vale´ rie Vernaeve, Catherine Staessen, Greta Verheyen, Andre´ Van Steirteghem, Paul Devroey, Herman Tournaye. Dutchspeaking Brussels Free Univ (Vrije Univ Brussel), Brussels, Belgium. Objective: To assess the availability of predictive factors for successful sperm retrieval in 47,XXY Klinefelter patients. Design: Retrospective, consecutive case series. Materials and Methods: We performed sperm recovery procedures in 50 non-mozaic Klinefelter patients who did not receive androgen substitution therapy. The predictive power of clinical parameters such as age, largest testicular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivity index for successful testicular sperm retrieval was analyzed using the receiver operating characteristics (ROC) curve analysis. Results: In 24 out of these 50 patients (48%) testicular spermatozoa were recovered. The mean FSH and testosterone values in patients with sperm was 31.2 IU/L and 3.1 ng/ml vs. 40.4 IU/L and 3.2 ng/ml in patients without sperm. The mean testicular volume of the largest testis in patients with sperm found was 4.2 ml vs. 3.6 ml in patients with no sperm found. The best discriminating age was 31 years (sensitivity 75.0%, specificity 61.5%) with
Vol. 80, Suppl. 3, September 2003
an area under the ROC curve (AUC) of 0.67. The best discriminating FSH value was 33.2 IU/L (sensitivity 68.2%, specificity 70.8%) with an AUC of 0.68. The best discriminating testosterone value was 2.2 ng/ml (sensitivity 70.6%, specificity 43.5%) with an AUC of 0.51. The best discriminating FSH/LH ratio was 1.4 (sensitivity 47.1%, specificity 82.6%) with an AUC of 0.59. The best discriminating androgen sensitivity index (LH x testosterone) was 76.8 (sensitivity 87.5%, specificity 40.9%) with an AUC of 0.61. Ninety-four percent of the men in whom sperm was found had a normal facial hair pattern compared to 93% in whom no sperm was recovered (NS). Seventeen percent of the men with successful testicular sperm extraction had gynecomastia compared to 31% of the men with failed testicular sperm extraction (NS). Conclusion: As in the general population of men with non-obstructive azoospermia, there are currently no factors predicting successful sperm retrieval in this subpopulation of patients with non-mozaic Klinefelter syndrome.
Design: Retrospective study. Materials and Methods: Chemical pregnancy losses after IVF/ET from January 1, 2003, and April 1, 2003, were studied for the frequency of abnormal sperm quality. Sperm quality was measured as the percentage of fragmented DNA (DFI) in the SDIa. Results: Among 56 chemical pregnancy losses, 28 male partners had SDIa performed. DFI⬎25% was present in 13 men (46%) and ⬍25% in 15 men (54%). When these values were compared with results of 68 men undergoing IVF/ET who did not have chemical pregnancy losses, 17 (25%) had DFI ⬎25% and 51 (75%) had DFI ⬍25%. The differences were significant (P⬍0.05). The odds ratio was 2.6 with the 95% confidence interval of 1.1-6.5. Conclusion: Chemical pregnancy loss is associated with elevated DFI measured in the SDIa. Couples experiencing chemical pregnancy losses should have an SDIa performed. P-257
P-255 Pregnany outcome after IVF/ET among couples who have elevated DNA fragmentation determined by the sperm DNA integrity assay (SDIa™). Carolyn B. Coulam, Peter Alhering, Herman Rodriguez, Levent Keskintepe, Geoffrey Sher, Roumen Roussev. Sher Institute for Reproductive Medicine/RPL and Millenova Immunology Lab, Chicago, IL; Sher Institute for Reproductive Medicine, St. Louis, MO; Sher Institute for Reproductive Medicine, Las Vegas, NV; RPL and Millenova Immunology Lab, Chicago, IL. Objective: To determine pregnancy outcomes of couples undergoing in vitro fertilization (IVF) and embryo transer (ET) in whom the male partners have elevated DNA fragmentation index (DFI) measured by the SDIa™. Design: Prospective observational study with retrospective analysis. Materials and Methods: Two hundred ten couples undergoing IVF/ET at the Sher Institutes for Reproductive Medicine in whom the male partner had SDIa™ performed served as the study patients. Before insemination, morphologically normal and motile spermatozoa selection was done by Percoll gradient and then swim up. All oocytes collected at the time of retrieval were inseminated with a single spermatozoon by intracytoplasmic sperm injection (ICSI). Pregnancy outcomes were documented as ongoing pregnancy, early pregnancy loss and not pregnant. An ongoing pregnancy was a pregnancy demonstrating normal embryonic size and heart rate at 8 weeks gestation. Early pregnancy loss included chemical pregnancy losses and clinical pfregnancy losses prior to 8 weeks gestation. An elevated DFI measured by SDIa™ was DFI greater than 25%. The frequency of ongoing pregnancies, early pregnancy losses and no pregnancies after IVF/ET with ICSI were compared between those couples with DFI ⬎25% and those ⬍25%. Results: Among the 210 couples, 101 (48%) had ongoing pregnancies, 30 (14%) had early pregnancy losses and 79 (38%) were not pregnant after IVF/ET with ICSI. Sixty (29%) of the male partners had DFI ⬎25% and 150 (71%) had DFI ⬍25%. Among 60 couples in whom the male partner had DFI ⬎25%, 29 (48%) had a ongoing pregnancy, 14 (24%) had an early pregnancy loss and 17 (28%) were not pregnant. These values compared with those in whom the 150 male partners had DFI ⬍25% as follows: ongoing pregnancy 74 (49%), early pregnancy loss 16 (11%) and not pregnant 60 (40%). No differences in pregnany rates were noted when DFI ⬎25% (P⫽0.3). However, a significant difference in early pregnancy loss rates were observed when DFI ⬎25% was compared with DFI ⬍25% (P⬍0.01). The odds ratio was 2.916 (95% conficence interval 1.264-6.729). Conclusion: DFI ⬎25% measured by the SDIa™ does not affect pregnancy rates after IVF/ET with ICSI but does predict early pregnancy loss. P-256 Elevated sperm fragmentation index measured by the sperm DNA integrity assay (SDIa) is associated with chemical pregnancy losses after IVF/ET. Carolyn B. Coulam, Roumen G. Roussev. Sher Institute for Reproductive Medicine/RPL and Millenova Immunology Lab, Chicago, IL; Millenova Immunology Lab, Chicago, IL. Objective: To evaluate the contribution of sperm quality to chemical pregnancy loss rates after in vitro fertilization (IVF) and embryo transfer (ET).
FERTILITY & STERILITY威
Erectile dysfunction: Seminal characteristics of men undergoing infertility treatment using viagra. Panayiotis M. Zavos, Michel Abou-Abdallah, Khalied Kaskar, Panayota N. Zarmakoupis-Zavos. Andrology Institute of America/Kentucky Ctr for Reproductive Medicine & IVF, Lexington, KY; Clin Dr. Rizk, Beirut, Lebanon. Objective: Erectile dysfunction (ED) is the inability to attain and maintain penile erection sufficient to permit satisfactory intercourse and afflicts approximately 10% of the adult US men. This is more and more evident in men that are asked to produce seminal specimens on demand for infertility evaluation and treatments. Recently, sildenafil citrate (Viagra(r)) has been considered as an effective treatment for erectile dysfunction (ED). Initial studies have shown that when Viagra(r) is administered to men with ED, it can bring about erection and subsequent ejaculation. It has also been recommended for use to treat temporary erectile dysfunction due to stress on the day of in vitro fertilization (IVF). The objective of this study was to evaluate the quantitative and qualitative characteristics of ejaculates in men of reproductive age with ED undergoing infertility evaluation and their suitability for intrauterine insemination (IUI) or other forms of Assisted Reproductive Technologies (ART’s). Design: Prospective study. Materials and Methods: A total of 3 patients with ED received Viagra(r) and produced a total of 18 ejaculates for evaluation and sperm preparation for IUI. Each ejaculate was produced at intercourse via the use of the Male Factor Pak. Seminal specimens were assessed and processed via the ZSC-II method for IUI. Each processed specimen was evaluated for its appropriateness for IUI. Results: Sperm quantitative and qualitative measurements after production at intercourse were within normal range (WHO standards) and when specimens were processed for IUI, the sperm quantity and quality was adequate to cause adequate conception. The results are shown in the table below.
Conclusion: The results in the current study show for the first time, that not only does sildenafil citrate help males with erectile dysfunction but it also reports the seminal characteristics of ejaculates produced at intercourse, along with semen preparation for use in subsequent intrauterine inseminations or ART’s. Sperm obtained after administering sildenafil citrate showed normal values according to WHO criteria. Not only were the sperm of good quality, but also a high motile fraction could be isolated for intrauterine insemination using the ZSC-II technology. It appears that Viagra(r) can be an effective tool for the treatment of reproductive age ED males undergoing infertility workup or treatment in an IUI or ART program. The ejaculates produced and the processed specimens for IUI were of adequate quality to establish a pregnancy in the treated couples. P-258 Repeated testicular sperm aspiration may provide good results in male infertility management. Mauro Bibancos de Rosa, Lia M. Rossi, Patrı´cia
S207