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Differences in health related quality of life between men and women undergoing IVF treatment.
contained elongated spermatids and primary spermatocytes, respectively, at 8 wks but complete spermatogenesis at later times was not seen. Serum testosterone levels were 24.4 ⫾ 1.3 and 36.8 ⫾ 1.4 ng/ml for the duration of the study. hFSH levels between injections were 19.6 ⫾ 2.4 mIU/ml during the first 6 weeks. Anti-hFSH antibodies were first detected in one male during the 7th week and continued to increase which correlated with decreased measurable serum hFSH levels. The other animal displayed no evidence of antibody formation. Estradiol levels were prepubertal throughout. Conclusions: The dramatic increase in testicular volume and spermatogenic development to the early spermatid stage observed here suggests that spermatogenesis in juvenile males can be rapidly stimulated. Thus, this approach may potentially be utilized to reduce generation times for propagation of valuable research animals with specific genetic traits. Stimulations adding an LH component to assist in the completion of spermiogenesis are ongoing. Supported by: Iodinated hFSH donated by Diagnostic Products Corporation.
P-255 The role of apoptosis in infertile men with varicoceles: Is the FAS system implicated? J. C. Lin, C. Dhabuwala, H. Li. Wayne State Univ, Detroit, MI. Objective: Varicoceles have been implicated as a cause of male infertility. The molecular mechanism by which varicoceles produce sperm dysfunction and infertility is still unknown. In this study, we investigated the role of apoptosis and the expression of the apoptotic regulator Fas/Fas ligand in infertile men with varicoceles. Design: Fresh semen samples were collected from men with the diagnosis of varicoceles and from normal pregnancy proven healthy males. Apoptosis was studied by TUNEL assay and Expression of Fas and Fas-L was studied using western blot. Materials/Methods: Fresh semen samples were collected from men with the diagnosis of varicoceles and from normal pregnancy proven healthy males. Samples were collected by masturbation into a sterile plastic container after 2– 4 days of sexual abstinence. They were then allowed to liquefy in an incubator at 37°C. Semen analysis was performed with the following variables into consideration: volume of ejaculate (ml), sperm concentration (⫻ 106/ml), forward motility (%), morphology (%) and vitality (%). Slides fixed in methanol were then used for in situ detection of DNA strand breaks by the terminal deoxynucleotidyl transferase (TdT)mediated dUTP in situ nick end-labeling (TUNEL) method. The samples were also centrifuged at 300 g for 7 minutes and sonicated in the lysis buffer. Western blot was performed using the anti-Fas/Fas-L antibody. The data was presented as a percentage of TUNEL positive staining cells from a total number of sperm counted in cross sections. Results: In varicocele patients, 29% of the sperm stained positive for TUNEL labeling (29% ⫾ 6.8). In contrast, only 9% of the sperm from control patients stained positive for TUNEL labeling (9% ⫾ 3.6). These results are statistically significant (p ⬍ 0.05). The Western blot also showed that the expression of Fas was upregulated in varicocele patients when compared to the control group. Whereas, there was little or no change seen in the expression of Fas ligand in both groups. Conclusions: The experimental data presented here suggest that apoptosis play an important role in the pathogenesis of sperm dysfunction and infertility in varicocele patients. The data also suggests that the Fas system may be a major player in the regulation of apoptosis in varicocele patients.
MENTAL HEALTH P-256 Differences in health related quality of life between men and women undergoing IVF treatment. I. Tur-Kaspa, Y. Maor, S. Meltzer, S. Segal. Barzilai Medical Ctr, Ashkelon, Israel; Gertner Institute, Tel Hashomer, Israel. Objective: Infertility is a unique disease where both partners suffer from the consequences of illness. We investigated whether men and women
FERTILITY & STERILITY威
undergoing IVF treatment differ in their health-related quality of life (HRQL). Design: Cross sectional study. Materials/Methods: A trained student interviewed wives and husbands separately before the beginning of an IVF cycle. The questionnaire included sociodemographic details, information regarding the duration of infertility, the number of IVF cycles the couples underwent, and the SF-36 assessing HRQL. The SF-36 includes 8 domains: physical functioning, role physical, bodily pain, general health perception, vitality, social functioning, role emotional and mental health. Paired t tests were used to assess whether men and women differed in their HRQL. Results: 92 couples were interviewed. The mean age of men was 34.5 (SD 5.7) and of women 31.0 (SD 5.6). Duration of infertility was 4.8 years (SD 3.5), and mean number of IVF cycles was 3.5 (SD 4.7). Statistically significant differences between men and women were observed in the following domains: bodily pain (87.7 vs. 77.7 respectively, P ⫽ 0.0011), role emotional (81.75 vs. 73.0 respectively, P ⫽ 0.0051), and mental health (71.73 vs. 65.45 respectively, P ⫽ 0.0025). In the other domains of the SF-36 the difference between men and women did not reach statistical significance. In particular, no difference was observed in the physical functioning domain (95.2 vs. 93.8 respectively, P ⫽ 0.5101). Conclusions: Women have reduced HRQL compared to their spouses. This was particularly evident in the mental health domain. In the physical functioning domain no difference was observed despite the fact that women receive most of the medical intervention and are thus prone to physical side effects related to treatment. Infertility specialists should be aware of the mental consequences of IVF treatment such as depression and anxiety particularly in women. Supported by: The Israel National Institute for Health Policy and Health Services Research.
P-257 Association between donor gamete use and choice of embryo donation for final disposition of cryopreserved embryos. R. G. Brzyski, C. A. Witz, C. A. Eddy, J. Pierce, P. A. Binkley, R. S. Schenken. UTHSCSA, San Antonio, TX. Objective: Transfers of cryopreserved embryos were responsible for over 2000 deliveries of one or more liveborn infants in 1998, or over 10% of the live birth events from assisted reproductive technology (ART) in the United States. However, the technology has generated a large inventory of cryopreserved embryos, and achieving a final disposition for the embryos (e.g. transfer, disposal, or donation to research or for use by other infertile couples) many times is difficult or impossible. To understand the potential role of embryo donation in the management of cryopreserved embryo inventories we examined the characteristics of patients who expressed an interest in such a program. Design: Cohort study of all ART patients with cryopreserved embryos in a University based ART program. Materials/Methods: The records of the embryo cryopreservation program were reviewed and the clinical characteristics of patients who expressed an interest in a new anonymous embryo donation program were collected and compared to overall program data. Results: Since January 1999 eleven patients have expressed an interest in donating embryos. Three patients eventually chose to destroy the embryos, one has made no decision regarding disposition, four have completed the donation process and three are in the process of donation. Of the three patients who chose to destroy their embryos, only one used donor gametes (donor oocytes). All seven embryo donors had used donor gametes to generate the donated embryos. Three patients used donor oocytes, one used donor sperm and three used both donor oocytes and donor sperm. Five of the seven donors (71%) had had at least one child through ART. Currently the program stores embryos for 144 patients. The frozen embryo inventory overall includes embryos from 55 patients (38% of the inventory) who used donor oocytes, embryos from five patients (3% of the inventory) who used donor sperm and embryos from six patients (4% of the inventory) who used both donor oocytes and donor sperm. In fact, the program has performed only seven cases of ART employing both donor oocytes and donor sperm since January 1995. Conclusions: Most patients expressing an interest in embryo donation used donor gametes to produce their cryopreserved embryos. In our program to date, embryo donation as a means of final disposition of cryopre-
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P-255 The role of apoptosis in infertile men with varicoceles: Is the FAS system implicated? J. C. Lin, C. Dhabuwala, H. Li. Wayne State Univ, Detroit, MI. Objective: Varicoceles have been implicated as a cause of male infertility. The molecular mechanism by which varicoceles produce sperm dysfunction and infertility is still unknown. In this study, we investigated the role of apoptosis and the expression of the apoptotic regulator Fas/Fas ligand in infertile men with varicoceles. Design: Fresh semen samples were collected from men with the diagnosis of varicoceles and from normal pregnancy proven healthy males. Apoptosis was studied by TUNEL assay and Expression of Fas and Fas-L was studied using western blot. Materials/Methods: Fresh semen samples were collected from men with the diagnosis of varicoceles and from normal pregnancy proven healthy males. Samples were collected by masturbation into a sterile plastic container after 2– 4 days of sexual abstinence. They were then allowed to liquefy in an incubator at 37°C. Semen analysis was performed with the following variables into consideration: volume of ejaculate (ml), sperm concentration (⫻ 106/ml), forward motility (%), morphology (%) and vitality (%). Slides fixed in methanol were then used for in situ detection of DNA strand breaks by the terminal deoxynucleotidyl transferase (TdT)mediated dUTP in situ nick end-labeling (TUNEL) method. The samples were also centrifuged at 300 g for 7 minutes and sonicated in the lysis buffer. Western blot was performed using the anti-Fas/Fas-L antibody. The data was presented as a percentage of TUNEL positive staining cells from a total number of sperm counted in cross sections. Results: In varicocele patients, 29% of the sperm stained positive for TUNEL labeling (29% ⫾ 6.8). In contrast, only 9% of the sperm from control patients stained positive for TUNEL labeling (9% ⫾ 3.6). These results are statistically significant (p ⬍ 0.05). The Western blot also showed that the expression of Fas was upregulated in varicocele patients when compared to the control group. Whereas, there was little or no change seen in the expression of Fas ligand in both groups. Conclusions: The experimental data presented here suggest that apoptosis play an important role in the pathogenesis of sperm dysfunction and infertility in varicocele patients. The data also suggests that the Fas system may be a major player in the regulation of apoptosis in varicocele patients.
MENTAL HEALTH P-256 Differences in health related quality of life between men and women undergoing IVF treatment. I. Tur-Kaspa, Y. Maor, S. Meltzer, S. Segal. Barzilai Medical Ctr, Ashkelon, Israel; Gertner Institute, Tel Hashomer, Israel. Objective: Infertility is a unique disease where both partners suffer from the consequences of illness. We investigated whether men and women
FERTILITY & STERILITY威
undergoing IVF treatment differ in their health-related quality of life (HRQL). Design: Cross sectional study. Materials/Methods: A trained student interviewed wives and husbands separately before the beginning of an IVF cycle. The questionnaire included sociodemographic details, information regarding the duration of infertility, the number of IVF cycles the couples underwent, and the SF-36 assessing HRQL. The SF-36 includes 8 domains: physical functioning, role physical, bodily pain, general health perception, vitality, social functioning, role emotional and mental health. Paired t tests were used to assess whether men and women differed in their HRQL. Results: 92 couples were interviewed. The mean age of men was 34.5 (SD 5.7) and of women 31.0 (SD 5.6). Duration of infertility was 4.8 years (SD 3.5), and mean number of IVF cycles was 3.5 (SD 4.7). Statistically significant differences between men and women were observed in the following domains: bodily pain (87.7 vs. 77.7 respectively, P ⫽ 0.0011), role emotional (81.75 vs. 73.0 respectively, P ⫽ 0.0051), and mental health (71.73 vs. 65.45 respectively, P ⫽ 0.0025). In the other domains of the SF-36 the difference between men and women did not reach statistical significance. In particular, no difference was observed in the physical functioning domain (95.2 vs. 93.8 respectively, P ⫽ 0.5101). Conclusions: Women have reduced HRQL compared to their spouses. This was particularly evident in the mental health domain. In the physical functioning domain no difference was observed despite the fact that women receive most of the medical intervention and are thus prone to physical side effects related to treatment. Infertility specialists should be aware of the mental consequences of IVF treatment such as depression and anxiety particularly in women. Supported by: The Israel National Institute for Health Policy and Health Services Research.
P-257 Association between donor gamete use and choice of embryo donation for final disposition of cryopreserved embryos. R. G. Brzyski, C. A. Witz, C. A. Eddy, J. Pierce, P. A. Binkley, R. S. Schenken. UTHSCSA, San Antonio, TX. Objective: Transfers of cryopreserved embryos were responsible for over 2000 deliveries of one or more liveborn infants in 1998, or over 10% of the live birth events from assisted reproductive technology (ART) in the United States. However, the technology has generated a large inventory of cryopreserved embryos, and achieving a final disposition for the embryos (e.g. transfer, disposal, or donation to research or for use by other infertile couples) many times is difficult or impossible. To understand the potential role of embryo donation in the management of cryopreserved embryo inventories we examined the characteristics of patients who expressed an interest in such a program. Design: Cohort study of all ART patients with cryopreserved embryos in a University based ART program. Materials/Methods: The records of the embryo cryopreservation program were reviewed and the clinical characteristics of patients who expressed an interest in a new anonymous embryo donation program were collected and compared to overall program data. Results: Since January 1999 eleven patients have expressed an interest in donating embryos. Three patients eventually chose to destroy the embryos, one has made no decision regarding disposition, four have completed the donation process and three are in the process of donation. Of the three patients who chose to destroy their embryos, only one used donor gametes (donor oocytes). All seven embryo donors had used donor gametes to generate the donated embryos. Three patients used donor oocytes, one used donor sperm and three used both donor oocytes and donor sperm. Five of the seven donors (71%) had had at least one child through ART. Currently the program stores embryos for 144 patients. The frozen embryo inventory overall includes embryos from 55 patients (38% of the inventory) who used donor oocytes, embryos from five patients (3% of the inventory) who used donor sperm and embryos from six patients (4% of the inventory) who used both donor oocytes and donor sperm. In fact, the program has performed only seven cases of ART employing both donor oocytes and donor sperm since January 1995. Conclusions: Most patients expressing an interest in embryo donation used donor gametes to produce their cryopreserved embryos. In our program to date, embryo donation as a means of final disposition of cryopre-
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