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Does PICSI offer an advantage over ICSI in art for patients with male factor
EJACULATE. M. Gallardo Molina, J. C. Garcia Lozano, M. Dorado Silva, M. Hebles Duvison, M. Gonzalez Martinez, P. Sanchez Martin. Unidad de Reproduccion, Clinicas Ginemed, Seville, Spain. OBJECTIVE: We aim to assess the improvement of sperm quality observed in the first ejaculate fraction compared to the second ejaculate fraction and total ejaculate. DESIGN: Usually, the ejaculate to be used for ART is collected in just one pot, producing a sustained contact between sperm and seminal liquid that can compromise chromatine stability. After a detailed explanations to the patients, semen samples were collected in two separate fractions in order to compare overall sperm quality in FEF. MATERIALS AND METHODS: 30 patients were included in the study. Their semen sample was collected in two separate fractions, after 2 to 5 days of sexual abstinence, and analyzed within an hour. In both fractions and the TEF, classic seminal parameters and Zinc, Citric Acid and Fructose content were assessed. DNA fragmentation test was performed using the Sperm Chromatin Decondensation assay with Halosperm kit. RESULTS: Compared to TEF and SEF, we observed in FEF a disminution of volume, higher sperm concentration, higher motility rates, better morphology according to Kruger criteria and lower DNA fragmentation (DIF), all statistically significant.
Volume (ml) Motility (a+b%) Sperm count Morphology DFI
FEF
SEF
TEF
0,63 48,5 89,5 4,9 17
1,53 31,9 40 3,4 32,3
40,3 65 4,5 24,7
p¼0,02 p¼0,01 p¼0,01 p¼0,01 p¼0,01
Chart 1: Parameters assessed in FEF, SEF and TEF. CONCLUSION: Collection of semen sample in two separate fractions offers the possibility to achieve a improved sperm population, which may act synergically for the selection of high quality spermatozoa with further techniques to be applied in later stages, such as DL-DGc and MACS prior to ICSI. Supported by: Fundacion Ginemed.
P-1280 Thursday, October 17, 2013 DOES PICSI OFFER AN ADVANTAGE OVER ICSI IN ART FOR PATIENTS WITH MALE FACTOR. M.-T. Sauerbrun-Cutler, S. Ozensoy, M. Vega, M. Keltz. OB/GYN, St Luke’s-Roosevelt Hospital Center, New York, NY. OBJECTIVE: Prior studies have suggested an advantage of PICSI in patients with male factor for both clinical pregnancy and fertilization rate. We assessed whether selecting mature hyaluronan (HA)-bound sperm for ICSI (PICSI) improves the IVF outcome of patients with male factor infertility. DESIGN: Retrospective case control trial. MATERIALS AND METHODS: All patients with PICSI IVF performed at a university IVF center from November 2009 to March 2012 were matched by age and date of procedure to controls that had IVF treatment with ICSI alone for male factor. RESULTS: 38 PICSI cycles were matched to 49 ICSI controls. PICSI and ICSI groups had no differences in age, semen analysis parameters, number of oocytes retrieved and number of mature oocytes inseminated. PICSI cases and ICSI controls had a similar number of prior cycles that were IVF failures. Embryo grade, percent high grade embryos, implantation and clinical pregnancy rates were not different between the ICSI and PICSI groups; however, there was a trend toward increased fertilization rates with PICSI. CONCLUSION: There was a trend toward increased fertilization rates, although we did not find a significant advantage in PICSI over ICSI in patients with male factor. This may reflect a selection bias towards lower prognosis patients undergoing PICSI. We are currently performing
S516
ASRM Abstracts
a randomized control study with split PICSI and ICSI in the same subjects. Supported by: Continuum Reproductive Center. TABLE 1. IVF outcomes
PICSI
ICSI
IRR 1 / RR2 [95% CI] /P-value
Mean Embryo 4.35 4.26 0.093 [-0.25,0.42], P -value: 0.61 Grade % of embryo 82% 76% P-value: 0.50 grade 4 or above Fertilization rate 90% (242/269) 83% (280/338) 1.0911 [0.91, 1.29], P- value: 0.35 Clinical pregnancy 32% (12/38) 41% (20/49) 0.772 [0.43, 1.38], P-value: 0.38 probability Implantation rate 18% (17/97) 19% (26/136) 0.9211 [0.50, 1.69], P- value: 0.78 1. IRR¼PICSI rate/ICSI rate; poisson p-value, 2. RR¼PICSI rate/ICSI rate; chi-square p-value, 3.Diff¼ Mean PICSI - Mean ICSI; t-test p-value.
P-1281 Thursday, October 17, 2013 COMPARISON OF THE OUTCOMES OF INTRACYTOPLASMIC SPERM INJECTION - EMBRYO TRANSFER CYCLES WITH CRYOPRESERVED TESTICULAR SPERM VERSUS CRYOPRESERVED EJACULATED SPERM. M. Ulug,a M. Karacan,a F. A. Alwaeely,b A. Arvas,a Z. Cebi,a T. Camlibel.a aObstetrics and Gynecology, FulyaJinemed Hospital, Istanbul, Turkey; bObstetrics and Gynecology, Basra Medical College, Al-Manar Fertility Center, Basra, Iraq. OBJECTIVE: Cryopresevation of sperm is a common approach for the future use. We aimed to compare the effect of cryopreservation on testicular sperm with ejaculated sperm in ICSI-ET cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: A total of 207 ICSI-ET cycles with cryopreserved ejaculated sperm (Group I, n¼85) or cryopreserved testicular sperm (Group II, n¼122) performed from 2005-2013 were analyzed. Ejaculated sperm freezing had been performed due to the male partners’ nonavailability on the day of oocyte collection. Women aged less than 42 years with normal uterine cavity and produced more than 3 oocytes following ovulation induction were included. Microdissection testicular sperm extraction was performed to obtain spermatozoa in azoospermic men and only mature forms were microinjected after thawing. Student’s t test and c2 test were used for statistical analysis. P< 0.05 was deemed statistically significant. RESULTS: There were no significant differences in terms of women’s age (34.44.7 vs. 31.35.1), number of oocytes collected (8.84.7 vs. 6.93.8), fertilized (6.42.7 vs. 5.22.3) and embryos transferred (2.21.3 vs. 2.41.2) between Group I and Group II, respectively (p>0.05). Implantation rates (15.8% vs 19.6%), clinical pregnancy rates (28.2% vs 32.7%) and ongoing pregnancy/live birth rates (25.8% vs. 29.5%) were also comparable between Group I and Group II, respectively (p>0.05). CONCLUSION: The utilization of cryopreserved testicular spermatozoa yields similar outcome as cryopreserved ejaculated spermatozoa in ICSI-ET cycle.
P-1282 Thursday, October 17, 2013 MODIFIED LUTEAL SUPPORT FOLLOWING GnRH-AGONIST TRIGGER. M. R. Banker, A. S. Shah, N. K. Jain, D. J. Sorathiya, H. N. Benani, P. M. Patel. Infertility, Nova IVI Fertility Clinics, Ahmedabad, Gujarat, India. OBJECTIVE: To demonstrate the use of modified luteal support following GnRh-agonist trigger in patients undergoing IVF/ICSI and at risk of Ovarian
Vol. 100, No. 3, Supplement, September 2013
Volume (ml) Motility (a+b%) Sperm count Morphology DFI
FEF
SEF
TEF
0,63 48,5 89,5 4,9 17
1,53 31,9 40 3,4 32,3
40,3 65 4,5 24,7
p¼0,02 p¼0,01 p¼0,01 p¼0,01 p¼0,01
Chart 1: Parameters assessed in FEF, SEF and TEF. CONCLUSION: Collection of semen sample in two separate fractions offers the possibility to achieve a improved sperm population, which may act synergically for the selection of high quality spermatozoa with further techniques to be applied in later stages, such as DL-DGc and MACS prior to ICSI. Supported by: Fundacion Ginemed.
P-1280 Thursday, October 17, 2013 DOES PICSI OFFER AN ADVANTAGE OVER ICSI IN ART FOR PATIENTS WITH MALE FACTOR. M.-T. Sauerbrun-Cutler, S. Ozensoy, M. Vega, M. Keltz. OB/GYN, St Luke’s-Roosevelt Hospital Center, New York, NY. OBJECTIVE: Prior studies have suggested an advantage of PICSI in patients with male factor for both clinical pregnancy and fertilization rate. We assessed whether selecting mature hyaluronan (HA)-bound sperm for ICSI (PICSI) improves the IVF outcome of patients with male factor infertility. DESIGN: Retrospective case control trial. MATERIALS AND METHODS: All patients with PICSI IVF performed at a university IVF center from November 2009 to March 2012 were matched by age and date of procedure to controls that had IVF treatment with ICSI alone for male factor. RESULTS: 38 PICSI cycles were matched to 49 ICSI controls. PICSI and ICSI groups had no differences in age, semen analysis parameters, number of oocytes retrieved and number of mature oocytes inseminated. PICSI cases and ICSI controls had a similar number of prior cycles that were IVF failures. Embryo grade, percent high grade embryos, implantation and clinical pregnancy rates were not different between the ICSI and PICSI groups; however, there was a trend toward increased fertilization rates with PICSI. CONCLUSION: There was a trend toward increased fertilization rates, although we did not find a significant advantage in PICSI over ICSI in patients with male factor. This may reflect a selection bias towards lower prognosis patients undergoing PICSI. We are currently performing
S516
ASRM Abstracts
a randomized control study with split PICSI and ICSI in the same subjects. Supported by: Continuum Reproductive Center. TABLE 1. IVF outcomes
PICSI
ICSI
IRR 1 / RR2 [95% CI] /P-value
Mean Embryo 4.35 4.26 0.093 [-0.25,0.42], P -value: 0.61 Grade % of embryo 82% 76% P-value: 0.50 grade 4 or above Fertilization rate 90% (242/269) 83% (280/338) 1.0911 [0.91, 1.29], P- value: 0.35 Clinical pregnancy 32% (12/38) 41% (20/49) 0.772 [0.43, 1.38], P-value: 0.38 probability Implantation rate 18% (17/97) 19% (26/136) 0.9211 [0.50, 1.69], P- value: 0.78 1. IRR¼PICSI rate/ICSI rate; poisson p-value, 2. RR¼PICSI rate/ICSI rate; chi-square p-value, 3.Diff¼ Mean PICSI - Mean ICSI; t-test p-value.
P-1281 Thursday, October 17, 2013 COMPARISON OF THE OUTCOMES OF INTRACYTOPLASMIC SPERM INJECTION - EMBRYO TRANSFER CYCLES WITH CRYOPRESERVED TESTICULAR SPERM VERSUS CRYOPRESERVED EJACULATED SPERM. M. Ulug,a M. Karacan,a F. A. Alwaeely,b A. Arvas,a Z. Cebi,a T. Camlibel.a aObstetrics and Gynecology, FulyaJinemed Hospital, Istanbul, Turkey; bObstetrics and Gynecology, Basra Medical College, Al-Manar Fertility Center, Basra, Iraq. OBJECTIVE: Cryopresevation of sperm is a common approach for the future use. We aimed to compare the effect of cryopreservation on testicular sperm with ejaculated sperm in ICSI-ET cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: A total of 207 ICSI-ET cycles with cryopreserved ejaculated sperm (Group I, n¼85) or cryopreserved testicular sperm (Group II, n¼122) performed from 2005-2013 were analyzed. Ejaculated sperm freezing had been performed due to the male partners’ nonavailability on the day of oocyte collection. Women aged less than 42 years with normal uterine cavity and produced more than 3 oocytes following ovulation induction were included. Microdissection testicular sperm extraction was performed to obtain spermatozoa in azoospermic men and only mature forms were microinjected after thawing. Student’s t test and c2 test were used for statistical analysis. P< 0.05 was deemed statistically significant. RESULTS: There were no significant differences in terms of women’s age (34.44.7 vs. 31.35.1), number of oocytes collected (8.84.7 vs. 6.93.8), fertilized (6.42.7 vs. 5.22.3) and embryos transferred (2.21.3 vs. 2.41.2) between Group I and Group II, respectively (p>0.05). Implantation rates (15.8% vs 19.6%), clinical pregnancy rates (28.2% vs 32.7%) and ongoing pregnancy/live birth rates (25.8% vs. 29.5%) were also comparable between Group I and Group II, respectively (p>0.05). CONCLUSION: The utilization of cryopreserved testicular spermatozoa yields similar outcome as cryopreserved ejaculated spermatozoa in ICSI-ET cycle.
P-1282 Thursday, October 17, 2013 MODIFIED LUTEAL SUPPORT FOLLOWING GnRH-AGONIST TRIGGER. M. R. Banker, A. S. Shah, N. K. Jain, D. J. Sorathiya, H. N. Benani, P. M. Patel. Infertility, Nova IVI Fertility Clinics, Ahmedabad, Gujarat, India. OBJECTIVE: To demonstrate the use of modified luteal support following GnRh-agonist trigger in patients undergoing IVF/ICSI and at risk of Ovarian
Vol. 100, No. 3, Supplement, September 2013