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Effect of varicocelectomy on nonobstructive azoospermic and severe oligospermic patients
or equal to 80% of the control. There were no exclusions for female factor or WHO male factor etiology. RESULTS: SDD scores and first IUI or IVF attempt outcome data were available for 58 males. Forty-three males had normal SDD scores and had a 22% success rate with IUI (N ¼ 23) and 35% with IVF (N ¼ 20) attempts. Fifteen males had abnormal SDD scores with a 0% success rate with IUI (N ¼ 6) and IVF (N ¼ 9) attempts. The difference between the 28% success rate of SDD normal patients (N ¼ 43, IUI/IVF combined) and 0% with SDD abnormal patients (N ¼ 15, IUI/IVF combined) was statistically significant using Fischer’s exact test (P¼0.0325) (Odds Ratio >5). An additional 18 patients underwent IVF with ICSI where 81% (N ¼ 16) of males with normal SDD scores had success and 100% (n ¼ 2) with an abnormal SDD had success, although there was not sufficient statistical power to conclude that the groups were different. There was no significant difference for the average age and FSH levels of female partners between SDD normal and SDD abnormal groups. Overall clinical pregnancy rates for this fertility practice at the time of this study were: IUI, 15%; IVF and ICSI, 53%. CONCLUSIONS: Based upon preliminary retrospective data, the SDD may be able to identify those male patients with reduced chances of success with IUI and IVF who may benefit from earlier consideration of ICSI. Further definitive studies are needed. Supported by: Repromedix. P-819 EFFECT OF VARICOCELECTOMY ON NONOBSTRUCTIVE AZOOSPERMIC AND SEVERE OLIGOSPERMIC PATIENTS. T. Ishikawa, Y. Kondo, K. Yamaguchi, Y. Sakamoto, T. Haraguchi, M. Fujisawa. Division of Urology, Department of Organs Therapeutics, Faculty of Medicine, Kobe University Graduate School of Medicine, Kobe, Japan. OBJECTIVE: Varicoceles are the most frequent physical abnormality found in infertile men and surgical ligation of spermatic vein is generally accepted as the treatment of choice for this condition. The aim of this study is to assess the treatment outcome and the benefits after varicocelectomy in men with nonobstructive azoospermia (NOA) and severe oligospermia. DESIGN: Retrospective clinical analysis. MATERIALS AND METHODS: The records were retrospectively evaluated for 6 patients with NOA and 54 severe oligospermic patients who underwent microsurgical inguinal varicocele ligation. The age was 33.3 5.3 (mean SD) years. Fifty-one (85%) underwent a unilateral left-sided procedure (5 of 6 with NOA, 46 of 54 with severe oligospermia), and 9 (15%) underwent a bilateral procedure. The presence of varicocele was diagnosed on the basis of a venous diameter of 3 mm or more with increasing diameter during Valsalva manoeuvre or when changing from supine to upright position. Severe oligoasthenospermia was defined as <5106/ml in all analyses submitted. RESULTS: After ligation, induction of spermatogenesis was achieved in two men (33%). The pathology of these patients was hypospermatogenesis and late maturation arrest (arrest at the spermatids stage). We colud not find the predictive factor retrospectively (e.g. hormone levels or testicular volume). The sperm concentration increased from 2.3 1.6 to 9.2 12.6 million/mL (P<0.001) with severe oligospermia patients. The sperm motility did not change significantly. Four (7.4%) of the 54 oligospermia men have contributed to unassisted pregnancies. Among 54 patients with severe oligospermia, improvement of sperm concentration was seen in 31 patients (responders, 57%). Between responders and non-responders with severe oligospermia, testosterone level (6.3 5.3 and 4.6 1.9 ng/mL, respectively, P¼0.10) showed a slight trend, however, no significant differences were seen in FSH level (9.2 5.5 and 11.4 7.9 IU/L, respectively, P¼0.22), LH level (4.7 2.2 and 5.7 3.5 IU/L, respectively, P¼0.18), prolactin level (9.3 9.2 and 9.3 6.3 ng/mL, respectively), left testicular volume (15.8 4.3 and 16.4 4.4 mL, respectively), the percentage of varicocele grade III (47 and 52 %, respectively), and the volume of semen (2.8 1.0 and 2.9 1.6 mL, respectively). CONCLUSIONS: Varicocelectomy resulted in the induction or enhancement of spermatogenesis for several men with NOA or severe oligospermia. It is reasonable to be considered an option in selective patients with NOA or severe oligospermia. Supported by: None. P-820 COMPARISON OF SEMEN PARAMETERS IN PREGNANCY AND NONPREGNANCY COUPLES WITH MALE FACTOR INFERTILITY DURING INTRAUTERINE INSEMINATION. C. Iltemir Duvan, B. Berker, O. Bayrak, K. Aydos, N. Ozturk Turhan, H. Satiroglu. Department of Gynecology and Obstetrics, Centre of Artificial Reproduction, Fatih Uni-
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versity, Ankara, Turkey; Department of Gynecology and Obstetrics, Centre of Artificial Reproduction, Ankara University, Ankara, Turkey. OBJECTIVE: The aim of this study was to compare the semen parameters in pregnancy and nonpregnancy couples with male factor infertility during intrauterine insemination (IUI). DESIGN: The retrospective design. MATERIALS AND METHODS: The study included a total of 156 IUI cycles performed in 109 couples at the University of Ankara and at the University of Fatih, Turkey, from January 2005 to December 2006 with the indication of male infertility. 156 IUI cycles were divided into two groups. Group 1, pregnancy (24 cycles) and Group 2 (132 cycles) nonpregnancy cycles. Male factor was defined as more than one semen analysis that did not meet the WHO criteria for concentration, motility. Means were compared by using Mann Whitney U test, where appropriate. RESULTS: The median age of women was 29 years and of males 33 years at the time of IUI. Pregnancy rate per cycle and per patient were 15.4 % and 22 %, respectively. In both groups, progressive motility neither initial nor processed sperm specimens were detected differed. When comparisons of semen parameters in groups were done in the initial specimen, sperm concentration and total motile sperm count (TMC) were significantly different between groups. After processing specimen a definite statistically significant difference also was found sperm concentration and inseminated motile sperm count (IMC) in pregnancy and nonpregnancy cycles. For initial sperm count, median sperm count was accepted 27 106/ml and initial sperm count was divided in quartiles. Although a linear correlation was shown with pregnancy rate, statistically no differences were detected. We categorized patients the average TMC as %10 million total motile sperm and >10 million total motile sperm. Although TMC > 10 106 provided a pregnancy rate (PR) of 18% compare with TMC < 10 106/ml (PR:10%), statistically no differences were detected. As median sperm count (14 106/ml) was taken into consideration in processed specimen, sperm count > 14.5 106/ml (P¼0.02) provided a favorable PR of 21.8 %. In present study median IMC was 3 106/ml detected. The lowest IMC count resulting in pregnancy was 0.3 106. According to literature, IMC was divided in two groups. Although lacking statistical significance, in the number of IMC > 1 106/ml group, pregnancy rate 16.9%, IMC of < 1 106/ml PR was 9.4%. CONCLUSIONS: The IUI data presented in this study demonstrate that in addition to the initial TMC and IMC, sperm count in specimens may influence IUI-related pregnancy in male factor infertility. Supported by: None.
P-821 USING MODIFIED INTRACYTOPLASMIC SPERM INJECTION TECHNIQUE TO INCREASE FERTILIZATION AND PREGNANCY RATES FOR GLOBOZOOSPERMIC PATIENTS. E. Ergin, Z. Oztel, T. Sohtorik, A. Ozay, R. Atmaca, H. Ozornek. EUROFERTIL Reproductive Health Center, Istanbul, Turkey; Gazi EUROFERTIL Reproductive Health Center, Gaziantep, Turkey. OBJECTIVE: Although globozoospermia is not a common sperm disorder, it is associated with male infertility and obtaining pregnancy using this round-headed sperm is very difficult. The aim of this study indicates that low fertilization and pregnancy rates from globozoospermic men may be possible to overcome with modified intracytoplasmic sperm injection (ICSI) technique. DESIGN: Retrospective study. MATERIALS AND METHODS: Standard and modified ICSI which was described by Tesarik et al (Fertil Steril 2002;78:619) procedures applied in the treatment of eight globozoospermic patients were compared. In modified ICSI procedure, oocytes for injection are secured by a holding pipette with the first polar body at the 6 or 12 o’clock position. When the injected sperm reaches the tip of the ICSI needle, the needle is inserted in to the oocyte at the three o’clock position. Firstly, the aspiration of the ooplasm is initiated. This process is continued until the distance between the sperm in the needle and the outer surface of the zona pellucida is equal to the distance between the outer surface of the zona pellucida and the center of the oocyte. And then the needle tip is pushed to the oocyte periphery. When the sperm reaches the needle tip, the aspirated ooplasm is reinjected to the oocyte. Until the needle tip reaches the central area of the oocyte, it is pulled back again and the same procedure is repeated once more. All spermatozoa were determined as round headed under light microscope. After the controlled ovarian hyperstimulation, collected oocytes and embryos were cultured in GIII series (Vitrolife, Sweden). Only mature oocytes were selected for ICSI. Assessment of fertilization was performed 18 hours after the injection. If two pronuclei and two polar bodies were obtained, the fertilization was accepted as normal.
Vol. 88, Suppl 1, September 2007
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versity, Ankara, Turkey; Department of Gynecology and Obstetrics, Centre of Artificial Reproduction, Ankara University, Ankara, Turkey. OBJECTIVE: The aim of this study was to compare the semen parameters in pregnancy and nonpregnancy couples with male factor infertility during intrauterine insemination (IUI). DESIGN: The retrospective design. MATERIALS AND METHODS: The study included a total of 156 IUI cycles performed in 109 couples at the University of Ankara and at the University of Fatih, Turkey, from January 2005 to December 2006 with the indication of male infertility. 156 IUI cycles were divided into two groups. Group 1, pregnancy (24 cycles) and Group 2 (132 cycles) nonpregnancy cycles. Male factor was defined as more than one semen analysis that did not meet the WHO criteria for concentration, motility. Means were compared by using Mann Whitney U test, where appropriate. RESULTS: The median age of women was 29 years and of males 33 years at the time of IUI. Pregnancy rate per cycle and per patient were 15.4 % and 22 %, respectively. In both groups, progressive motility neither initial nor processed sperm specimens were detected differed. When comparisons of semen parameters in groups were done in the initial specimen, sperm concentration and total motile sperm count (TMC) were significantly different between groups. After processing specimen a definite statistically significant difference also was found sperm concentration and inseminated motile sperm count (IMC) in pregnancy and nonpregnancy cycles. For initial sperm count, median sperm count was accepted 27 106/ml and initial sperm count was divided in quartiles. Although a linear correlation was shown with pregnancy rate, statistically no differences were detected. We categorized patients the average TMC as %10 million total motile sperm and >10 million total motile sperm. Although TMC > 10 106 provided a pregnancy rate (PR) of 18% compare with TMC < 10 106/ml (PR:10%), statistically no differences were detected. As median sperm count (14 106/ml) was taken into consideration in processed specimen, sperm count > 14.5 106/ml (P¼0.02) provided a favorable PR of 21.8 %. In present study median IMC was 3 106/ml detected. The lowest IMC count resulting in pregnancy was 0.3 106. According to literature, IMC was divided in two groups. Although lacking statistical significance, in the number of IMC > 1 106/ml group, pregnancy rate 16.9%, IMC of < 1 106/ml PR was 9.4%. CONCLUSIONS: The IUI data presented in this study demonstrate that in addition to the initial TMC and IMC, sperm count in specimens may influence IUI-related pregnancy in male factor infertility. Supported by: None.
P-821 USING MODIFIED INTRACYTOPLASMIC SPERM INJECTION TECHNIQUE TO INCREASE FERTILIZATION AND PREGNANCY RATES FOR GLOBOZOOSPERMIC PATIENTS. E. Ergin, Z. Oztel, T. Sohtorik, A. Ozay, R. Atmaca, H. Ozornek. EUROFERTIL Reproductive Health Center, Istanbul, Turkey; Gazi EUROFERTIL Reproductive Health Center, Gaziantep, Turkey. OBJECTIVE: Although globozoospermia is not a common sperm disorder, it is associated with male infertility and obtaining pregnancy using this round-headed sperm is very difficult. The aim of this study indicates that low fertilization and pregnancy rates from globozoospermic men may be possible to overcome with modified intracytoplasmic sperm injection (ICSI) technique. DESIGN: Retrospective study. MATERIALS AND METHODS: Standard and modified ICSI which was described by Tesarik et al (Fertil Steril 2002;78:619) procedures applied in the treatment of eight globozoospermic patients were compared. In modified ICSI procedure, oocytes for injection are secured by a holding pipette with the first polar body at the 6 or 12 o’clock position. When the injected sperm reaches the tip of the ICSI needle, the needle is inserted in to the oocyte at the three o’clock position. Firstly, the aspiration of the ooplasm is initiated. This process is continued until the distance between the sperm in the needle and the outer surface of the zona pellucida is equal to the distance between the outer surface of the zona pellucida and the center of the oocyte. And then the needle tip is pushed to the oocyte periphery. When the sperm reaches the needle tip, the aspirated ooplasm is reinjected to the oocyte. Until the needle tip reaches the central area of the oocyte, it is pulled back again and the same procedure is repeated once more. All spermatozoa were determined as round headed under light microscope. After the controlled ovarian hyperstimulation, collected oocytes and embryos were cultured in GIII series (Vitrolife, Sweden). Only mature oocytes were selected for ICSI. Assessment of fertilization was performed 18 hours after the injection. If two pronuclei and two polar bodies were obtained, the fertilization was accepted as normal.
Vol. 88, Suppl 1, September 2007