- Email: [email protected]
Low dose human chorionic gonadotropin prevents azoospermia and maintains fertility in hypogonadal men on testosterone replacement therapy
P-117 Tuesday, October 26, 2010 THROMBOPHILIC GENE MUTATION IN WOMEN WITH REPEATED IVF FAILURE. A. Rezk, N. Fathy, A. Idris, M. Auda, H. Al-Inany. Obstetrics & Gynecology, Benha University, Benha, Khalyobia, Egypt. OBJECTIVE: to evaluate the value of detecting mutation in thrombophilic genes [factor V (FV) gene, prothrombin (PT) gene and methylenetetrahydrofolate reductase (MTHFR) gene] in women with repeated IVF- embryo transfer failure with unknown causes. DESIGN: Cross sectional study. MATERIALS AND METHODS: Three groups of women were included : Group A - women who conceived spontaneously with no previous history of miscarriage. Group B : women who have had successful pregnancy after their first IVF embryo transfer cycle. Group (C): women with repeated IVF failure cycles with unknown causes. Blood samples were obtained and examined for genotype mutation of the three thrombophillic genes (FVL mutation G1691A, prothrombin mutation (PTH) G20210A and MTHFR C677T). RESULTS: There was no difference between all groups regarding age, BMI and hormonal profile. However, among women with repeated IVF failure, there was statistically significant increase in the number of patients with single and multiple genes mutation (two or more), as compared to control groups, p<0.001. CONCLUSION: Women with repeated IVF- embryo transfer failure should be screened for thrombophilia.
P-118 Tuesday, October 26, 2010 PRE-IMPLANTATION GENETIC SCREENING USING MICRO-ARRAY BASED 24 CHROMOSOME ANEUPLOIDY SCREENING: ANEUPLOIDY INCIDENCE WITH AND WITHOUT MICROSORTÒ SPERM SEPARATION. C. D. Khoury, J. Frederick, M. Coffler, D. Johnson, D. Karabinus, D. A. Potter. HRC Fertility, Laguna Hills, CA; Gene Security Network, Redwood, CA; Genetics & IVF Institute, Fairfax, VA. OBJECTIVE: To determine if separating X- or Y- bearing sperm using MicroSortÒ(in clinical trial) prior to ICSI affects the rate of incidence of aneuploidy. DESIGN: Retrospective analysis of 15 months data on aneuploidy screening using 24 chromosome parental support technology. MATERIALS AND METHODS: We reviewed the records of 66 patients who underwent an IVF cycle with Pre-implantation genetic screening (PGS) for aneuploidy. Group A consists of patients that underwent IVF with ICSI using unsorted sperm and PGS. Group B consists of patients that underwent IVF with ICSI using Microsorted sperm and PGS. Embryos were biopsied on day 3 and euploidy status was determined by 24 chromosome technology. RESULTS: Results are summerized below. TABLE 1 Group A: using unsorted sperm 44 patients # of embryos biopsied¼ 390 Euploid ¼25.1% 47XXX/XXY¼1.9% 45X¼0.8% Monosomy¼13.1% Tri/ Poly¼7.8% Del/ Dup¼2.9% Comples Abnormalities¼ 48.4% Maternal origin¼54% Paternal origin¼10% Mixed origin¼36% Blastocyst Fromation¼ 59%
Group B: Using sorted sperm 22 patients # of embryos biopsied¼ 195 Euploid ¼31.9% 47XXX/XXY¼1.1% 45X¼0.6% Monosomy¼9.3% Tri/ Poly¼6.0% Del/ Dup¼3.3% Comples Abnormalities¼ 47.8% Maternal origin¼60% Paternal origin¼7% Mixed origin¼33% Blastocyst Fromation¼ 59%
Significant difference
(c2 ¼2.47, p¼0.12) (c2 ¼0.04, p¼0.85) (c2 ¼0.09, p¼0.77) (c2 ¼0.65, p¼0.42) (c2 ¼0.79, p¼0.78) (c2 ¼0.02, p¼0.88) (c2 ¼0.94, p¼0.33) (c2 ¼1.06, p¼0.30) (c2 ¼0.70, p¼0.40) (c2 ¼0.21, p¼0.65)
CONCLUSION: There was no significant difference in any of the categories of table 1. Aneuploidy screening remains the only way to determine whether an embryo has a balanced set of chromosomes & therefore is capable
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Abstracts
of producing a good pregnancy. Separating X- or Y- bearing sperm using MicroSortÒ did not affect the rate of incidence of aneuploidy using 24 chromosome parental support technology in fresh IVF cycles.
P-119 Tuesday, October 26, 2010 WHAT IS THE POTENTIAL OF CRYOPRESERVED BLASTOCYSTS DERIVED FROM EMBRYOS BIOPSIED FOR PREIMPLANTATION GENETIC DIAGNOSIS? D. R. Kinzer, M. M. Alper, B. Barrett. Boston IVF, Waltham, MA. OBJECTIVE: To date there has not been a large amount of data published on the potential of cryopreserved blastocysts derived from embryos biopsied for preimplantation genetic diagnosis (PGD). The objective of this study was to examine the potential of these embryos by evaluating the experience at a large private infertility practice. DESIGN: Retrospective analysis of PGD cycles from 11/04-12/09. MATERIALS AND METHODS: We retrospectively analyzed data from 801 cycles in which patients (pts) were undergoing PGD for aneuploidy and single gene defects. We biopsied 6370 embryos (R four cells) on day 3. Embryos were placed into calcium and magnesium free Hepes-buffered HTF medium with 10% PlasmanateÒ and positioned so that a nucleated cell was adjacent to the planned biopsy site. A small hole was made in the zona with an acidified Tyrodes solution or by diode laser (Hamilton Thorne), and the blastomere was removed. Biopsied embryos were rinsed and placed into medium for extended culture. Blastomeres were fixed to a glass slide and sent to a reference lab for analysis. Surplus normal blastocysts with well-developed ICM and trophectoderm were cryopreserved using a glycerol-based medium and a slow freeze program. Data analyzed included post-thaw survival rate and clinical pregnancy rates. Chi Square analysis was used with P values < 0.05 considered statistically significant (NS ¼ not significant). RESULTS: Out of the 6,370 embryos biopsied, 1601 (25.1%) were unaffected. Of these, 873 were transferred in 537 patients and 173 of these had clinical pregnancies (32%). One hundred thirty eight surplus normal blastocysts met the criteria to be frozen for 77 of the pts. Twenty-nine pts have had 53 embryos thawed. 47/53 (88.7%) survived and were transferred to 27 pts. 5/27 (18.5%) pts became clinically pregnant (NS from fresh). CONCLUSION: Blastocysts derived from biopsied cleavage stage embryos survive cryopreservation well and will increase the PGD patients’ cumulative pregnancy rate when transferred in subsequent cycles.
MALE REPRODUCTIVE UROLOGY P-120 Tuesday, October 26, 2010 LOW DOSE HUMAN CHORIONIC GONADOTROPIN PREVENTS AZOOSPERMIA AND MAINTAINS FERTILITY IN HYPOGONADAL MEN ON TESTOSTERONE REPLACEMENT THERAPY. D. Avila, P. R. Gittens, K. Hwang, J. W. Weedin, J. A. Rumohr, L. I. Lipshultz. Urology, Baylor College of Medicine, Houston, TX; Urology, Kelsey-Seybold Clinic, Houston, TX. OBJECTIVE: Exogenous testosterone administration decreases serum gonadotropins, impairs normal spermatogenesis and suppresses intratesticular testosterone levels. Azoospermia occurs in 65% of patients on testosterone replacement therapy(TRT). Recent studies have demonstrated that intratesticular testosterone levels can be maintained during exogenous TRT with co-administration of low dose human chorionic gonadotropin(HCG). It is hypothesized that HCG is protective and supports continued spermatogenesis in patients on TRT. DESIGN: This is a retrospective review of patients on TRT that were given low-dose HCG to preserve their fertility from 2008-2009. MATERIALS AND METHODS: TRT was administered as a daily topical gel or a weekly injection. Men desiring to preserve fertility were also prescribed HCG 500 units every other day. Serum testosterone, semen analysis and pregnancy outcomes were obtained before and after initiation of therapy. Statistical analysis was performed using SPSS. RESULTS: A total of 17 men were treated, with mean follow-up of 8.6 months. 71% of patients were on injectable testosterone and 29% were on topical gel. Mean serum testosterone was 290 prior to treatment and 960 during treatment. Mean sperm density was 34 M/ml prior to TRT and 26 M/ml during treatment(p¼0.5). Mean sperm motility was 47% prior to therapy and 51% during therapy(p¼0.8). Compared to baseline, 6/17 of patients had
Vol. 94., No. 4, Supplement, September 2010
a lower sperm density and 2/17 had a decrease in motility during TRT. However, no patient became azoospermic. Pregnancy was achieved in 9/12 of patients attempting to conceive during treatment. CONCLUSION: Low dose HCG may be beneficial for men in their reproductive years that require TRT. HCG is protective and supportive of continued spermatogenesis when given in conjunction with injectable or topical TRT. Concurrent HCG use can preserve fertility in hypogonadal males desiring pregnancy while on TRT. Longer follow-up is needed to determine whether this benefit is sustained. Supported by: Department of Urology, Baylor College of Medicine.
P-121 Tuesday, October 26, 2010 ELEVATED FSH IS ASSOCIATED WITH A HIGHER UTILIZATION OF ASSISTED REPRODUCTION (IUI OR IVF) BUT SIMILAR BIRTH RATES AFTER VASECTOMY REVERSAL. W. Hsiao, R. Sultan, R. Lee, M. Goldstein. Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Institute of Reproductive Medicine, Weill Cornell Medical College, New York, NY; Population Council Center for Biomedical Research, New York, NY. OBJECTIVE: We test the hypothesis that elevated pre-op FSH levels predict a lower paternity rate in men with suspected impaired sperm production after vasectomy reversal. DESIGN: A retrospective review of vasectomy reversal patients at our institution. MATERIALS AND METHODS: Preop FSH levels were obtained in 249 of 946 reversal patients chosen because of suspected impaired spermatogenesis for any of the following reasons: no prior proven fertility, history of infertility, or suspected subfertility based on physical exam. Men were divided into normal FSH (<10, n¼194) and high FSH (R 10, n¼55) groups. Multiple logistic regressions evaluated for predictors of assisted reproduction. RESULTS: Mean follow-up was 2.5 3.1 years. Mean FSH for the normal group was 5.1 2.1 U/L and for the high group was 16.1 6.0 U/L. Baseline characteristics were similar for the two groups except for higher LH levels and lower testis volumes in the high FSH group. Post-op live birth rates were similar in both groups (40.2% vs. 32.7%, p¼0.32). However, in the high FSH group, there was a higher utilization of assisted reproduction (IUI or IVF, 72.7% vs. 45.3%, p¼0.0014) and longer mean time to pregnancy (2.3 vs 1.5 years, p¼0.02). On multivariate analysis, only obstructed interval greater than 10 years (OR 1.92, 95% CI: 1.03-3.59) and FSH >10 U/L (OR 1.92, 95%CI: 1.15-5.62) were associated with higher use of assisted reproduction. CONCLUSION: Men with high FSH have similar baseline characteristics except for slightly lower testicular volume and higher LH, which is consistent with poorer testis function. Live birth rates were lower than our previously reported rates which is not surprising since FSH levels were only obtained preoperatively in men with suspected of impaired fertility. Elevated FSH, was associated with higher rates of assisted reproduction, even after controlling for confounding covariates. Supported by: Institutional.
ET cycles, BMI exerted a negative effect on clinical pregnancy (OR 0.91, p¼0.03), especially in overweight women (OR 0.38, p¼0.03) despite comparable embryo quality. BMI did not affect clinical pregnancy in FET cycles. Although peak E2 levels did not affect pregnancy rates in ET cycles, there was a trend toward higher pregnancy rates in women < age 38 with peak E2 levels >3000 pg/mL. (70.0% vs. 37.8%, p¼0.055). Patients in ET cycles who had embryos to freeze had higher pregnancy rates (OR 3.01, p¼0.03). CONCLUSION: This study demonstrates comparable pregnancy rates between ET and FET cycles. FET cycle pregnancy rates were only dependant on the number of grade 1 or 2 embryos transferred. BMI, specifically >25kg/m2, negatively predicted clinical pregnancy in ET but not FET cycles. The effect of BMI was unrelated to embryo quality and peak E2 levels. Contrary to other published data, higher E2 levels in our younger patients seemed to predict successful pregnancy outcome. BMI likely exerted its influence through altered endometrial receptivity.
P-123 Tuesday, October 26, 2010 THE EFFECT OF BODY MASS INDEX ON THE OUTCOMES OF VARICOCELECTOMY. K. N. Pham, J. I. Sandlow. Department of Urology, Medical College of Wisconsin, Milwaukee, WI. OBJECTIVE: Obesity is a potential contributor to male factor infertility. There are no studies that have examined the effect of varicocelectomy in obese men. We sought to determine if body mass index (BMI) significantly affects the outcome of varicocelectomy. DESIGN: Retrospective chart review was performed for all patients who underwent varicocelectomy for clinically palpable varicoceles from September 2003 to December 2009 at a single institution by a single surgeon. MATERIALS AND METHODS: Men with non-obstructive azoospermia, lack of clinical follow-up, or varicocelectomy performed for pain and/or adolescent gonadal growth retardation alone were excluded. Patients were placed into 3 groups based on BMI: normal weight (group A, 38 patients, BMI 18.5-24.9), overweight (group B, 59 patients, BMI 25-29.9) or obese (group C, 46 patients, BMI R 30). Semen analyses (SA) were performed preoperatively and at 3 and 6 month intervals, postoperatively. Significant improvement was defined as > 50% increase in the total motile/ejaculate (TME) parameter on SA postoperatively. RESULTS: 143 patients had adequate postoperative follow up and were available for analysis. No significant differences existed among patients in all three groups except for BMI. Significant improvements in TME on SA were 71.1% (A), 61.0% (B) and 58.7% (C). Pregnancy rates were 36.8% (A), 22.0% (B) and 26.1% (C). There were no statistically significant differences in improvement in TME (p ¼ 0.214, p ¼ 0.172) or pregnancy rate (p ¼ 0.088, p ¼ 0.273) between the normal weight group and either the overweight or obese groups. CONCLUSION: Varicocelectomy for men with clinically palpable varicoceles results in improvement in semen parameters and pregnancy rates, regardless of preoperative BMI. The outcomes of varicocelectomy in overweight and obese patients were similar with those of normal weight men, although there is a trend favoring those men with normal BMI. Therefore, varicocelectomy can be performed effectively and safely in overweight and obese men.
P-122 Tuesday, October 26, 2010 COMPARABLE PREGNANCY OUTCOMES BETWEEN FRESH AND FROZEN-THAWED EMBRYO TRANSFER DEPEND ON EMBRYO QUALITY. N. Singhania, E. S. Knochenhauer, P. Vaid, M. Traub. Obstetrics and Gynecology, Staten Island University Hospital, Staten Island, NY; Assisted Reproductive Unit, Island Reproductive Services, South Plainfield, NJ. OBJECTIVE: To compare pregnancy rates between fresh and frozenthawed transfer cycles and factors influencing pregnancy outcome. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Charts of all non-donor cycles of fresh embryo transfer (ET) (n¼117) and frozen embryo transfer (FET) (n¼50) between January 1 and December 31, 2008 were reviewed at a single private IVF center. Patient characteristics (age, BMI, FSH) and cycle characteristics (eggs retrieved, peak E2 levels, embryo quality) were compared. Outcomes of interest were positive hCG and clinical pregnancy. RESULTS: ET and FET pregnancy rates were comparable (38% v 44%, p¼ .605). In FET cycles, grade 1 embryos (OR 1.95, p¼0.059) and total grade 1 and 2 embryos transferred (OR 2.39, p¼0.055) tended to predict clinical pregnancy, after adjusting for age, FSH, BMI, and total motile count. In
FERTILITY & STERILITYÒ
P-124 Tuesday, October 26, 2010 ANATOMIC BASIS FOR DENERVATION OF THE SPERMATIC CORD FOR CHRONIC ORCHIALGIA: TRIFECTA OF PAIN. S. J. Parekattil, K. J. Priola, H. N. Atalah, M. S. Cohen, R. W. Allan. Urology and Pathology, University of Florida, Gainesville, FL. OBJECTIVE: Levine et al. have shown that microsurgical denervation of the spermatic cord (MDSC) is a treatment option for men with chronic orchialgia (CO). Uceyler et al. have shown that patients with neuropathic pain may have Wallerian degeneration in peripheral nerves. This study provides an anatomical basis on how the denervation technique may provide pain relief. DESIGN: A prospective control study was performed: comparing the spermatic cord anatomy of men with CO versus those without. MATERIALS AND METHODS: Specimens of tissue where obtained in a mapped fashion from cross-sections of the spermatic cord during 57 MDSC procedures (MayAll specimens were reviewed by a single pathologist (RWA). A human cadaver dissection was performed to confirm localization of the nerve distribution found on pathology.
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P-118 Tuesday, October 26, 2010 PRE-IMPLANTATION GENETIC SCREENING USING MICRO-ARRAY BASED 24 CHROMOSOME ANEUPLOIDY SCREENING: ANEUPLOIDY INCIDENCE WITH AND WITHOUT MICROSORTÒ SPERM SEPARATION. C. D. Khoury, J. Frederick, M. Coffler, D. Johnson, D. Karabinus, D. A. Potter. HRC Fertility, Laguna Hills, CA; Gene Security Network, Redwood, CA; Genetics & IVF Institute, Fairfax, VA. OBJECTIVE: To determine if separating X- or Y- bearing sperm using MicroSortÒ(in clinical trial) prior to ICSI affects the rate of incidence of aneuploidy. DESIGN: Retrospective analysis of 15 months data on aneuploidy screening using 24 chromosome parental support technology. MATERIALS AND METHODS: We reviewed the records of 66 patients who underwent an IVF cycle with Pre-implantation genetic screening (PGS) for aneuploidy. Group A consists of patients that underwent IVF with ICSI using unsorted sperm and PGS. Group B consists of patients that underwent IVF with ICSI using Microsorted sperm and PGS. Embryos were biopsied on day 3 and euploidy status was determined by 24 chromosome technology. RESULTS: Results are summerized below. TABLE 1 Group A: using unsorted sperm 44 patients # of embryos biopsied¼ 390 Euploid ¼25.1% 47XXX/XXY¼1.9% 45X¼0.8% Monosomy¼13.1% Tri/ Poly¼7.8% Del/ Dup¼2.9% Comples Abnormalities¼ 48.4% Maternal origin¼54% Paternal origin¼10% Mixed origin¼36% Blastocyst Fromation¼ 59%
Group B: Using sorted sperm 22 patients # of embryos biopsied¼ 195 Euploid ¼31.9% 47XXX/XXY¼1.1% 45X¼0.6% Monosomy¼9.3% Tri/ Poly¼6.0% Del/ Dup¼3.3% Comples Abnormalities¼ 47.8% Maternal origin¼60% Paternal origin¼7% Mixed origin¼33% Blastocyst Fromation¼ 59%
Significant difference
(c2 ¼2.47, p¼0.12) (c2 ¼0.04, p¼0.85) (c2 ¼0.09, p¼0.77) (c2 ¼0.65, p¼0.42) (c2 ¼0.79, p¼0.78) (c2 ¼0.02, p¼0.88) (c2 ¼0.94, p¼0.33) (c2 ¼1.06, p¼0.30) (c2 ¼0.70, p¼0.40) (c2 ¼0.21, p¼0.65)
CONCLUSION: There was no significant difference in any of the categories of table 1. Aneuploidy screening remains the only way to determine whether an embryo has a balanced set of chromosomes & therefore is capable
S128
Abstracts
of producing a good pregnancy. Separating X- or Y- bearing sperm using MicroSortÒ did not affect the rate of incidence of aneuploidy using 24 chromosome parental support technology in fresh IVF cycles.
P-119 Tuesday, October 26, 2010 WHAT IS THE POTENTIAL OF CRYOPRESERVED BLASTOCYSTS DERIVED FROM EMBRYOS BIOPSIED FOR PREIMPLANTATION GENETIC DIAGNOSIS? D. R. Kinzer, M. M. Alper, B. Barrett. Boston IVF, Waltham, MA. OBJECTIVE: To date there has not been a large amount of data published on the potential of cryopreserved blastocysts derived from embryos biopsied for preimplantation genetic diagnosis (PGD). The objective of this study was to examine the potential of these embryos by evaluating the experience at a large private infertility practice. DESIGN: Retrospective analysis of PGD cycles from 11/04-12/09. MATERIALS AND METHODS: We retrospectively analyzed data from 801 cycles in which patients (pts) were undergoing PGD for aneuploidy and single gene defects. We biopsied 6370 embryos (R four cells) on day 3. Embryos were placed into calcium and magnesium free Hepes-buffered HTF medium with 10% PlasmanateÒ and positioned so that a nucleated cell was adjacent to the planned biopsy site. A small hole was made in the zona with an acidified Tyrodes solution or by diode laser (Hamilton Thorne), and the blastomere was removed. Biopsied embryos were rinsed and placed into medium for extended culture. Blastomeres were fixed to a glass slide and sent to a reference lab for analysis. Surplus normal blastocysts with well-developed ICM and trophectoderm were cryopreserved using a glycerol-based medium and a slow freeze program. Data analyzed included post-thaw survival rate and clinical pregnancy rates. Chi Square analysis was used with P values < 0.05 considered statistically significant (NS ¼ not significant). RESULTS: Out of the 6,370 embryos biopsied, 1601 (25.1%) were unaffected. Of these, 873 were transferred in 537 patients and 173 of these had clinical pregnancies (32%). One hundred thirty eight surplus normal blastocysts met the criteria to be frozen for 77 of the pts. Twenty-nine pts have had 53 embryos thawed. 47/53 (88.7%) survived and were transferred to 27 pts. 5/27 (18.5%) pts became clinically pregnant (NS from fresh). CONCLUSION: Blastocysts derived from biopsied cleavage stage embryos survive cryopreservation well and will increase the PGD patients’ cumulative pregnancy rate when transferred in subsequent cycles.
MALE REPRODUCTIVE UROLOGY P-120 Tuesday, October 26, 2010 LOW DOSE HUMAN CHORIONIC GONADOTROPIN PREVENTS AZOOSPERMIA AND MAINTAINS FERTILITY IN HYPOGONADAL MEN ON TESTOSTERONE REPLACEMENT THERAPY. D. Avila, P. R. Gittens, K. Hwang, J. W. Weedin, J. A. Rumohr, L. I. Lipshultz. Urology, Baylor College of Medicine, Houston, TX; Urology, Kelsey-Seybold Clinic, Houston, TX. OBJECTIVE: Exogenous testosterone administration decreases serum gonadotropins, impairs normal spermatogenesis and suppresses intratesticular testosterone levels. Azoospermia occurs in 65% of patients on testosterone replacement therapy(TRT). Recent studies have demonstrated that intratesticular testosterone levels can be maintained during exogenous TRT with co-administration of low dose human chorionic gonadotropin(HCG). It is hypothesized that HCG is protective and supports continued spermatogenesis in patients on TRT. DESIGN: This is a retrospective review of patients on TRT that were given low-dose HCG to preserve their fertility from 2008-2009. MATERIALS AND METHODS: TRT was administered as a daily topical gel or a weekly injection. Men desiring to preserve fertility were also prescribed HCG 500 units every other day. Serum testosterone, semen analysis and pregnancy outcomes were obtained before and after initiation of therapy. Statistical analysis was performed using SPSS. RESULTS: A total of 17 men were treated, with mean follow-up of 8.6 months. 71% of patients were on injectable testosterone and 29% were on topical gel. Mean serum testosterone was 290 prior to treatment and 960 during treatment. Mean sperm density was 34 M/ml prior to TRT and 26 M/ml during treatment(p¼0.5). Mean sperm motility was 47% prior to therapy and 51% during therapy(p¼0.8). Compared to baseline, 6/17 of patients had
Vol. 94., No. 4, Supplement, September 2010
a lower sperm density and 2/17 had a decrease in motility during TRT. However, no patient became azoospermic. Pregnancy was achieved in 9/12 of patients attempting to conceive during treatment. CONCLUSION: Low dose HCG may be beneficial for men in their reproductive years that require TRT. HCG is protective and supportive of continued spermatogenesis when given in conjunction with injectable or topical TRT. Concurrent HCG use can preserve fertility in hypogonadal males desiring pregnancy while on TRT. Longer follow-up is needed to determine whether this benefit is sustained. Supported by: Department of Urology, Baylor College of Medicine.
P-121 Tuesday, October 26, 2010 ELEVATED FSH IS ASSOCIATED WITH A HIGHER UTILIZATION OF ASSISTED REPRODUCTION (IUI OR IVF) BUT SIMILAR BIRTH RATES AFTER VASECTOMY REVERSAL. W. Hsiao, R. Sultan, R. Lee, M. Goldstein. Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Institute of Reproductive Medicine, Weill Cornell Medical College, New York, NY; Population Council Center for Biomedical Research, New York, NY. OBJECTIVE: We test the hypothesis that elevated pre-op FSH levels predict a lower paternity rate in men with suspected impaired sperm production after vasectomy reversal. DESIGN: A retrospective review of vasectomy reversal patients at our institution. MATERIALS AND METHODS: Preop FSH levels were obtained in 249 of 946 reversal patients chosen because of suspected impaired spermatogenesis for any of the following reasons: no prior proven fertility, history of infertility, or suspected subfertility based on physical exam. Men were divided into normal FSH (<10, n¼194) and high FSH (R 10, n¼55) groups. Multiple logistic regressions evaluated for predictors of assisted reproduction. RESULTS: Mean follow-up was 2.5 3.1 years. Mean FSH for the normal group was 5.1 2.1 U/L and for the high group was 16.1 6.0 U/L. Baseline characteristics were similar for the two groups except for higher LH levels and lower testis volumes in the high FSH group. Post-op live birth rates were similar in both groups (40.2% vs. 32.7%, p¼0.32). However, in the high FSH group, there was a higher utilization of assisted reproduction (IUI or IVF, 72.7% vs. 45.3%, p¼0.0014) and longer mean time to pregnancy (2.3 vs 1.5 years, p¼0.02). On multivariate analysis, only obstructed interval greater than 10 years (OR 1.92, 95% CI: 1.03-3.59) and FSH >10 U/L (OR 1.92, 95%CI: 1.15-5.62) were associated with higher use of assisted reproduction. CONCLUSION: Men with high FSH have similar baseline characteristics except for slightly lower testicular volume and higher LH, which is consistent with poorer testis function. Live birth rates were lower than our previously reported rates which is not surprising since FSH levels were only obtained preoperatively in men with suspected of impaired fertility. Elevated FSH, was associated with higher rates of assisted reproduction, even after controlling for confounding covariates. Supported by: Institutional.
ET cycles, BMI exerted a negative effect on clinical pregnancy (OR 0.91, p¼0.03), especially in overweight women (OR 0.38, p¼0.03) despite comparable embryo quality. BMI did not affect clinical pregnancy in FET cycles. Although peak E2 levels did not affect pregnancy rates in ET cycles, there was a trend toward higher pregnancy rates in women < age 38 with peak E2 levels >3000 pg/mL. (70.0% vs. 37.8%, p¼0.055). Patients in ET cycles who had embryos to freeze had higher pregnancy rates (OR 3.01, p¼0.03). CONCLUSION: This study demonstrates comparable pregnancy rates between ET and FET cycles. FET cycle pregnancy rates were only dependant on the number of grade 1 or 2 embryos transferred. BMI, specifically >25kg/m2, negatively predicted clinical pregnancy in ET but not FET cycles. The effect of BMI was unrelated to embryo quality and peak E2 levels. Contrary to other published data, higher E2 levels in our younger patients seemed to predict successful pregnancy outcome. BMI likely exerted its influence through altered endometrial receptivity.
P-123 Tuesday, October 26, 2010 THE EFFECT OF BODY MASS INDEX ON THE OUTCOMES OF VARICOCELECTOMY. K. N. Pham, J. I. Sandlow. Department of Urology, Medical College of Wisconsin, Milwaukee, WI. OBJECTIVE: Obesity is a potential contributor to male factor infertility. There are no studies that have examined the effect of varicocelectomy in obese men. We sought to determine if body mass index (BMI) significantly affects the outcome of varicocelectomy. DESIGN: Retrospective chart review was performed for all patients who underwent varicocelectomy for clinically palpable varicoceles from September 2003 to December 2009 at a single institution by a single surgeon. MATERIALS AND METHODS: Men with non-obstructive azoospermia, lack of clinical follow-up, or varicocelectomy performed for pain and/or adolescent gonadal growth retardation alone were excluded. Patients were placed into 3 groups based on BMI: normal weight (group A, 38 patients, BMI 18.5-24.9), overweight (group B, 59 patients, BMI 25-29.9) or obese (group C, 46 patients, BMI R 30). Semen analyses (SA) were performed preoperatively and at 3 and 6 month intervals, postoperatively. Significant improvement was defined as > 50% increase in the total motile/ejaculate (TME) parameter on SA postoperatively. RESULTS: 143 patients had adequate postoperative follow up and were available for analysis. No significant differences existed among patients in all three groups except for BMI. Significant improvements in TME on SA were 71.1% (A), 61.0% (B) and 58.7% (C). Pregnancy rates were 36.8% (A), 22.0% (B) and 26.1% (C). There were no statistically significant differences in improvement in TME (p ¼ 0.214, p ¼ 0.172) or pregnancy rate (p ¼ 0.088, p ¼ 0.273) between the normal weight group and either the overweight or obese groups. CONCLUSION: Varicocelectomy for men with clinically palpable varicoceles results in improvement in semen parameters and pregnancy rates, regardless of preoperative BMI. The outcomes of varicocelectomy in overweight and obese patients were similar with those of normal weight men, although there is a trend favoring those men with normal BMI. Therefore, varicocelectomy can be performed effectively and safely in overweight and obese men.
P-122 Tuesday, October 26, 2010 COMPARABLE PREGNANCY OUTCOMES BETWEEN FRESH AND FROZEN-THAWED EMBRYO TRANSFER DEPEND ON EMBRYO QUALITY. N. Singhania, E. S. Knochenhauer, P. Vaid, M. Traub. Obstetrics and Gynecology, Staten Island University Hospital, Staten Island, NY; Assisted Reproductive Unit, Island Reproductive Services, South Plainfield, NJ. OBJECTIVE: To compare pregnancy rates between fresh and frozenthawed transfer cycles and factors influencing pregnancy outcome. DESIGN: Retrospective cohort. MATERIALS AND METHODS: Charts of all non-donor cycles of fresh embryo transfer (ET) (n¼117) and frozen embryo transfer (FET) (n¼50) between January 1 and December 31, 2008 were reviewed at a single private IVF center. Patient characteristics (age, BMI, FSH) and cycle characteristics (eggs retrieved, peak E2 levels, embryo quality) were compared. Outcomes of interest were positive hCG and clinical pregnancy. RESULTS: ET and FET pregnancy rates were comparable (38% v 44%, p¼ .605). In FET cycles, grade 1 embryos (OR 1.95, p¼0.059) and total grade 1 and 2 embryos transferred (OR 2.39, p¼0.055) tended to predict clinical pregnancy, after adjusting for age, FSH, BMI, and total motile count. In
FERTILITY & STERILITYÒ
P-124 Tuesday, October 26, 2010 ANATOMIC BASIS FOR DENERVATION OF THE SPERMATIC CORD FOR CHRONIC ORCHIALGIA: TRIFECTA OF PAIN. S. J. Parekattil, K. J. Priola, H. N. Atalah, M. S. Cohen, R. W. Allan. Urology and Pathology, University of Florida, Gainesville, FL. OBJECTIVE: Levine et al. have shown that microsurgical denervation of the spermatic cord (MDSC) is a treatment option for men with chronic orchialgia (CO). Uceyler et al. have shown that patients with neuropathic pain may have Wallerian degeneration in peripheral nerves. This study provides an anatomical basis on how the denervation technique may provide pain relief. DESIGN: A prospective control study was performed: comparing the spermatic cord anatomy of men with CO versus those without. MATERIALS AND METHODS: Specimens of tissue where obtained in a mapped fashion from cross-sections of the spermatic cord during 57 MDSC procedures (MayAll specimens were reviewed by a single pathologist (RWA). A human cadaver dissection was performed to confirm localization of the nerve distribution found on pathology.
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