P-115 Fertilization after standard in vitro fertilization (IVF) versus intracytoplasmic sperm injection (ICSI) in subfertile males using sibling oocytes

from the same patients. /%hCG was determined with a high sensitive and specific assay commercially available for urinary human/~-hCG. Materials and Methods: Fifty-two patients undergoing oocyte donation were recruited. Each woman collected an early morning urine sample on days 6, 8, 10, 12 and 14 after embryo transfer until the pregnancy was confirmed by standard biochemical pregnancy testing (testpack+plus, Abbot Diagnosticos, Madrid, Spain, sensitivity >25 mUI/ml) or until menstruation began. As a control group, urine samples were collected from 6 patients in mock cycles previous to embryo transfer cycles at the same days as described in the study group considering in this case the day 3 of P administration as the day of embryo transfer. The urine samples were frozen and stored at - 2 0 until assayed. /%hCG was measured by using an standardized microparticle enzymoimmunoassay (MEIA) (Abbot diagnosticos, Madrid, Spain, sensitivity ---2 mUI/ml). We assayed 30 urine samples corresponding to the control group. Homogeneity of the results were verified statistically by using a design of repeated measures and nonparametric test. According to these results obtained in the absence of embryos, the criteria for detection of early pregnancy loss was a/~-hCG>2.37 mUI/ml at least two consecutive days, corresponding to the maximal level obtained in the control group and being higher than the sensitivity of the technique. Results: Of the 52 patients enrolled in the study, 48 contributed with all five samples required. Twenty out of forty-eight patients studied were positive at day 14 after embryo transfer by a biochemical pregnancy test. In all cases gestational sac/s were observed by vaginal ultrasonography. In 2 patients a clinical pregnancy loss was recorded (10%). Of the remaining 28 patients, 11 fulfilled the criteria of early pregnancy loss corresponding to 22.91% of total number of patients studied or 39.32% of patients with a negative routine biochemical pregnancy test. Conclusion: Our results demonstrate that patients undergoing oocyte donation have increased early pregnancy losses (before menstruation occurs) than normal patients (39.32% versus 32% respectively). Furthermore, patients undergoing oocyte donation received 3 to 4 good-quality embryos instead of one embryo in natural cycles. Taking together, these observations suggest an endometrial efficiency in terms of receptivity even lower than expected in patients undergoing oocyte donation.

extension of the technique to subfertile males. Conventional IVF in these couples may result in less oocyte damage than ICSI, but at the expense of decreased fertilization. Therefore, we evaluated IVF versus ICSI in sibling oocytes in the subfertile male population to assess fertilization and embryo quality. Design: Prospective experimental study. Material and Methods: Couples (n=26) with at least one abnormal semen parameter (WHO criteria and Kruger's strict criteria), underwent an IVF cycle in which oocytes were divided without prejudice between conventional IVF (n=167) and ICSI (n = 188). Fertilization rates were compared between the 2 groups by the Wilcoxon matched pairs test. Embryo quality, assessed by cell number, cell grade and an arbitrary scoring system incorporating these 2 parameters, was compared with the Mann-Whitney U test. Results:

# Cycleswith Fertilization OocyteFertilization Rate

IVF

ICSI

21 (81%) 92/167(55%)

25 (96%) 122/188(65%)A

X2, NS

AOf the 66 oocytesnot fertilized, 23 were killed with ICSI. One couple had no fertilization with either treatment and 4 couples had no fertilization with conventional IVF whereas ICSI resulted in >50% fertilization of the sibling oocytes. There was no statistically significant difference between the 2 procedures in each couple. Semen parameters did not predict fertilization success with either IVF or ICSI. There was no statistically significant difference in embryo quality (cell number, cell grade, score) between the 2 procedures on sibling oocytes. Transfer of embryos from both procedures resulted in 14 pregnancies, diagnosed by positive /%HCG and confirmed by ultrasound. Currently, there are 12 ongoing pregnancies, 1 term infant, and 1 ectopic pregnancy; an intrauterine pregnancy rate of 50%. Conclusion: There is no statistically significant difference in fertilization and embryo quality between IVF and ICSI in the subfertile male population. At present, no semen parameters predict superiority of one treatment modality in this patient population. Until such a predictor becomes available, optimal outcome occurs when oocytes are divided and a portion fertilized in vitro, with the remaining treated by ICSI.

P-115

P-116

Fertilization After Standard In Vitro Fertilization (IVF) Versus Intracytoplasmic Sperm Injection (ICSI) In Subfertile Males Using Sibling Oocytes.

Detailed Semen Analysis and ICSI in Azoospermialike Infertile Patients. D. R. Lee, Y. J. Lim, J. W. Kim,

1M. D. Pisarska, 1p. R. Casson, 1p. L. Cisneros, 2D. J. Lamb, 2L. I. Lipshultz, 1j. E. Buster, 1S. A. Carson. 1Department of OB/GYN, and 2Department of Urology, Baylor College Of Medicine, Houston, TX. Objective: The impressive pregnancy rate after IVFICSI in couples with severe male factor infertility led to

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Abstracts

S. J. Yoon, H. S. Yoon, J. S. Jeon, H. W. Min, J. H. Cho, S. I. Roh. Infertility Research Center, Jeil Women's Hospital, Seoul, Korea. Objective: The introduction of intracytoplasmic sperm injection (ICSI) in human ART programs can overcome the most of male infertility, but many patients with azoospermia cannot benefit from ICSI. For there is a tiny