- Email: [email protected]
P-119 Testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI) for non-obstructive azoospermia
562), P=0.024). But, in t h e cases of m a n y oocytes (-<13) or more t h a n 4 cycles of IVF-ET, clinical p r e g n a n c y r a t e was not different in both groups. In BAH groups, clinical p r e g n a n c y r a t e was s i m i l a r b e t w e e n conventional IVF a n d ICSI group. Conclusion: F r o m t h e s e results, clinical p r e g n a n c y r a t e was i n c r e a s e d by BAH in h u m a n IVF-ET programs. Specially, in p a t i e n t s over 35 y e a r s old or with low oocyte r e t r i e v a l rate, clinical p r e g n a n c y r a t e was significantly i n c r e a s e d by BAH. BAH in both conventional IVF a n d ICSI group b r o u g h t about increase of clinical p r e g n a n c y rate. Therefore, we suggest t h a t BAH u s i n g p r o n a s e E m a y be simple, safe a n d v a l u a b l e technique t h a n other a s s i s t e d h a t c h i n g techniques u s i n g m i c r o m a n i p u l a t o r .
Table 1. Fertilization, embryonic development and pregnancy rates in obstructive and non-obstructive azoospermic patients after ICSI or ROSI
OB a HYPO
b
SCO d
ICSI ROSI ICSI ROSI ICSI ROSI ICSI ROSI
No. of case
No. of MII oocytes
No. of 2PN (%)
66 -9 4 6 7 5 10
636 -110 61 56 101 64 106
480 (75.5) -83 (75.5) 20 (32.8)** 32 (57.1)** 23 (22.8)** 41 (64.1)* 18 (17.0)**
No. of Embryos
P-118 OB a
Application of ICSI or ROSI by Testicular Biopsy in Non-obstructive Azoospermia. D. R. Lee, Y. J. Lim,
HYPO b
H. S. Yoon, J. H. Lee, J . T . Seo, J. S. Jeon, H . N . Shim, J. H. Cho, S. I. Roh. I n f e r t i l i t y R e s e a r c h Center, J e i l Wornen's Hospital, Seoul, Korea.
MA~ SCO d
Objectives: F o r t h e r e is a t i n y focus of s p e r m a t o g e n e s i s in the t e s t i s of non-obstructive azoospermic p a t i e n t s , pregn a n c y can be achieved in t h e s e p a t i e n t s by t e s t i c u l a r s p e r m e x t r a c t i o n (TESE) a n d i n t r a c y t o p l a s m i c s p e r m injection (ICSI). It was also r e p o r t e d t h a t fertilization a n d p r e g n a n c y were achieved by r o u n d s p e r m a t i d injection (ROSI). The p r e s e n t s t u d y was performed in order to evalu a t e t h e presence of r o u n d s p e r m a t i d s or s p e r m a t o z o a in the t e s t i s of non-obstructive azoospermic p a t i e n t s , a n d to analyze t h e r e s u l t s of t h e i r application in t h e ART prog r a m according to t h e i r histology of testis. Design: We a n a l y z e d t h e r e s u l t s of wet p r e p a r a t i o n of t e s t i c u l a r tissues according to histology in non-obstructive azoospermic patients. Fertilization, embryonic developm e n t a n d p r e g n a n c y r a t e in these p a t i e n t s after ICSI or ROSI were c o m p a r e d w i t h t h a t of obstructive azoospermic p a t i e n t s which were k n o w n to h a v e n o r m a l s p e r m a t o genesis. M a t e r i a l s a n d Methods: T e s t i c u l a r t i s s u e s were obt a i n e d from 52 non-obstructive azoospermic p a t i e n t s by m u l t i p l e t e s t i c u l a r biopsy. Biopsied tissues were w a s h e d in PBS for removing blood a n d each seminiferous t u b u l e was isolated u n d e r stereomicroscope. S p e r m a t o g e n i c cells were squeezed out u s i n g fine forcep a n d t r a n s f e r r e d into microdrops in culture dish. We d e t e r m i n e d the existence of r o u n d s p e r m a t i d s a n d spermatozoa, a n d isolated t h e m for I C S I or ROSI. After ICSI or ROSI, fertilization of oocytes were a s s e s s e d by detection of two pronuclei a t 16 hours. E m b r y o s were t r a n s f e r r e d to u t e r u s after culture for 48 hours. Results: I n h y p o s p e r m a t o g e n e s i s p a t i e n t s (n=13) of non-obstructive azoospermia, we observed r o u n d s p e r m a tid in all cases a n d s p e r m a t o z o a in 9 cases. Round s p e r m a tid a n d s p e r m a t o z o a were observed in 13 a n d 6 cases of m a t u r a t i o n a r r e s t (n= 17) a n d in 15 a n d 5 cases of Sertoli cell only s y n d r o m e (n=22), respectively. S148
Abstracts
OBa HYPO b MA~ SCO d
ICSI ROSI ICSI ROSI ICSI ROSI ICSI ROSI
ICSI ROSI ICSI ROSI ICSI ROSI ICSI ROSI
developed (%)
arrested (%)
412 (99.5) -44 (100) 15 (75.0)** 31 (96.9) 11 (61.1)** 32 (91.4)** 10 (55.6)**
2 (0.5) -0 (0) 5 (25.0)** 1 (3.1) 7 (38.9)** 3 (8.6)** 8 (44.4)**
No. of ET (%)
Pregnancy (%)
66 (100) -9 (100) 4 (100) 6 (100) 4 (57.1)** 5 (100) 6 (60.0)
26 (39.4) -3 (33.3) 1 (25) 1 (16.6) 0 (0) 1 (20) 0 (0)
* P < 0.05, **P < 0.01, Obstructive azoospermic patients, bHypospermatogenesis, ~Maturation arrest, d Sertoli cell only syndrome a
Conclusion: I t was possible to achieve n o r m a l fertilization a n d p r e g n a n c y by t e s t i c u l a r s p e r m or s p e r m a t i d s in t h e non-obstructive azoospermic patients. Therefore, in case of failed TESE, introduction of ROSI in h u m a n ART p r o g r a m will be useful m e t h o d s for t r e a t m e n t of non-obstructive azoospermic patients. But, t h e application of r o u n d s p e r m a t i d r e s u l t e d in lower fertilization a n d pregn a n c y r a t e as well as h i g h e r d e v e l o p m e n t a l a r r e s t t h a n ICSI of n o r m a l s p e r m a n d f u r t h e r r e s e a r c h will be needed for overcome t h e s e problems. P-119
Testicular Sperm Extraction (TESE) and Intracytoplasmic Sperm Injection (ICSI) for Non-obstructive Azoospermia. 1S. J. Silber, 2H. Tournaye, 2G. Verheyen, 2p. Nagy, ~P. 1Infertility C e n t e r of Louis, MO, U S A a n d U n i v e r s i t y Hospital, Brussels, Belgium.
Devroey, 2A. C. Van Steirteghem. St. Louis, St. Luke's Hospital, St. 1Centre for Reproductive Medicine, D u t c h - S p e a k i n g F r e e University,
Objectives: The discovery that azoospermic men with germinal failure often have tiny foci of intact spermatogenesis somewhere in their testes has brought hope that these men could now father a child by virtue of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). There has also been some hope expressed that early round spermatids could be found and used for ICSI in patients who have no sperm recoverable. We wish to present our results and our analysis. Method: 74 men with non-obstructive azoospermia caused by germinal failure underwent TESE-ICSI. Results were analyzed by the particular testicular pathology, by the age of the wife, and by the presence or absence of sperm or round spermatids in the testes. Results: Spermatozoa and elongated spermatids were recoverable in 46 (62%) of the 74 azoospermic couples. Neither embryo transfer rate (58%), 2PN fertilization rate (39%), cleavage rate (81%), nor the delivered pregnancy rate (23%) per initiated cycle was affected by whether the pathology was Sertoli cell "only," maturation arrest, postchemotherapy, or cryptorchid atrophy. The delivered pregnancy rate per cycle, (and the delivered pregnancy rate per cycle with sperm found) was not related to the quality or the quantity of sperm recovered. However, it was related directly to the age of the wife. The delivered pregnancy rate for all cycles in which sperm were recovered was 37%. For women under 33 years, the delivered pregnancy rate was 44%; for women 33 to 36 years, it was 33%; for women 37 to 39 years, it was 16%; there were no pregnancies in women 40 and older. In the 28 men (38%) in whom no sperm was found at TESE, round spermatids were not found, either in the TESE procedure itself, or in a subsequent examination of histologic sections. Round spermatids were never found in the absence of elongated spermatids or sperm. Conclusions: 1) The specific pathology of azoospermic germinal failure (Sertoli cell "only," mauration arrest, cryptorchidism, etc.) had no effect on the likelihood of finding sperm with TESE-ICSI or on the pregnancy rate; 2) The age of the wife did significantly affect the pregnancy rate (but not fertilization or embryo cleavage); 3) In the absence of elongated spermatids or sperm, round spermatids could not be found.
parameters included recipient's age, endometrial thickness and serum estradiol and progesterone levels on the day of oocyte retrieval, embryo grade, cumulative embryo score, number of embryos transferred, number of gestational sacs, and pregnancy outcome. All embryos were transferred two days following oocyte retrieval. Positive pregnancy was defined as the presence of a gestational sac with appropriately rising serum pHCG levels. Uterine artery velocity wave forms were analyzed for the measurement of pulsatility index [(peak systolic velocity-end diastolic velocity)/mean velocity]. Sonographic measurements were made by a single operator using an Acuson 128 with color doppler flow and 5 mHz transvaginal probe (Acuson, Mountain View, CA). Recipients with PI values > mean+ one standard deviation comprised the study group and were compared to recipients with PI values
P-120
Elevated Day 3 FSH May Predict Fetal Aneuploidy. 1A. Nasseri, 1A. B. Copperman. 1Dept of OB/GYN, Division of Reproductive Endocrinology, Mount Sinai School of Medicine, New York, NY.
U t e r i n e A r t e r y D o p p l e r V e l o c i m e t r y D o e s N o t Accur a t e l y P r e d i c t IVF O u t c o m e in a C o h o r t o f Recipients. 1A. Nasseri, 1T. Mukherjee, lB. A. Walker, 1A. B. Copperman. 1Dept of OB/GYN, Division of Reproductive Endocrinology, Mount Sinai School of Medicine, New York, NY. Objective: To determine whether elevated uterine artery pulsatility index (PI) adversely affects implantation rate and pregnancy outcome in oocyte donation cycles. Design: A retrospective cohort study. Materials and Methods: Records from 61 consecutive fresh embryo transfer cycles in patients who received unshared donor oocytes at the Mount Sinai Medical Center from June 1994 through June 1996 were reviewed. Study
P-121
Objective: To determine whether an elevated day 3 FSH in addition to predicting poor ovarian response can predict a risk for the occurrence of a karyotypically abnormal fetus. Design: A retrospective cohort study. Materials and Methods: Records from 64 consecutive patients undergoing assisted reproductive technologies at the Mount Sinai Medical Center with the diagnosis of blighted ovum or missed abortion whose products of conception were evaluated for genetic make-up from April 1989 through J a n u a r y 1997 were reviewed. Patients were divided into two groups, those with karyotypically abnorAbstracts
S149
Table 1. Fertilization, embryonic development and pregnancy rates in obstructive and non-obstructive azoospermic patients after ICSI or ROSI
OB a HYPO
b
SCO d
ICSI ROSI ICSI ROSI ICSI ROSI ICSI ROSI
No. of case
No. of MII oocytes
No. of 2PN (%)
66 -9 4 6 7 5 10
636 -110 61 56 101 64 106
480 (75.5) -83 (75.5) 20 (32.8)** 32 (57.1)** 23 (22.8)** 41 (64.1)* 18 (17.0)**
No. of Embryos
P-118 OB a
Application of ICSI or ROSI by Testicular Biopsy in Non-obstructive Azoospermia. D. R. Lee, Y. J. Lim,
HYPO b
H. S. Yoon, J. H. Lee, J . T . Seo, J. S. Jeon, H . N . Shim, J. H. Cho, S. I. Roh. I n f e r t i l i t y R e s e a r c h Center, J e i l Wornen's Hospital, Seoul, Korea.
MA~ SCO d
Objectives: F o r t h e r e is a t i n y focus of s p e r m a t o g e n e s i s in the t e s t i s of non-obstructive azoospermic p a t i e n t s , pregn a n c y can be achieved in t h e s e p a t i e n t s by t e s t i c u l a r s p e r m e x t r a c t i o n (TESE) a n d i n t r a c y t o p l a s m i c s p e r m injection (ICSI). It was also r e p o r t e d t h a t fertilization a n d p r e g n a n c y were achieved by r o u n d s p e r m a t i d injection (ROSI). The p r e s e n t s t u d y was performed in order to evalu a t e t h e presence of r o u n d s p e r m a t i d s or s p e r m a t o z o a in the t e s t i s of non-obstructive azoospermic p a t i e n t s , a n d to analyze t h e r e s u l t s of t h e i r application in t h e ART prog r a m according to t h e i r histology of testis. Design: We a n a l y z e d t h e r e s u l t s of wet p r e p a r a t i o n of t e s t i c u l a r tissues according to histology in non-obstructive azoospermic patients. Fertilization, embryonic developm e n t a n d p r e g n a n c y r a t e in these p a t i e n t s after ICSI or ROSI were c o m p a r e d w i t h t h a t of obstructive azoospermic p a t i e n t s which were k n o w n to h a v e n o r m a l s p e r m a t o genesis. M a t e r i a l s a n d Methods: T e s t i c u l a r t i s s u e s were obt a i n e d from 52 non-obstructive azoospermic p a t i e n t s by m u l t i p l e t e s t i c u l a r biopsy. Biopsied tissues were w a s h e d in PBS for removing blood a n d each seminiferous t u b u l e was isolated u n d e r stereomicroscope. S p e r m a t o g e n i c cells were squeezed out u s i n g fine forcep a n d t r a n s f e r r e d into microdrops in culture dish. We d e t e r m i n e d the existence of r o u n d s p e r m a t i d s a n d spermatozoa, a n d isolated t h e m for I C S I or ROSI. After ICSI or ROSI, fertilization of oocytes were a s s e s s e d by detection of two pronuclei a t 16 hours. E m b r y o s were t r a n s f e r r e d to u t e r u s after culture for 48 hours. Results: I n h y p o s p e r m a t o g e n e s i s p a t i e n t s (n=13) of non-obstructive azoospermia, we observed r o u n d s p e r m a tid in all cases a n d s p e r m a t o z o a in 9 cases. Round s p e r m a tid a n d s p e r m a t o z o a were observed in 13 a n d 6 cases of m a t u r a t i o n a r r e s t (n= 17) a n d in 15 a n d 5 cases of Sertoli cell only s y n d r o m e (n=22), respectively. S148
Abstracts
OBa HYPO b MA~ SCO d
ICSI ROSI ICSI ROSI ICSI ROSI ICSI ROSI
ICSI ROSI ICSI ROSI ICSI ROSI ICSI ROSI
developed (%)
arrested (%)
412 (99.5) -44 (100) 15 (75.0)** 31 (96.9) 11 (61.1)** 32 (91.4)** 10 (55.6)**
2 (0.5) -0 (0) 5 (25.0)** 1 (3.1) 7 (38.9)** 3 (8.6)** 8 (44.4)**
No. of ET (%)
Pregnancy (%)
66 (100) -9 (100) 4 (100) 6 (100) 4 (57.1)** 5 (100) 6 (60.0)
26 (39.4) -3 (33.3) 1 (25) 1 (16.6) 0 (0) 1 (20) 0 (0)
* P < 0.05, **P < 0.01, Obstructive azoospermic patients, bHypospermatogenesis, ~Maturation arrest, d Sertoli cell only syndrome a
Conclusion: I t was possible to achieve n o r m a l fertilization a n d p r e g n a n c y by t e s t i c u l a r s p e r m or s p e r m a t i d s in t h e non-obstructive azoospermic patients. Therefore, in case of failed TESE, introduction of ROSI in h u m a n ART p r o g r a m will be useful m e t h o d s for t r e a t m e n t of non-obstructive azoospermic patients. But, t h e application of r o u n d s p e r m a t i d r e s u l t e d in lower fertilization a n d pregn a n c y r a t e as well as h i g h e r d e v e l o p m e n t a l a r r e s t t h a n ICSI of n o r m a l s p e r m a n d f u r t h e r r e s e a r c h will be needed for overcome t h e s e problems. P-119
Testicular Sperm Extraction (TESE) and Intracytoplasmic Sperm Injection (ICSI) for Non-obstructive Azoospermia. 1S. J. Silber, 2H. Tournaye, 2G. Verheyen, 2p. Nagy, ~P. 1Infertility C e n t e r of Louis, MO, U S A a n d U n i v e r s i t y Hospital, Brussels, Belgium.
Devroey, 2A. C. Van Steirteghem. St. Louis, St. Luke's Hospital, St. 1Centre for Reproductive Medicine, D u t c h - S p e a k i n g F r e e University,
Objectives: The discovery that azoospermic men with germinal failure often have tiny foci of intact spermatogenesis somewhere in their testes has brought hope that these men could now father a child by virtue of testicular sperm extraction (TESE) and intracytoplasmic sperm injection (ICSI). There has also been some hope expressed that early round spermatids could be found and used for ICSI in patients who have no sperm recoverable. We wish to present our results and our analysis. Method: 74 men with non-obstructive azoospermia caused by germinal failure underwent TESE-ICSI. Results were analyzed by the particular testicular pathology, by the age of the wife, and by the presence or absence of sperm or round spermatids in the testes. Results: Spermatozoa and elongated spermatids were recoverable in 46 (62%) of the 74 azoospermic couples. Neither embryo transfer rate (58%), 2PN fertilization rate (39%), cleavage rate (81%), nor the delivered pregnancy rate (23%) per initiated cycle was affected by whether the pathology was Sertoli cell "only," maturation arrest, postchemotherapy, or cryptorchid atrophy. The delivered pregnancy rate per cycle, (and the delivered pregnancy rate per cycle with sperm found) was not related to the quality or the quantity of sperm recovered. However, it was related directly to the age of the wife. The delivered pregnancy rate for all cycles in which sperm were recovered was 37%. For women under 33 years, the delivered pregnancy rate was 44%; for women 33 to 36 years, it was 33%; for women 37 to 39 years, it was 16%; there were no pregnancies in women 40 and older. In the 28 men (38%) in whom no sperm was found at TESE, round spermatids were not found, either in the TESE procedure itself, or in a subsequent examination of histologic sections. Round spermatids were never found in the absence of elongated spermatids or sperm. Conclusions: 1) The specific pathology of azoospermic germinal failure (Sertoli cell "only," mauration arrest, cryptorchidism, etc.) had no effect on the likelihood of finding sperm with TESE-ICSI or on the pregnancy rate; 2) The age of the wife did significantly affect the pregnancy rate (but not fertilization or embryo cleavage); 3) In the absence of elongated spermatids or sperm, round spermatids could not be found.
parameters included recipient's age, endometrial thickness and serum estradiol and progesterone levels on the day of oocyte retrieval, embryo grade, cumulative embryo score, number of embryos transferred, number of gestational sacs, and pregnancy outcome. All embryos were transferred two days following oocyte retrieval. Positive pregnancy was defined as the presence of a gestational sac with appropriately rising serum pHCG levels. Uterine artery velocity wave forms were analyzed for the measurement of pulsatility index [(peak systolic velocity-end diastolic velocity)/mean velocity]. Sonographic measurements were made by a single operator using an Acuson 128 with color doppler flow and 5 mHz transvaginal probe (Acuson, Mountain View, CA). Recipients with PI values > mean+ one standard deviation comprised the study group and were compared to recipients with PI values
P-120
Elevated Day 3 FSH May Predict Fetal Aneuploidy. 1A. Nasseri, 1A. B. Copperman. 1Dept of OB/GYN, Division of Reproductive Endocrinology, Mount Sinai School of Medicine, New York, NY.
U t e r i n e A r t e r y D o p p l e r V e l o c i m e t r y D o e s N o t Accur a t e l y P r e d i c t IVF O u t c o m e in a C o h o r t o f Recipients. 1A. Nasseri, 1T. Mukherjee, lB. A. Walker, 1A. B. Copperman. 1Dept of OB/GYN, Division of Reproductive Endocrinology, Mount Sinai School of Medicine, New York, NY. Objective: To determine whether elevated uterine artery pulsatility index (PI) adversely affects implantation rate and pregnancy outcome in oocyte donation cycles. Design: A retrospective cohort study. Materials and Methods: Records from 61 consecutive fresh embryo transfer cycles in patients who received unshared donor oocytes at the Mount Sinai Medical Center from June 1994 through June 1996 were reviewed. Study
P-121
Objective: To determine whether an elevated day 3 FSH in addition to predicting poor ovarian response can predict a risk for the occurrence of a karyotypically abnormal fetus. Design: A retrospective cohort study. Materials and Methods: Records from 64 consecutive patients undergoing assisted reproductive technologies at the Mount Sinai Medical Center with the diagnosis of blighted ovum or missed abortion whose products of conception were evaluated for genetic make-up from April 1989 through J a n u a r y 1997 were reviewed. Patients were divided into two groups, those with karyotypically abnorAbstracts
S149