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Pregnancy Rates (PRs) per Embryo Transfer (ET) May Be Improved by Conventional Oocyte Insemination for Male Factor Rather Than Intracytoplasmic Sperm Injection (ICSI)
Sheffield, United Kingdom; University of Sheffield, Sheffield, United Kingdom. OBJECTIVE: Our aim was to examine the efficacy of our donor insemination program which was a variation on a previously published theme, and to test the reproducibility of the suggested protocol. DESIGN: Retrospective cohort. MATERIALS AND METHODS: In 2001 we implemented a sequential step up protocol that was previously described. We audited our results in term of clinical pregnancy rate per cycle (CPR/C) in the whole population and per modality of treatment applied and cumulative clinical pregnancy rates (CCPR). We also examined the cumulative pregnancy rate in two groups of women stratified by age (⬍35 and ⱖ35). All patients underwent intrauterine insemination. The protocol included up to 3 natural cylcles, up to 3 clomiphene-stimulated cycles and up to 3 gonadotrophin-stimulated cycles. Slight variations took place upon the request of the individual patient or special circumstances such as age and ovulation status. Clinical pregnancy was diagnosed by the visualisation of fetal cardiac activity on ultrasound scan. All patients were couples with severe male factor infertility who were not suitable for ICSI treatment. RESULTS: 85 women underwent 298 cycles of donor insemination (147 natural, 122 clomiphene-stimulated and 29 gonadotrophin-stimulated cycles). The average number of cycles per patients was 3.5. The mean ⫾ SD age was 32.1 ⫾ 4 (range ⫽ 20-44 years). The overall CPR/C was 21.8%, 23.1% for natural, 21.3 for clomiphene-stimulated and 17.2 for gonadotrophin-stimulated cycles. The overall CCPR was 76.5% after 8 consecutive cycles of different treatment modalities. The CCPR was 90.9% for those ⬍35 years of age and 46.7% for those ⱖ35. CONCLUSIONS: Due to the increasing shortage of donor sperm, optimisation of this treatment modality is essential. We have adapted a previously suggested protocol and successfully optimized our success rates confirming the original hypothesis and the reproducibility of that protocol. More fine tuning of the over 35 group is required to increase the efficacy of their DI treatment. Supported by: None
P-186 Pregnancy Rates (PRs) per Embryo Transfer (ET) May Be Improved by Conventional Oocyte Insemination for Male Factor Rather Than Intracytoplasmic Sperm Injection (ICSI). B. Katsoff, J. H. Check, D. Summers-Chase, W. Yuan, D. Horwath. UMDNJ, Robert Wood Johnson Med. School, Marlton, NJ. OBJECTIVE: Prior to the advent of ICSI milder male factor problems were treated with IVF with conventional insemination of oocytes. Often rather than risk the possibility of failed fertilization, the couples chooses to attempt fertilization by ICSI so that the best sperm in the lot can be used to fertilize the egg. The aim of the present study was to retrospectively compare pregnancy outcome following conventional oocyte insemination vs. ICSI where the only reason for doing in vitro fertilization-embryo transfer (IVF-ET) was infertility related to male factor. DESIGN: Retrospective review. MATERIALS AND METHODS: All IVF cycles in women ⱕ39 years old performed for male factor exclusively during a 3 year time period were included if male factor was the only reason for performing IVF. Cases requiring testicular aspiration were excluded. The choice of ICSI or not was based on physician/embryologist suggestion but the couple’s ultimate decision. The definition of male factor included low concentration, low motility, low normal morphology, antisperm antibodies or low hypoosmotic swelling test (⬍50%). RESULTS: The large majority of cycles involved ICSI (549/578, 93.2%). The average number of embryos transferred was 3.2 for those having ICSI vs. 3.2 for no ICSI. The fertilization rates were similar (64.5% vs. 62.7%). The clinical PR (ultrasound evidence of pregnancy) was 41.5% (228/549) vs. 72.4% (21/29) (p⫽.001). The delivered PR was 36.9% (203/549) vs. 65.5% (19/29) (p⫽.004). The implantation rates were 21.7% (347/1598) vs. 38.0% (35/92) (p⬍.0001). CONCLUSIONS: Though many of the semen specimens seemed quite sufficient to fertilize the eggs by conventional means, the concept of possibility choosing the best morphologic sperm and the fear of fertilization failure influenced the vast majority of doctor/patient decisions to select ICSI. The disproportionately high PR found with conventional insemination
FERTILITY & STERILITY威
may have merely been fortuitous in view of the relatively small sample size. It is also possible that because there would be a bias for using the sperm with only the mildest abnormalities in semen parameters for conventional insemination, perhaps these data could indicate that markedly abnormal sperm produce lesser quality embryos despite normal embryo appearance. However, another possibility exists and that is that fertilizing an oocyte in the conventional manner leads to a heartier embryo than one created by ICSI. These data will now be presented to the couple and it may influence a greater proportion of doctor/patient decisions to choose conventional insemination over ICSI for milder male factor cases. Possibly these data may stimulate a well designed prospective study comparing the method of fertilization with pregnancy outcome. Supported by: None.
MALE REPRODUCTION AND UROLOGY: CLINICAL P-187 Detection of 90K/MAC-2BP in the Seminal Plasma of Infertile Males With Accessory Gland Infection and Effect of Quinolones Treatment on its Secretion. E. Caroppo, P. A. Iacovazzi, M. Correale, G. D’Amato. IRCCS S. de Bellis Reproductive Unit, Castellana Grotte (BA), Italy; IRCCS S. de Bellis, Clinical Pathology Unit, Castellana Grotte (BA), Italy; IRCCS S. de Bellis Clinical Pathology Unit, Castellana Grotte (BA), Italy. OBJECTIVE: The 90K/MAC-2BP (90K) is a glycoprotein member of the Scavenger Receptor Cystein Rich (SRCR) superfamily, originally described as a tumor-secreted antigen and subsequently found to have a role in the immune defense against cancer and other pathogens, as viruses. In particular it was found to have stimulatory activity on NK and LAK cytotoxic effector cells and to increase IL-2 secretion. 90K serum level were also found to correlate with the severity of HCV infection and to predict patients unresponsiveness to treatment. Aim of this study was to assess 90K level in the seminal plasma of infertile male patients with male accessory gland infection (MAGI) and to verify if this level can predict the efficacy of treatment with fluoroquinolones. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: We retrospectively evaluated 49 infertile male patients, referred to our center for primary infertility. Patients were diagnosed to have MAGI when two or more of the following criteria were fulfilled: presence of one or two conventional ejaculate signs, one or two coltures with significant bacteriospermia, signs of accessory gland inflammation at physical examination. Patients’ sperm parameters and seminal 90K seminal plasma level, assayed using an ELISA sandwich method, were compared to those obtained from a control group of 30 subjects with normal sperm parameters and without MAGI. Statistical analysis was made by ANOVA. Patients received levofloxacin 500 mg once a day for 2 weeks plus serratiopeptidase 10 mg/day for 4 weeks, then their sperm parameters were re-evaluated. Treatment was continued for up to six months in case of persisting bacteriospermia and/or clinical and ejaculate signs of MAGI. 90K seminal plasma level was re-evaluated at the end of treatment. Pretreatment and post-treatment 90K levels were compared by paired T test. 90K seminal plasma levels were correlated to sperm parameters by Pearson test. RESULTS: Patients exhibited 90K seminal plasma levels significantly lower with respect to controls (75.26 ⫾ 23.5 vs 91.9 ⫾ 28.4; p⬍0.001). Their sperm parameters were also impaired compared to controls. No significant correlation was found between 90K seminal plasma level and sperm parameters in patients with MAGI as well as in controls. Patients 90K seminal plasma level significantly increased after treatment (111.6 ⫾ 28.4 vs 75.26 ⫾ 23.5; p⬍0.0001). Pre-treatment 90K seminal levels were comparable in patients who responded (42.8%) or did not respond (57.1%) to treatment. Post-treatment 90K level was slightly higher in non responders, but the difference was not statistically significant (116.36 ⫾ 21 vs 104.2 ⫾ 36.5); however non responders had post-treatment 90K levels significantly increased with regards to those assayed in controls. CONCLUSIONS: 90K level is decreased in the seminal plasma of patients with MAGI, probably as expression of an altered locally immune response. 90K level seems to be not involved in the paracrine control of spermatogenesis, due to the lack of its correlation with sperm parameters. Quinolones, whose immunomodulatory effects are known, seem to be able to restore 90k seminal levels in patients with MAGI, although this effect is not alway followed by the recovery of MAGI. Further studies are required to better clarify the role of 90K in the modulation of the locally immune response.
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P-186 Pregnancy Rates (PRs) per Embryo Transfer (ET) May Be Improved by Conventional Oocyte Insemination for Male Factor Rather Than Intracytoplasmic Sperm Injection (ICSI). B. Katsoff, J. H. Check, D. Summers-Chase, W. Yuan, D. Horwath. UMDNJ, Robert Wood Johnson Med. School, Marlton, NJ. OBJECTIVE: Prior to the advent of ICSI milder male factor problems were treated with IVF with conventional insemination of oocytes. Often rather than risk the possibility of failed fertilization, the couples chooses to attempt fertilization by ICSI so that the best sperm in the lot can be used to fertilize the egg. The aim of the present study was to retrospectively compare pregnancy outcome following conventional oocyte insemination vs. ICSI where the only reason for doing in vitro fertilization-embryo transfer (IVF-ET) was infertility related to male factor. DESIGN: Retrospective review. MATERIALS AND METHODS: All IVF cycles in women ⱕ39 years old performed for male factor exclusively during a 3 year time period were included if male factor was the only reason for performing IVF. Cases requiring testicular aspiration were excluded. The choice of ICSI or not was based on physician/embryologist suggestion but the couple’s ultimate decision. The definition of male factor included low concentration, low motility, low normal morphology, antisperm antibodies or low hypoosmotic swelling test (⬍50%). RESULTS: The large majority of cycles involved ICSI (549/578, 93.2%). The average number of embryos transferred was 3.2 for those having ICSI vs. 3.2 for no ICSI. The fertilization rates were similar (64.5% vs. 62.7%). The clinical PR (ultrasound evidence of pregnancy) was 41.5% (228/549) vs. 72.4% (21/29) (p⫽.001). The delivered PR was 36.9% (203/549) vs. 65.5% (19/29) (p⫽.004). The implantation rates were 21.7% (347/1598) vs. 38.0% (35/92) (p⬍.0001). CONCLUSIONS: Though many of the semen specimens seemed quite sufficient to fertilize the eggs by conventional means, the concept of possibility choosing the best morphologic sperm and the fear of fertilization failure influenced the vast majority of doctor/patient decisions to select ICSI. The disproportionately high PR found with conventional insemination
FERTILITY & STERILITY威
may have merely been fortuitous in view of the relatively small sample size. It is also possible that because there would be a bias for using the sperm with only the mildest abnormalities in semen parameters for conventional insemination, perhaps these data could indicate that markedly abnormal sperm produce lesser quality embryos despite normal embryo appearance. However, another possibility exists and that is that fertilizing an oocyte in the conventional manner leads to a heartier embryo than one created by ICSI. These data will now be presented to the couple and it may influence a greater proportion of doctor/patient decisions to choose conventional insemination over ICSI for milder male factor cases. Possibly these data may stimulate a well designed prospective study comparing the method of fertilization with pregnancy outcome. Supported by: None.
MALE REPRODUCTION AND UROLOGY: CLINICAL P-187 Detection of 90K/MAC-2BP in the Seminal Plasma of Infertile Males With Accessory Gland Infection and Effect of Quinolones Treatment on its Secretion. E. Caroppo, P. A. Iacovazzi, M. Correale, G. D’Amato. IRCCS S. de Bellis Reproductive Unit, Castellana Grotte (BA), Italy; IRCCS S. de Bellis, Clinical Pathology Unit, Castellana Grotte (BA), Italy; IRCCS S. de Bellis Clinical Pathology Unit, Castellana Grotte (BA), Italy. OBJECTIVE: The 90K/MAC-2BP (90K) is a glycoprotein member of the Scavenger Receptor Cystein Rich (SRCR) superfamily, originally described as a tumor-secreted antigen and subsequently found to have a role in the immune defense against cancer and other pathogens, as viruses. In particular it was found to have stimulatory activity on NK and LAK cytotoxic effector cells and to increase IL-2 secretion. 90K serum level were also found to correlate with the severity of HCV infection and to predict patients unresponsiveness to treatment. Aim of this study was to assess 90K level in the seminal plasma of infertile male patients with male accessory gland infection (MAGI) and to verify if this level can predict the efficacy of treatment with fluoroquinolones. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: We retrospectively evaluated 49 infertile male patients, referred to our center for primary infertility. Patients were diagnosed to have MAGI when two or more of the following criteria were fulfilled: presence of one or two conventional ejaculate signs, one or two coltures with significant bacteriospermia, signs of accessory gland inflammation at physical examination. Patients’ sperm parameters and seminal 90K seminal plasma level, assayed using an ELISA sandwich method, were compared to those obtained from a control group of 30 subjects with normal sperm parameters and without MAGI. Statistical analysis was made by ANOVA. Patients received levofloxacin 500 mg once a day for 2 weeks plus serratiopeptidase 10 mg/day for 4 weeks, then their sperm parameters were re-evaluated. Treatment was continued for up to six months in case of persisting bacteriospermia and/or clinical and ejaculate signs of MAGI. 90K seminal plasma level was re-evaluated at the end of treatment. Pretreatment and post-treatment 90K levels were compared by paired T test. 90K seminal plasma levels were correlated to sperm parameters by Pearson test. RESULTS: Patients exhibited 90K seminal plasma levels significantly lower with respect to controls (75.26 ⫾ 23.5 vs 91.9 ⫾ 28.4; p⬍0.001). Their sperm parameters were also impaired compared to controls. No significant correlation was found between 90K seminal plasma level and sperm parameters in patients with MAGI as well as in controls. Patients 90K seminal plasma level significantly increased after treatment (111.6 ⫾ 28.4 vs 75.26 ⫾ 23.5; p⬍0.0001). Pre-treatment 90K seminal levels were comparable in patients who responded (42.8%) or did not respond (57.1%) to treatment. Post-treatment 90K level was slightly higher in non responders, but the difference was not statistically significant (116.36 ⫾ 21 vs 104.2 ⫾ 36.5); however non responders had post-treatment 90K levels significantly increased with regards to those assayed in controls. CONCLUSIONS: 90K level is decreased in the seminal plasma of patients with MAGI, probably as expression of an altered locally immune response. 90K level seems to be not involved in the paracrine control of spermatogenesis, due to the lack of its correlation with sperm parameters. Quinolones, whose immunomodulatory effects are known, seem to be able to restore 90k seminal levels in patients with MAGI, although this effect is not alway followed by the recovery of MAGI. Further studies are required to better clarify the role of 90K in the modulation of the locally immune response.
S217