- Email: [email protected]
Severe male factor is affecting blastocyst rate formation in those cycles coming from standard oocytes and not from donated oocytes
benefit of Intracytoplasmic Morphologically-selected Sperm Injection (IMSI) for couples with UI and NT. DESIGN: At least 7% of spermatozoa with normal nucleus per ejaculate is the laboratory standard for normal fertile males. This threshold enabled comparison between couples with UI, who were and were not defined as NT. MATERIALS AND METHODS: Ninety UI couples with a normal andrological profile and a normal female partner (%38 years), who failed to conceive after four COH/IUI trials and at least 1 standard IVF and intracytoplasmic sperm injection (ICSI) in sibling oocytes with fertilization rate R 50% in IVF. Each of these couples was referred for further evaluation by MSOME and a single IVF-IMSI trial, were sperm selection is based on MSOME. Unvaried analysis of variance (ANOVA) for continuous variables and Chi square tests for discrete variables were used. RESULTS: Sixty five (72.2%) of the 90 males with UI were defined by MSOME as NT. The males with and without NT (n¼65 and n¼25, respectively, were statistically similar in their demographic data and morphological normalcy of the sperm cell subcellular organelles, except percentage of normal nucleus, which was significantly lower in males with NT compared to those without NT (2.62.3% vs 15.46.2%, F¼208.1, z¼7.3, p%0.01). Comparison between the two study groups in IVF-IMSI outcome parameters revealed no statistical difference between them in any of these variables except implantation and pregnancy rates, which were significantly higher in the NT group compared to those without NT (25.137.0% vs. 5.315.0%; F¼6.7; and 64.6% vs.12.0%; Chi square¼20.0, respectively, p%0.01). CONCLUSIONS: MSOME is a first rate tool for revealing a hidden male fertility factor of infertility in couples with unexplained infertility. IVF–IMSI should be considered for UI couples who have been diagnosed by MSOME to have nucleo-teratozoospermia. Supported by: None.
Tuesday, November 11, 2008 3:30 pm O-166 THE RISK OF CRYOPRESERVED SPERMATID INJECTION INTO AN ELECTRICALLY STIMULATED OOCYTE. REPRODUCTIVE HEALTH STUDY ON 189 NEW BORN BABIES. A. Tanaka, M. Nagayoshi, S. Awata, N. Himeno, I. Tanaka. Saint Mother Hospital, Kitakyushu, Japan. OBJECTIVE: To overcome the low fertilization rate following conventional intracytoplasmic spermatid injection and the need for repeated testicular biopsies, we carried out spermatid cryopreservation and electrical stimulated oocyte activation. In this report we detail the clinical health findings of 189 babies (\:_ ¼ 101:88) conceived following the use of this technique at our facility. DESIGN: Restrospective evaluation of health of babies following cryopreserved spermatid injection into electrically stimulated oocytes. MATERIALS AND METHODS: 582 non-obstructive azoospermic men whose spermatogenesis had been arrested at the early or late stage spermatid level had participated in a total of 1449 treatment cycles. Biopsied tissue was separated by enzymatic procedures. Cryopreservation: Each spermatogenic cell suspension was transferred into a tube containing cryoprotectant (1.6mol/l ethylene glycol with 0.2mol/l sucrose). After holding at 7 C for 20 min, during which time seeding was induced automatically, freezing was carried out from 7 C to 30 C at a rate of 0.3 C/min. Thawing: Each straw was exposed to air for 5 seconds and then immediately inserted into a 30 C water bath. Electrical stimulation: Oocytes were transferred to a 295mM mannitol solution containing 0.1mM of CaCl2 and 0.05mM MgCl2, and then stimulated with an alternating current of 2V/cm at 1MHz for 8s followed by a single 1.2kV/cm pulse of direct current for 99ms. Microinjection: Individual spermatids were drawn into an injection pipette and the spermatid nucleus along with a small amount of cytoplasm was injected into an ooplasm. RESULTS: 1. The pregnancy and abortion rates for early and late stage spermatids were 16.0% (117/731), 29.9% (35/117), and 20.2% (145/718), 26.2% (38/145) respectively. 2. One case of anal atresia and one case of mental retardation (early spermatid origin) were found among the 189 babies. 3. In 74 cases, cytogenetic chromosomal analysis was performed on fetal cells obtained through amniocentesis, which resulted in one paternally-inherited abnormal karyotype (late staged spermatid origin) with balanced mutual translocation. CONCLUSIONS: This method is effective for improving pregnancy success rates amongst couples where the man is a non-obstructive azoospermic
S60
Abstracts
male whose spermatogenesis had been arrested at the early or late stage spermatid level. Furthermore, we found that this technique did not increase the risk of developing unhealthy babies more than that following unassisted natural conception. Supported by: None.
Tuesday, November 11, 2008 3:45 pm O-167 ENZYMATIC ANTIOXIDANTS IN SEMEN AND FOLLICULAR FLUID OF INFERTILE COUPLES UNDERGOING ASSISTED REPRODUCTION: IS THERE A RELATIONSHIP WITH PREGNANCY? E. B. Pasqualotto, M. Salvador, T. C. S. Bonetti, D. P. A. F. Braga, E. Borges, Jr, F. F. Pasqualotto. Institute of Biotechnology, University of Caxias do Sul, Caxias do Sul, RS, Brazil; Scientific Research, Sapientiae Institute, Sa˜o Paulo, Brazil; Scientific Research, Fertility - Assisted Fertilization Center, Sa˜o Paulo, Brazil; Clinical Department, Fertility Assisted Fertilization Center, Sa˜o Paulo, Brazil. OBJECTIVE: The uncontrolled and excessive production of ROS in spermatozoa, appears to have a significant role an infertile status, the interaction between the spermatozoa and the oocytes may require certain levels of ROS. In addition, a relationship between markers of oxidative stress and both gametes is not well established. The goal of our study was to evaluate superoxide dismutase, catalase and lipid peroxidation levels in the semen, wives serum and follicular fluid of couples undergoing assisted reproduction techniques. DESIGN: Experimental study. MATERIALS AND METHODS: Two hundred and eight infertile couples underwent ICSI from January 2004 to December 2006 and accepted to participate of the study. We evaluated in the semen, wives serum and follicular fluid the levels of superoxide dismutase (SOD), catalase and lipid peroxidation (LPO) from these couples. RESULTS: The presence of SOD, Catalase and LPO levels were determined in 932 follicles from 208 patients. Of those, 781 (83.8%) were mature. Semen catalase was highly correlate with fertilization (r ¼ 0.114; p ¼ 0.013) and cleavage rates (r ¼ 0.299; p ¼ 0.001), but not with pregnancy rates (r ¼ 0.007; p ¼ 0.883). Semen SOD did not correlate with fertilization, cleavage or pregnancy rates. The mean and the standard error for SOD (4.45 1.4) and Catalase (1.7 0.28) in the follicular fluid were higher than the levels in the blood serum (3.6 0.5; p ¼ 0.04, and 1.1 0.13; p ¼ 0.03, respectively). Fertilization rate was correlate with SOD in the follicular fluid (r ¼ 0.116; p ¼ 0.010), Catalase in the follicular fluid (r ¼ 0.099; p ¼ 0.028) Catalase in the serum (r ¼ 0.121; p ¼ 0.026) and negatively correlated with follicular fluid lipid peroxidation levels (r ¼ - 0.164; p ¼ 0.001). Cleavage rates was correlated with SOD in the follicular fluid (r ¼ 0.102; p ¼ 0.028), Catalase in the follicular fluid (r ¼ 0.138; p ¼ 0.003), serum SOD levels (r ¼ 0.137; p ¼ 0.015) and negatively correlated with lipid peroxidation levels in the follicular fluid (r ¼ 0.187; p ¼ 0.001). After adjusting for age, a negative correlation was detected between the LPO levels in the blood serum (r ¼ 0.165; p ¼ 0.01) and follicular fluid (r ¼ 0.211; p ¼ 0.01) with the pregnancy rates. CONCLUSIONS: Superoxide dismutase and Catalase levels present in the follicular fluid have a good correlation with fertilization and cleavage rates. The follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy. Supported by: None.
Tuesday, November 11, 2008 4:00 pm O-168 SEVERE MALE FACTOR IS AFFECTING BLASTOCYST RATE FORMATION IN THOSE CYCLES COMING FROM STANDARD OOCYTES AND NOT FROM DONATED OOCYTES. I. Perez-Cano, N. Garrido, M. Mu~noz, E. Selles, A. Lopez-Herva´s, M. Meseguer. Clinical Embriology, IVI Alicante, Alicante, Spain; IVI Alicante, Valencia, Spain. OBJECTIVE: Contradictory data are available in the literature regarding the effects of sperm on embryo development and mainly in the blastocyst
Vol. 90, Suppl 1, September 2008
formation. Ovum donation (OD)programme offers a valuable tool in the study of male factor influence on the IVF treatment results. Our aim with this work was to determine the effect of severe male factor in the blastocyst formation rate (BR) by comparing an OD model with standard IVF cycles (SC). DESIGN: Controlled retrospective cohort study. MATERIALS AND METHODS: A total of 2467 embryos from couples (Table 1) undergoing IVF/ICSI of SC and OD cylces were evaluated for BR (Table 1). Human blastocysts were scored on day 5 (120h) according to the expansion of the blastocoel’s cavity and the number and integrity of both the inner cell mass and trophoectoderm cells. Donors and patients with PCO or endometriosis were excluded. Sperm samples used in the cycles were analyzed for basic sperm parameters and those with less than 5 million/ml of sperm cells were defined as severe male factor (SMF). A stratified test for cohorts was used to compare BR in those coming from SMF sperm and not, taking oocyte origin (OD or SD) like confusion factor. RESULTS: BR is clearly improved OR¼1.76 (CI95 1.49-2.08) and SMF is less represented OR¼0.39 (CI95 0.31-0.49) in OD compared with SC.
120h after fertilization Standard cycle SMF Non-SMF Oocyte donation SMF Non-SMF Overall SMF Non-SMF
Arrested
Morula
Blastocyst
OR
p value
50.0 % (n¼90) 22.2 %(n¼40) 27.8 %(n¼50) 41.6 %(n¼324) 17.1%(n¼133) 43.3 %(n¼321)
0.67(CI95 0.52-0.86) 0.0008
30.4 %(n¼38) 21.6 %(n¼27) 48.0 %(n¼60) 32.7 %(n¼453) 14.1%(n¼195) 53.2 %(n¼736)
0.90(CI95 0.74 -1.1) NS
41.9 %(n¼128) 21.9 %(n¼67) 36.1 %(n¼110) 0.74(CI95 0.63-0.86) 0.00003 35.9 %(n¼777) 16.0%(n¼328) 48.8 %(n¼1057)
OR¼ Odds Ratio. Following Mantel-Haenszel weighting OR of BR were 0.79 (CI95% 0.670.91) p>0.001, quite similar to overall PR underlying that the effect of SMF is affecting globally to BR being this effect more evident in SC. CONCLUSIONS: Severe male factor in conditioning a lower blastocyst rate but is partially surmount by the quality of the oocytes, those from young and fertile women are in some measure overcoming the problems caused by a deficient sperm source. A possible explanation could be found in the repairing oocyte machinery against DNA defects present in defective spermatogenesis. Supported by: None.
Tuesday, November 11, 2008 4:15 pm O-169 ANEUPLOIDY IN FIRST TRIMESTER PREGNANCY LOSS FOLLOWING IN VITRO FERTILIZATION AND INTRACYTOPLASMIC SPERM INJECTION. V. A. Kushnir, R. T. Scott, J. L. Frattarelli. Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, UMDNJ, Newark, NJ; Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, UMDNJ, Morristown. OBJECTIVE: The literature on pregnancy outcomes after intracytoplasmic sperm injection (ICSI) is limited and inconclusive concerning the risk of miscarriage and aneuploidy. ICSI bypasses natural selection mechanisms and could potentially lead to higher aneuploidy rates in embryos through both procedure dependent and independent pathways. We sought to compare the aneuploidy rate in first trimester pregnancy losses with regards to patients undergoing ICSI or conventional insemination at the time of IVF. DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: All patients undergoing IVF cycles at an academic IVF center from January 2000 to December 2006 were included. All patients had a first trimester pregnancy loss followed by evacuation of the pregnancy and karyotyping of the abortus. The main outcome measure was rate of aneuploidy following Conventional IVF (n¼159) and
FERTILITY & STERILITYÒ
ICSI (n¼196). The study population’s demographics were similar for both groups; semen parameters as expected varied significantly between the groups. RESULTS: A significant increase in fetal aneuploidy rate was noted with increasing maternal age (<30 years ¼ 26.1 % vs. 31 to 34 years. ¼ 38.2 % vs. 35 to 39 years. ¼ 51.3% vs. >39 years. ¼ 65.9 %). There was no difference in aneuploidy rates for conventional IVF vs. ICSI for each maternal age group. Overall aneuploidy rates were similar in the ICSI vs. conventional IVF group (52.6 % vs. 47.2% (p 0.31, RR 1.11, 95% CI 0.90, 1.38)). Six sex chromosome anomalies were noted in the ICSI group vs. none in the conventional IVF group. Autosomal trisomy was the most common aneuploidy in both groups. Among abortuses with normal cytogenetic results, female karyotype was found three times more frequently then male karyotype in both groups. This finding may represent predominance of maternal cells in culture or absences of products of conception in the sample. CONCLUSIONS: The aneuploidy rate in first trimester abortuses significantly increases with increasing maternal age. ICSI was not shown to significantly increase the aneuploidy rate. However, more sex chromosome anomalies were found among pregnancies resulting from ICSI. Supported by: None.
Tuesday, November 11, 2008 4:30 pm O-170 IS EXPANDED USE OF ICSI MAKING A DIFFERENCE? AN ANALYSIS OF NATIONAL SURVEILLANCE DATA, 2004-2006. G. Jeng, M. Sunderam, J. Chang, M. Macaluso. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA. OBJECTIVE: Use of intracytoplasmic sperm injection (ICSI) for IVF has increased in the U.S. since the mid 1990’s. Initially limited to the treatment of male infertility, ICSI is now also used to treat couples with female infertility only. We examine the impact of this expanded use of ICSI on ART success rates. DESIGN: Retrospective cohort study using data from CDC’s National Assisted Reproductive Technology (ART) surveillance system (NASS). MATERIALS AND METHODS: We analyzed data on IVF’s performed in 2004-2006 in U.S. Cumulative logit models were used to compare the outcomes of ICSI and non-ICSI cycles for couples with no indication of male infertility. The outcome was measured by whether or not the cycle was terminated at different stages. Indicators of poor female prognosis were adjusted for the analysis, including advanced age, previous preterm delivery, pregnancy loss, prior IVF failure, and few embryos available for transfer. RESULTS: Approximately 60% of 323,231 fresh IVF cycles (from donors and non-donors) performed in 2004-2006 used ICSI. Among those, 47% was to treat cases of male-factor infertility, 22% with no male-factor but poor female prognosis, and 31% with neither. Among couples with no male-factor infertility, after adjusting for prognostic factors and types of IVF procedures, cycles using ICSI were less likely to fail prior to transfer (odds ratio (OR):0.91, 95% confidence interval (95%CI):0.88-0.94); but more likely to result in no implantation (OR: 1.14, 95%CI: 1.12-1.16) and in pregnancy loss (OR: 1.15, 95%CI: 1.11-1.19). The odds of a live birth delivery were lower with ICSI (OR: 0.84, 95%CI: 0.83-0.86) than non-ICSI. Additional analyses were limited to women with previous IVF without ICSI, whose cycles were terminated prior to transfer. Success rates for this group were not higher in the next cycle with ICSI than without (data not shown). Couples with no male-factor infertility were more likely to use ICSI if treatment costs were covered by their insurance program (OR: 1.46, 95%CI: 1.42-1.49). CONCLUSIONS: Treatment of couples with solely female factor infertility accounted for only a portion of increased use of ICSI-IVF cycles in recent years. The data suggest no benefit for use of ICSI for this group of women. Limitations of the NASS data include the inaccuracy of diagnoses reported, and lack of detailed information on male-factor diagnosis. Despite these limitations, it seems unlikely that expanded use of ICSI, as currently practiced in the U.S., has improved ART success rates. Supported by: CDC.
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Tuesday, November 11, 2008 3:30 pm O-166 THE RISK OF CRYOPRESERVED SPERMATID INJECTION INTO AN ELECTRICALLY STIMULATED OOCYTE. REPRODUCTIVE HEALTH STUDY ON 189 NEW BORN BABIES. A. Tanaka, M. Nagayoshi, S. Awata, N. Himeno, I. Tanaka. Saint Mother Hospital, Kitakyushu, Japan. OBJECTIVE: To overcome the low fertilization rate following conventional intracytoplasmic spermatid injection and the need for repeated testicular biopsies, we carried out spermatid cryopreservation and electrical stimulated oocyte activation. In this report we detail the clinical health findings of 189 babies (\:_ ¼ 101:88) conceived following the use of this technique at our facility. DESIGN: Restrospective evaluation of health of babies following cryopreserved spermatid injection into electrically stimulated oocytes. MATERIALS AND METHODS: 582 non-obstructive azoospermic men whose spermatogenesis had been arrested at the early or late stage spermatid level had participated in a total of 1449 treatment cycles. Biopsied tissue was separated by enzymatic procedures. Cryopreservation: Each spermatogenic cell suspension was transferred into a tube containing cryoprotectant (1.6mol/l ethylene glycol with 0.2mol/l sucrose). After holding at 7 C for 20 min, during which time seeding was induced automatically, freezing was carried out from 7 C to 30 C at a rate of 0.3 C/min. Thawing: Each straw was exposed to air for 5 seconds and then immediately inserted into a 30 C water bath. Electrical stimulation: Oocytes were transferred to a 295mM mannitol solution containing 0.1mM of CaCl2 and 0.05mM MgCl2, and then stimulated with an alternating current of 2V/cm at 1MHz for 8s followed by a single 1.2kV/cm pulse of direct current for 99ms. Microinjection: Individual spermatids were drawn into an injection pipette and the spermatid nucleus along with a small amount of cytoplasm was injected into an ooplasm. RESULTS: 1. The pregnancy and abortion rates for early and late stage spermatids were 16.0% (117/731), 29.9% (35/117), and 20.2% (145/718), 26.2% (38/145) respectively. 2. One case of anal atresia and one case of mental retardation (early spermatid origin) were found among the 189 babies. 3. In 74 cases, cytogenetic chromosomal analysis was performed on fetal cells obtained through amniocentesis, which resulted in one paternally-inherited abnormal karyotype (late staged spermatid origin) with balanced mutual translocation. CONCLUSIONS: This method is effective for improving pregnancy success rates amongst couples where the man is a non-obstructive azoospermic
S60
Abstracts
male whose spermatogenesis had been arrested at the early or late stage spermatid level. Furthermore, we found that this technique did not increase the risk of developing unhealthy babies more than that following unassisted natural conception. Supported by: None.
Tuesday, November 11, 2008 3:45 pm O-167 ENZYMATIC ANTIOXIDANTS IN SEMEN AND FOLLICULAR FLUID OF INFERTILE COUPLES UNDERGOING ASSISTED REPRODUCTION: IS THERE A RELATIONSHIP WITH PREGNANCY? E. B. Pasqualotto, M. Salvador, T. C. S. Bonetti, D. P. A. F. Braga, E. Borges, Jr, F. F. Pasqualotto. Institute of Biotechnology, University of Caxias do Sul, Caxias do Sul, RS, Brazil; Scientific Research, Sapientiae Institute, Sa˜o Paulo, Brazil; Scientific Research, Fertility - Assisted Fertilization Center, Sa˜o Paulo, Brazil; Clinical Department, Fertility Assisted Fertilization Center, Sa˜o Paulo, Brazil. OBJECTIVE: The uncontrolled and excessive production of ROS in spermatozoa, appears to have a significant role an infertile status, the interaction between the spermatozoa and the oocytes may require certain levels of ROS. In addition, a relationship between markers of oxidative stress and both gametes is not well established. The goal of our study was to evaluate superoxide dismutase, catalase and lipid peroxidation levels in the semen, wives serum and follicular fluid of couples undergoing assisted reproduction techniques. DESIGN: Experimental study. MATERIALS AND METHODS: Two hundred and eight infertile couples underwent ICSI from January 2004 to December 2006 and accepted to participate of the study. We evaluated in the semen, wives serum and follicular fluid the levels of superoxide dismutase (SOD), catalase and lipid peroxidation (LPO) from these couples. RESULTS: The presence of SOD, Catalase and LPO levels were determined in 932 follicles from 208 patients. Of those, 781 (83.8%) were mature. Semen catalase was highly correlate with fertilization (r ¼ 0.114; p ¼ 0.013) and cleavage rates (r ¼ 0.299; p ¼ 0.001), but not with pregnancy rates (r ¼ 0.007; p ¼ 0.883). Semen SOD did not correlate with fertilization, cleavage or pregnancy rates. The mean and the standard error for SOD (4.45 1.4) and Catalase (1.7 0.28) in the follicular fluid were higher than the levels in the blood serum (3.6 0.5; p ¼ 0.04, and 1.1 0.13; p ¼ 0.03, respectively). Fertilization rate was correlate with SOD in the follicular fluid (r ¼ 0.116; p ¼ 0.010), Catalase in the follicular fluid (r ¼ 0.099; p ¼ 0.028) Catalase in the serum (r ¼ 0.121; p ¼ 0.026) and negatively correlated with follicular fluid lipid peroxidation levels (r ¼ - 0.164; p ¼ 0.001). Cleavage rates was correlated with SOD in the follicular fluid (r ¼ 0.102; p ¼ 0.028), Catalase in the follicular fluid (r ¼ 0.138; p ¼ 0.003), serum SOD levels (r ¼ 0.137; p ¼ 0.015) and negatively correlated with lipid peroxidation levels in the follicular fluid (r ¼ 0.187; p ¼ 0.001). After adjusting for age, a negative correlation was detected between the LPO levels in the blood serum (r ¼ 0.165; p ¼ 0.01) and follicular fluid (r ¼ 0.211; p ¼ 0.01) with the pregnancy rates. CONCLUSIONS: Superoxide dismutase and Catalase levels present in the follicular fluid have a good correlation with fertilization and cleavage rates. The follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy. Supported by: None.
Tuesday, November 11, 2008 4:00 pm O-168 SEVERE MALE FACTOR IS AFFECTING BLASTOCYST RATE FORMATION IN THOSE CYCLES COMING FROM STANDARD OOCYTES AND NOT FROM DONATED OOCYTES. I. Perez-Cano, N. Garrido, M. Mu~noz, E. Selles, A. Lopez-Herva´s, M. Meseguer. Clinical Embriology, IVI Alicante, Alicante, Spain; IVI Alicante, Valencia, Spain. OBJECTIVE: Contradictory data are available in the literature regarding the effects of sperm on embryo development and mainly in the blastocyst
Vol. 90, Suppl 1, September 2008
formation. Ovum donation (OD)programme offers a valuable tool in the study of male factor influence on the IVF treatment results. Our aim with this work was to determine the effect of severe male factor in the blastocyst formation rate (BR) by comparing an OD model with standard IVF cycles (SC). DESIGN: Controlled retrospective cohort study. MATERIALS AND METHODS: A total of 2467 embryos from couples (Table 1) undergoing IVF/ICSI of SC and OD cylces were evaluated for BR (Table 1). Human blastocysts were scored on day 5 (120h) according to the expansion of the blastocoel’s cavity and the number and integrity of both the inner cell mass and trophoectoderm cells. Donors and patients with PCO or endometriosis were excluded. Sperm samples used in the cycles were analyzed for basic sperm parameters and those with less than 5 million/ml of sperm cells were defined as severe male factor (SMF). A stratified test for cohorts was used to compare BR in those coming from SMF sperm and not, taking oocyte origin (OD or SD) like confusion factor. RESULTS: BR is clearly improved OR¼1.76 (CI95 1.49-2.08) and SMF is less represented OR¼0.39 (CI95 0.31-0.49) in OD compared with SC.
120h after fertilization Standard cycle SMF Non-SMF Oocyte donation SMF Non-SMF Overall SMF Non-SMF
Arrested
Morula
Blastocyst
OR
p value
50.0 % (n¼90) 22.2 %(n¼40) 27.8 %(n¼50) 41.6 %(n¼324) 17.1%(n¼133) 43.3 %(n¼321)
0.67(CI95 0.52-0.86) 0.0008
30.4 %(n¼38) 21.6 %(n¼27) 48.0 %(n¼60) 32.7 %(n¼453) 14.1%(n¼195) 53.2 %(n¼736)
0.90(CI95 0.74 -1.1) NS
41.9 %(n¼128) 21.9 %(n¼67) 36.1 %(n¼110) 0.74(CI95 0.63-0.86) 0.00003 35.9 %(n¼777) 16.0%(n¼328) 48.8 %(n¼1057)
OR¼ Odds Ratio. Following Mantel-Haenszel weighting OR of BR were 0.79 (CI95% 0.670.91) p>0.001, quite similar to overall PR underlying that the effect of SMF is affecting globally to BR being this effect more evident in SC. CONCLUSIONS: Severe male factor in conditioning a lower blastocyst rate but is partially surmount by the quality of the oocytes, those from young and fertile women are in some measure overcoming the problems caused by a deficient sperm source. A possible explanation could be found in the repairing oocyte machinery against DNA defects present in defective spermatogenesis. Supported by: None.
Tuesday, November 11, 2008 4:15 pm O-169 ANEUPLOIDY IN FIRST TRIMESTER PREGNANCY LOSS FOLLOWING IN VITRO FERTILIZATION AND INTRACYTOPLASMIC SPERM INJECTION. V. A. Kushnir, R. T. Scott, J. L. Frattarelli. Obstetrics, Gynecology and Women’s Health, New Jersey Medical School, UMDNJ, Newark, NJ; Obstetrics, Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School, UMDNJ, Morristown. OBJECTIVE: The literature on pregnancy outcomes after intracytoplasmic sperm injection (ICSI) is limited and inconclusive concerning the risk of miscarriage and aneuploidy. ICSI bypasses natural selection mechanisms and could potentially lead to higher aneuploidy rates in embryos through both procedure dependent and independent pathways. We sought to compare the aneuploidy rate in first trimester pregnancy losses with regards to patients undergoing ICSI or conventional insemination at the time of IVF. DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: All patients undergoing IVF cycles at an academic IVF center from January 2000 to December 2006 were included. All patients had a first trimester pregnancy loss followed by evacuation of the pregnancy and karyotyping of the abortus. The main outcome measure was rate of aneuploidy following Conventional IVF (n¼159) and
FERTILITY & STERILITYÒ
ICSI (n¼196). The study population’s demographics were similar for both groups; semen parameters as expected varied significantly between the groups. RESULTS: A significant increase in fetal aneuploidy rate was noted with increasing maternal age (<30 years ¼ 26.1 % vs. 31 to 34 years. ¼ 38.2 % vs. 35 to 39 years. ¼ 51.3% vs. >39 years. ¼ 65.9 %). There was no difference in aneuploidy rates for conventional IVF vs. ICSI for each maternal age group. Overall aneuploidy rates were similar in the ICSI vs. conventional IVF group (52.6 % vs. 47.2% (p 0.31, RR 1.11, 95% CI 0.90, 1.38)). Six sex chromosome anomalies were noted in the ICSI group vs. none in the conventional IVF group. Autosomal trisomy was the most common aneuploidy in both groups. Among abortuses with normal cytogenetic results, female karyotype was found three times more frequently then male karyotype in both groups. This finding may represent predominance of maternal cells in culture or absences of products of conception in the sample. CONCLUSIONS: The aneuploidy rate in first trimester abortuses significantly increases with increasing maternal age. ICSI was not shown to significantly increase the aneuploidy rate. However, more sex chromosome anomalies were found among pregnancies resulting from ICSI. Supported by: None.
Tuesday, November 11, 2008 4:30 pm O-170 IS EXPANDED USE OF ICSI MAKING A DIFFERENCE? AN ANALYSIS OF NATIONAL SURVEILLANCE DATA, 2004-2006. G. Jeng, M. Sunderam, J. Chang, M. Macaluso. Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA. OBJECTIVE: Use of intracytoplasmic sperm injection (ICSI) for IVF has increased in the U.S. since the mid 1990’s. Initially limited to the treatment of male infertility, ICSI is now also used to treat couples with female infertility only. We examine the impact of this expanded use of ICSI on ART success rates. DESIGN: Retrospective cohort study using data from CDC’s National Assisted Reproductive Technology (ART) surveillance system (NASS). MATERIALS AND METHODS: We analyzed data on IVF’s performed in 2004-2006 in U.S. Cumulative logit models were used to compare the outcomes of ICSI and non-ICSI cycles for couples with no indication of male infertility. The outcome was measured by whether or not the cycle was terminated at different stages. Indicators of poor female prognosis were adjusted for the analysis, including advanced age, previous preterm delivery, pregnancy loss, prior IVF failure, and few embryos available for transfer. RESULTS: Approximately 60% of 323,231 fresh IVF cycles (from donors and non-donors) performed in 2004-2006 used ICSI. Among those, 47% was to treat cases of male-factor infertility, 22% with no male-factor but poor female prognosis, and 31% with neither. Among couples with no male-factor infertility, after adjusting for prognostic factors and types of IVF procedures, cycles using ICSI were less likely to fail prior to transfer (odds ratio (OR):0.91, 95% confidence interval (95%CI):0.88-0.94); but more likely to result in no implantation (OR: 1.14, 95%CI: 1.12-1.16) and in pregnancy loss (OR: 1.15, 95%CI: 1.11-1.19). The odds of a live birth delivery were lower with ICSI (OR: 0.84, 95%CI: 0.83-0.86) than non-ICSI. Additional analyses were limited to women with previous IVF without ICSI, whose cycles were terminated prior to transfer. Success rates for this group were not higher in the next cycle with ICSI than without (data not shown). Couples with no male-factor infertility were more likely to use ICSI if treatment costs were covered by their insurance program (OR: 1.46, 95%CI: 1.42-1.49). CONCLUSIONS: Treatment of couples with solely female factor infertility accounted for only a portion of increased use of ICSI-IVF cycles in recent years. The data suggest no benefit for use of ICSI for this group of women. Limitations of the NASS data include the inaccuracy of diagnoses reported, and lack of detailed information on male-factor diagnosis. Despite these limitations, it seems unlikely that expanded use of ICSI, as currently practiced in the U.S., has improved ART success rates. Supported by: CDC.
S61