Severe testicular atrophy does not affect the success of microdissection testicular sperm extraction

unchanged. F should be discontinued in subfertile men with oligospermia, & used with caution in men interested in having children. O-234 Tuesday, October 15, 2013 04:45 PM SEVERE TESTICULAR ATROPHY DOES NOT AFFECT THE SUCCESS OF MICRODISSECTION TESTICULAR SPERM EXTRACTION. R. Ramasamy, C. F. Bryson, G. D. Palermo, Z. Rosenwaks, P. N. Schlegel. Center for Reproductive Medicine, New York - Presbyterian Hospital, New York, NY. OBJECTIVE: Men with severe testicular atrophy may be counseled to avoid undergo sperm retrieval due to perceived limited success. We evaluated the outcomes of microdissection testicular sperm extraction (micro-TESE) in men with severe testicular atrophy (volume < 2 mL). DESIGN: Retrospective study. MATERIALS AND METHODS: We reviewed the records of 1127 men with nonobstructive azoospermia who underwent micro-TESE followed by intracytoplasmic sperm injection. The men were classified into three groups based on average testicular volume (mL), <2, 2-10, >10. Sperm retrieval, clinical pregnancy, and live birth rates were calculated. The clinical features evaluated included age, FSH, history of cryptorchidism, Klinefelter syndrome, varicocele, and testicular histology. RESULTS: Testicular sperm were successfully retrieved in 56% of the men. Sperm retrieval rates (SRR) in men with testicular volumes of <2, 210, and >10 mL was 55%, 56% and 55% respectively. Of those men who had sperm retrieved, clinical pregnancy and live birth rates were similar in the three groups (55%, 50%, and 47%, and 47%, 43% and 42% respectively). Of the 106 men with testis volume < 2 mL bilaterally, men who had sperm retrieved were younger (31 vs. 35 years), and were more likely to have a history of Klinefelter syndrome (82.2% vs 55.6%) compared to those in whom sperm was not found (p < 0.05). Men younger than 30 years with Klinefelter syndrome had a higher SRR (82%) compared to men older than 30 without Klinefelter syndrome (33%, p<0.01). There was no cut-point for age beyond which sperm was not retrieved in men with small testes. On multivariable analysis, younger age was the only preoperative factor associated with successful sperm retrieval in men with small testes (<2cc). CONCLUSION: Testicular volume does not affect sperm retrieval rates with micro-TESE. For men with the smallest volume testes, those younger men with Klinefelter syndrome had the highest sperm retrieval rates. Severe testicular atrophy should not be a contraindication for micro-TESE. O-235 Tuesday, October 15, 2013 05:00 PM DISCUSSING FERTILITY PRESERVATION IN ADOLESCENT MALE CANCER PATIENTS: PEDIATRIC ONCOLOGY PROVIDERS’ ATTITUDES AND APPROACHES. A. B. Fuchs,a M. L. Clayman,b T. K. Woodruff,c Y. C. Gosiengfiao,d B. A. Lockart,d R. E. Brannigan.e aNorthwestern University, Feinberg School of Medicine, Chicago, IL; bDepartment of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL; cDepartment of Obstetrics and Gynecology, Northwestern University, Feinberg School of Medicine, Chicago, IL; d Department of Pediatrics, Division of Hematology, Oncology and Transplantation, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL; eDepartment of Urology, Northwestern University, Feinberg School of Medicine, Chicago, IL. OBJECTIVE: To evaluate providers’ attitudes towards fertility preservation (FP), approach to FP discussion, and FP knowledge within adolescent male oncology care. DESIGN: Cross-sectional survey. MATERIALS AND METHODS: A forty-item online survey was distributed to US based physicians, nurse practitioners and nurses within the field of pediatric oncology. In total, 3,257 individuals were contacted via email and invited to complete the survey on Surveymonkey.com. Survey responses were coded and analyzed using SPSS. RESULTS: 326 (10%) individuals responded to the online survey. Respondents included 157 physicians, 59 nurse practitioners (NP), 54 nurses, and three others. When asked about personal comfort in discussing FP options with adolescent males, physicians and NPs reported greater comfort than nurses; 78.7% of physicians and 81.4% of NPs reported high levels of comfort compared to only 51.9% of nurses (p< .001). Similarly, 51% of physicians and 54.2% of NPs reported using educational materials usually or always when talking to patients, compared to 38.9% of nurses (p< .001). Regarding knowledge of FP technologies, 48.7% and 52.5% of physicians

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and NPs, respectively, reported being unfamiliar with intracytoplasmic sperm injection compared to 81.1% of nurses (p< .001). An overwhelming majority (93.1%) of respondents reported having no formal training in discussing FP with adolescent male patients. Finally, an overwhelming majority (84.8%) of respondents believed formal training on this issue would be useful to them. CONCLUSION: This study illustrates an unmet need in the education of pediatric oncology providers, as knowledge gaps and discomfort are common themes reported by health care professionals within the context of adolescent male FP care. Supported by: Northwestern University Medical Student Summer Research Program. O-236 Tuesday, October 15, 2013 05:15 PM IS THERE A ROLE FOR TESTICULAR SAMPLING IN NON-AZOOT. Fields,a P. N. Schlegel,b SPERMIC MEN? Q. V. Neri,a Z. Rosenwaks,a G. D. Palermo.a aReproductive Medicine - CRM, Weill Cornell Medical College, New York, NY; bUrology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY. OBJECTIVE: To test the advantage of using testicular spermatozoa in non-azoospermic men with dysfunctional male gametes. DESIGN: We identified couples who had undergone at least 1 failed ICSI cycle with dysfunctional ejaculated (EJAC) spermatozoa and underwent TESE. These couples were then grouped according to the number of spermatozoa present in their ejaculates. MATERIALS AND METHODS: Normo-oligozoospermic men with a failed ICSI cycle either for complete absence of motility, viability, anejaculation at retrieval time or with disproportionately high DFI were included. Following dedicated counseling, these men consented to undergo TESE. A total of 77 couples underwent ICSI using 162 EJAC samples and 97 TESE. RESULTS: Normozoospermic men undergoing ICSI with ejaculates had an average concentration of 36.9x106/ml, a motility of 30.2%, and 2.3% normal morphology, while the TESE cohort yielded remarkably lower density at 1.4 x106/ml (P<0.00001), motility at 4.7
7% (P<0.00001) and typical forms. Although fertilization was higher in the EJAC group at 65.5% vs 56.0% in TESE (P<0.00001), clinical pregnancy (36vs38%) and implantation rates (12vs14%) remained comparable. Once we stratified the data to couples with female partners %35yo, the clinical pregnancy rate was remarkably higher for TESE (P¼0.04). Interestingly, in men compounded by oligo-cryptozoospermia (about 70,000 spermatozoa) TESE provided a higher number at 600,000 (P<0.0001) but lower motility (P<0.0001). While fertilization (51vs49%) was not improved, TESE granted higher pregnancy (28vs40%) and embryo implantation rates (13vs25%, P<0.01). CONCLUSION: Spermatozoa isolated from seminiferous tubules of men with dysfunctional ejaculated spermatozoa did not evidence any particular advantage when a larger number of gamete in the ejaculates was available. Instead, in cases compounded by oligo-cryptozoospermia, the use of testicular spermatozoa achieved higher pregnancy rates and implantation. Supported by: Institutional. FEMALE REPRODUCTIVE SURGERY O-237 Tuesday, October 15, 2013 04:00 PM TREATMENT OF SEVERE INTRAUTERINE ADHESIONS WITH SERIAL OFFICE HYSTEROSCOPIC ADHESIOLYSIS UNDER TRANSABDOMINAL ULTRASOUND GUIDANCE-ANATOMIC, REPRODUCTIVE AND PREGNANCY OUTCOMES. B. Urman,a,b S. Aksoy,a O. Oktem,a,b C. Ayhan,a K. Yakin,a C. Alatas.a aWomen’s Health Center Assisted Reproduction Unit, American Hospital, Istanbul, Turkey; b Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey. OBJECTIVE: To analyse the anatomic, reproductive and pregnancy outcomes after treatment of severe intrauterine adhesions with serial office hysteroscopic adhesiolysis. DESIGN: A non-interventional, retrospective, single-centre cohort study. MATERIALS AND METHODS: 201 patients with moderate to severe fibromuscular adhesions involving the mid and upper parts of the uterine cavity were treated with office hysteroscopic adhesiolysis using the Versapoint Bipolar Electrosurgical System with the Twizzle electrode. A single operator

Vol. 100, No. 3, Supplement, September 2013