Use of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with cryptozoospermia: a meta-analysis

Table 1.

Age FSH LH E2 PRL FOL INY FERT

Group 1

Group 2

P

33.7
2.3 6.1
1.3 6.0
3.9 33.1
16.2 19.5
10.4 14.3
8.2 9.6
7.5 5.0
3.9

29.4
4.8 6.4
2.2 6.4
2.2 44.6
25.4 28.2
11.2 10.4
4.6 9.2
5.3 4.6
3.0

0.004 NS NS NS NS NS NS NS

P-406 Wednesday, October 21, 2015 EJACULATED SPERM MAY NOT RESULT IN THE BEST CLINICAL OUTCOME FOR ICSI TREATMENT CYCLES. Y. Lin,a L. Cai,b J. Dong,b J. Liu,c R. Chian.d areproduction medicine, nanjing, China; bThe First Affiliated Hospital of Nanjing Medical U, Nanjing, China; c the First Affiliated Hospital of Nanjing Medical U, Nanjing, China; dMcGill University, Montreal, QC, Canada. OBJECTIVE: To evaluate the impact of different sperm sources on fertilization, embryo quality, clinical pregnancy and implantation rates in intracytoplasmic sperm injection (ICSI) treatment cycles. DESIGN: A retrospective analysis was performed in 1,263 patients undergoing ICSI treatment cycles in our center from January 2012 to March 2014. MATERIALS AND METHODS: The patients were classified into 4 groups based on the sources of sperm obtained, namely fresh ejaculated semen, (n¼950), fresh testicular sperm aspiration (TESA) (n¼12), fresh percutaneous epididymal sperm aspiration (PESA) (n¼204), and frozen PESA sperm (n¼97). Fertilization, high-quality embryo, implantation, clinical pregnancy and live birth rates in the fresh embryo transferred cycle were compared among the groups. RESULTS: There were no differences in the fertilization rates among four groups (74.4%, 75.6%, 75.1% and 74.7%, respectively). The patients with fresh TESA sperm and frozen PESA sperm showed significantly higher high-quality embryo rates (75.4 % and 73.9 %) than those of fresh ejaculated semen (63.8%) and fresh PESA sperm (66.3%) groups (P<0.05). The implantation rates with fresh TESA sperm (50.0 %) and fresh PESA sperm (36.3%) were significantly higher than those of fresh ejaculated semen (29.8%). The clinical pregnancy and live birth rates with fresh PESA sperm (50.0%, 45.1%) were significantly higher than those of fresh ejaculated semen (42.8%, 36.7%) group (P<0.05). CONCLUSIONS: Although the different sources of sperm seem do not affect the fertilization rates in ICSI treatment cycles, the sperm obtained from fresh PESA may associate with higher implantation rates, resulting in better clinical pregnancy and live birth outcomes than those of fresh ejaculated semen.

P-407 Wednesday, October 21, 2015 LONG TERM PROGNOSIS OF CHILDREN BORN THROUGH ASSISTED REPRODUCTIVE TECHNOLOGIES IN JAPAN. J. Kojima,a,b K. Suzuki,c H. Shimada,a E. Hasegawa,a H. Ito,a N. Kuji,a A. Tanaka,d T. Utsunomiya,e H. Akutsu,b A. Umezawa,b Z. Yamagata,c K. Isaka.a aTokyo Medical University, Tokyo, Japan; bNational Research Institute for Child Health and Development, Tokyo, Japan; c University of Yamanashi, Yamanashi, Japan; dSt. Mother Hospital, Fukuoka, Japan; eSt. Luke Clinic, Oita, Japan. OBJECTIVE: Previous reports suggested that the birth weights of children born from FET were significantly higher from those of naturally conceived children, but those difference disappeared by the age of 18 months. Developmental scores are supposed to be similar between children born from ART and those naturally conceived.The aim of this study is to ascertain any difference in body growth and psychomotor development up to 18 months in children born via assisted reproductive technology (ART) compared with natural conceptions in Japan, a racially homogeneous country. DESIGN: Multicenter retrospective cohort study. MATERIALS AND METHODS: Eight hundred forty-nine singleton children born from fresh embryo transfer (FreET), 1325 from FET, 612 from infertility treatment other than ART (INF) and 542 spontane-

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ASRM Abstracts

ously conceived children (SC) were recruited between 1 October 2008 and 30 November 2009. All of the embryo freezing was performed by vitrification. In a voluntary setting, the parents of these children answered a structured mailed questionnaire concerning body growth and developmental status. The precise ART treatment records of each child were matched with data from the Japanese ART register. Developmental status was measured by the parents using the KIDS developmental scoring system. RESULTS: Birth weights of singleton children conceived by FreET, FET, INF and SC were 3017, 3071, 2975 and 2998 g and after 18 month, 10451, 10461, 10266 and 10356 g, respectively. Although the birth weight of FET singleton babies was significantly heavier than that of NC and INF babies at birth (P < 0.001), none of the treatment modalities (ovarian stimulation, IVF or ICSI) had any relationship with this difference. Those differences disappeared at 18 months of age, after adjusting for sex, BMI at birth and birth order. Congenital malformations were not recognized in 67% at birth, then recognized by 18 months. The development score was significantly superior in children conceived by FreET, FET and INF compared with SC children (P < 0.005). CONCLUSIONS: The birth weights of singleton children born from frozen embryo transfer (FET), which were significantly heavier, became similar at the age of 18 months. Developmental scores were not inferior among the ART children at the age of 18 months, compared with those of naturally conceived children. Supported by: Health Labour Sciences Research Grant (Grant Nos. H22jisedai-004) from the Ministry of Health, Labour and Welfare, Japan.

P-408 Wednesday, October 21, 2015 USE OF TESTICULAR VERSUS EJACULATED SPERM FOR INTRACYTOPLASMIC SPERM INJECTION AMONG MEN WITH CRYPTOZOOSPERMIA: A META-ANALYSIS. M. Kathrins,a M. Shapiro,a Y. Kobori,b C. Niederberger.b aUrology, University of Illinois at Chicago, Chicago, IL; bUniversity of Illinois at Chicago, Chicago, IL. OBJECTIVE: The question of whether or not to proceed with intracytoplasmic sperm injection (ICSI) using ejaculated or testicular sperm among men with cryptozoospermia remains unanswered. Our aim was to examine the relationship between sperm source in men with cryptozoospermia–ejaculated versus testicular–and ICSI outcomes. DESIGN: Meta-analysis. MATERIALS AND METHODS: A systematic search was performed in PubMed (inception to March 2015). Search terms included variations on: ‘cryptozoospermia’, ‘severe oligozoospermia’, ‘oligo-astheno-teratozoospermia’, ‘ejaculated’, and ‘testicular’. Inclusion criteria included human studies comparing ICSI outcomes among men with cryptozoospermia who underwent consecutive ICSI cycles using either testicular or ejaculated sperm. Primary outcomes included fertilization rate or pregnancy rate. The secondary outcome was maternal age at time of ICSI. Meta-analysis of weighted data was performed using RevMan 5.3 and a random effects model was employed, due to clinical heterogeneity among the studies. Results are reported as odds ratio (OR) or weighted mean differences (WMD) with 95% confidence interval. RESULTS: A total of 773 studies were identified, of which five cohort studies were included for analysis.(1-5) The included studies examined either pregnancy or fertilization rates, encompassing 272 ICSI cycles and 2547 injected oocytes, respectively. There were no differences in the ICSI pregnancy rates (OR 0.44, 95% CI: 0.12-1.64, p¼0.22, I2¼69%) or fertilization rates (OR 0.84, 95% CI: 0.63-1.11, p¼0.22, I2¼69%). A non-significant trend toward increasing maternal age at the time of ICSI with testicular sperm was noted (WMD 3.03, 95% CI: -.04-6.09). Posthoc power analysis revealed pb <20% for pregnancy rate analysis and pb<10% for fertilization rate analysis. Thus, the risk of Type II error was low. CONCLUSIONS: Among men with cryptozoospermia, the use of testicular sperm was shown to have no advantage in regard to ICSI fertilization or pregnancy rates as compared to ejaculated sperm. Thus, men should be encouraged to proceed with ICSI cycles using ejaculated sperm preferentially over invasive surgically-extracted testicular sperm. References: 1. Amirjannati N, Heidari-Vala H, Akhondi MA, et al. Comparison of intracytoplasmic sperm injection outcomes between spermatozoa retrieved from testicular biopsy and from ejaculation in cryptozoospermic men. Andrologia 2012;44 Suppl 1(2):704-9.

Vol. 104, No. 3, Supplement, September 2015

2. Ben-Ami I, Raziel A, Strassburger D, Komarovsky D, Ron-El R, Friedler S. Intracytoplasmic sperm injection outcome of ejaculated versus extracted testicular spermatozoa in cryptozoospermic men. Fertil. Steril. 2013;99(7):1867-71. 3. Bendikson KA, Neri Q V, Takeuchi T, et al. The outcome of intracytoplasmic sperm injection using occasional spermatozoa in the ejaculate of men with spermatogenic failure. J. Urol. 2008;180(3):1060-4. 4. Hauser R, Bibi G, Yogev L, et al. Virtual Azoospermia and Cryptozoospermia–Fresh/Frozen Testicular or Ejaculate Sperm for Better IVF Outcome? J. Androl. 2011;32(5):484-490. 5. Weissman A, Horowitz E, Ravhon A, Nahum H, Golan A, Levran D. Pregnancies and live births following ICSI with testicular spermatozoa after repeated implantation failure using ejaculated spermatozoa. Reprod. Biomed. Online 2008;17(5):605-609.

P-409 Wednesday, October 21, 2015 ARE OBESE MEN SUBFERTILE? S. Alshahrani. Prince Sattam University, Alkharj, Saudi Arabia. OBJECTIVE: Although it is well known that overweight and obesity can affect female fertility, in men the negative effects on reproductive system attributed to obesity are less evident and have been less often studied. The aim of this study is to evaluate the effect of Body Mass Index (BMI) on different semen parameters. DESIGN: prospective study. MATERIALS AND METHODS: After IRB approval, semen samples from 439 male partners of couples presenting for evaluation of their infertility, in the period from 2013-2014, were collected. Men were divided into three BMI groups; normal , overweight and obese. Meticulous scrotal examination plus scrotal ultrasound were performed. Hormonal profile, including testosterone, FSH, LH and prolactin was done to exclude any possible causative hormonal factor. RESULTS: Mean BMI was 29.67
5.89. ANOVA testing revealed no significant differences in semen parameters between the 3 different BMI groups. Also, pair-wise multiple comparisons were found to be non-significant (P > 0.05). The distribution of patients with normal sperm concentration per BMI group was as follows: normal weight, 46/75 (61.33%); overweight, 114/179 (63.69%); and obese, 116/185 (62.70%). BMI had a negative correlation with semen volume, sperm concentration, sperm motility and sperm morphology. However, this correlation reached a significant level only between BMI and sperm concentration (r¼0.101; p¼0.035). CONCLUSIONS: Although found to have no significant relation with semen volume, sperm motility or sperm morphology; BMI was proved, in our study, to have a significant effect on sperm concentration. The effect of BMI on semen parameters. Parameters

Total patients Normal BMI Over weight

Number (%) BMI Age (y) Volume (ml) Concentration (mil/ml) Actively motile sperm (%) Normal morphology (%)

439 (100) 29.67
5.89 36.85
6.73 3.07
1.49 41.46
50.96 44.53
19.54 3.21
2.95

75 (17.08) 23.05
1.34 35.64
6.56 3.12
1.42 44.64
57.25 46.00
18.50 3.20
2.92

179 (40.77) 27.06
1.41 36.83
6.82 3.18
1.47 41.32
48.96 44.11
20.46 3.24
3.02

Obese

p-value

185 (42.14) 34.88
5.31 37.37
6.69 2.94
1.53 40.30
50.40 44.35
19.10 3.15
2.91

˂0.001 0.173 0.297 0.824 0.770 0.957

P-410 Wednesday, October 21, 2015 INDEPENDENT PREDICTORS OF INTRAUTERINE INSEMINATION (IUI) SUCCESS. R. D. Kasturya G. S. Taliadouros.b aObstetrics and Gynecology, Inspira Health Network, Vineland, NJ; bReproductive Endocrinology and Infertility, Inspira Health Network, Vineland, NJ. OBJECTIVE: Various causes of infertility are treated with intrauterine insemination (IUI). Many factors affect IUI outcomes. Previously published studies have provided conflicting results regarding the independent predictors for the success of this treatment (1). In this study, we aim to evaluate these predictors in a well-defined patient population. DESIGN: A retrospective study. MATERIALS AND METHODS: Our analysis evaluated 509 couples, between ages 24 and 44, that underwent infertility assessment and subsequent intrauterine insemination. Fresh partner’s semen was processed through a

FERTILITY & STERILITYÒ

50%/90% discontinuous gradient and one IUI was performed at the time of ovulation, confirmed by ultrasonography and laboratory values. Females with tubal factor infertility and patients with severe male factor infertility were excluded. All other major medical concerns were addressed prior to initiating treatment. Anti-estrogen and gonadotropins were used to address ovulatory aberrations. The primary outcome measure was the occurrence of pregnancy. Univariate (EXPAND) and multivariate logistic regression analyses were used. The strength of association between pregnancy and each independent predictor is presented as an odds ratio (OR) with confidence interval (CI). All statistical tests used a two-tailed alpha of 0.05. RESULTS: Univariate analysis shows that motile sperm count in the unprocessed semen (OR ¼ 0.0023, CI ¼ 0.0010 - 0.0037, p ¼ 0.0005) and total motile sperm inseminated (OR ¼ 0.0064, CI ¼ 0.0029 - 0.0098, p ¼ 0.0003) were significant factors associated with the occurrence of pregnancy. Sperm morphology performed using Kruger’s strict criteria, did not have statistical significance on the occurrence of pregnancy. The age of female was extremely predictive of pregnancy occurrence (OR ¼ -0.047, CI ¼ -0.0792 to -0.0149, p ¼ 0.0041) and the type of ovarian stimulation, gonadotropins, also proved to be statistically significant in predicting a positive outcome (OR ¼ -0.3257, CI ¼ -0.6256 to -0.0248, p ¼ 0.0339). Multivariate analysis demonstrated that female age and number of motile sperm in the ejaculate are the strongest predictors of pregnancy, p ¼ 0.0009 & 0.0007 respectively. Gonadotropin stimulation increased the chance of achieving pregnancy by 30%. CONCLUSIONS: Our results indicate that the total number of motile sperm in the ejaculate is a significant predictor for pregnancy occurrence. As expected, the increased number of oocytes available during controlled ovarian stimulation will have an additive effect on the results. It has been widely accepted that female age has an impact on fecundity. These findings corroborate previously reported data, which can be used to advise future couples on the likelihood of achieving pregnancy and guide physicians with appropriate treatment selection. Reference: 1. Ombelet W, Dhont N, Thijssen A, Bosmans E, Kruger T. Semen quality and prediction of IUI success in male subfertility: a systematic review. Reprod Biomed Online. 2014;28:300-309. P-411 Wednesday, October 21, 2015 IS IT NECESSARY TO DO INTRACYTOPLASMIC SPERM INJECTION ON PATIENTS WITH ABNORMAL SPERM DNA FRAGMENTATION VALUE IN ART? S. M. Kang, J. H. Kim, Y. J. Lee. I-Dream Center, Mizmedi Women’s Hospital, Seoul, Korea, Republic of. OBJECTIVE: The purpose of this study is to evaluate how effective intracytoplasmic sperm injection (ICSI) could be in the pregnancy outcome of patients with DNA-fragmented sperm by comparison to conventional in vitro fertilization (IVF). DESIGN: A retrospective clinical study. MATERIALS AND METHODS: According to standard protocol, 137 (ICSI and IVF) cycles that were performed with at least 5 retrieved eggs, normal count and motility of sperms (the World Health Organization criteria) at each cycle were retrospectively analyzed. Sperms that were used in this study were classified into three groups depending on the sperm DNA fragmentation (SDF) value (by Halosperm kit) as follows: Abnormal, SDF>30%; Sub-normal, 15%
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