insemination for mild male factor infertility

total tail swelling response, and also for specific swelling patterns developed. Swelling patterns were described as those spermatozoa exhibiting maximal (⬎ 50% tail length swelling) or minimal (⬍ 50% tail length swelling) swelling of the tail region with or without associated sperm motility. Results: In the HOS solution, the most predominant patterns were maximal swelling/non-motile (increased from 37⫾6.2% at 0 min, to 54⫾8.1% after 30 min of exposure), and minimal swelling/immotile (decreased from 20.7⫾8.1% at 0 min, to 13⫾3.2% after 30 min of exposure). In the H-SSS solution, the most predominant swelling patterns were minimal swelling/ immotile (decreased from 49⫾3.7% at 0 min, to 34⫾3.4% after 30 min of exposure) and minimal swelling/motile (increased from 25.0⫾5.7% at 0 min, to 39⫾5.5% after 30 min of exposure). The tendency of the minimal swelling/non-motile pattern was to decrease during incubation, while the swelling motile pattern tended to increased with incubation. In the control sample, motility and spontaneous sperm swelling remained stable throughout the incubation period. Conclusion: The results obtained in this study provide additional evidence to support the role of protein supplementation to delay the swelling response, which permits the development of swelling patterns in a nonabrupt manner. The findings suggest that spermatozoa exhibiting the minimal tail swelling patterns are better fit for regulating their internal environment due to a higher membrane activity, which must be necessary to respond to the hypoosmotic stress as evidenced in this study. The evaluation of the behavior and the various tail swelling patterns developed may lead to improving the criteria for evaluating the swelling response, its clinical application in cases of intracytoplasmic sperm injection and its relationship to other sperm qualitative characteristics.

factor infertility, or when previous IVF treatment resulted in unexpected fertilization failure, the routine use of ICSI will maximize fertilization rates and the yield of good-quality embryos.

P-253

WITHDRAWN

P-252 Value of split intracytoplasmic sperm injection/insemination for mild male factor infertility. Michael P. Steinkampf, Karen R. Hammond, Phillip A. Kretzer. Univ of Alabama at Birmingham, Birmingham, AL. Objective: Intracytoplasmic sperm injection (ICSI) is a widely used adjunct to in vitro fertilization (IVF) for male-factor infertility when fertilization failure is suspected, but the specific sperm parameters in which ICSI should be performed are not clear. The purpose of this study was to assess the value of the allocation of some eggs to ICSI and others to conventional insemination (“split ICSI/insemination”) in IVF cycles in which semen parameters are mildly abnormal, or when complete fertilization failure has occurred in a previous IVF cycle in patients with normal semen parameters. Design: Retrospective study in an academic reproductive technology program. Materials and Methods: IVF cases performed between September 1, 1996 and March 31, 2003 in which split ICSI/insemination was performed were reviewed. During this time period, split ICSI/insemination was offered to infertile couples enrolled for IVF when the total motile sperm count was between 10 million and 20 million (“mild male factor”), or when complete fertilization failure had been encountered in a previous IVF cycle despite a normal semen analysis. Ovarian stimulation and egg retrieval were performed in the standard fashion, and oocytes were randomly assigned to either ICSI or conventional insemination, using a concentration of 105 motile sperm/mL. For each patient, rates of fertilization and cleavage, and the embryo quality on day 3 after egg retrieval were compared between the two oocyte cohorts. Results: A total of 21 split ICSI/insemination cycles were performed in women 29 to 40 years of age (mean 33.7). Eighteen cycles had been performed because of mild male factor infertility, and three cycles because of previous unexpected fertilization failure. A mean of 18.4 eggs were retrieved per patient (range 5-36). There were no differences between ICSI and insemination oocyte goups with respect to total number of eggs allocated (ICSI: 9.5, INS: 8.4; P⫽0.61) or number of mature eggs allocated (ICSI: 8.4, INS: 6.5; P⫽0.13). Fertilization occurred in both oocyte groups in 10 patients, and in the ICSI group only in 11 patients. Oocytes randomized to ICSI yielded a higher fertilization rate per mature egg (ICSI: 74.3%, INS⫽18.0%; P⬍0.0001), and the percentage of mature eggs that ultimately yielded an 8-cell embryo three days after egg retrieval was substantially higher with ICSI (ICSI⫽14.1%, INS⫽8.5%; P⫽0.036). There was no difference in the cleavage rates of fertilized eggs obtained in either group (ICSI⫽95.5%, INS⫽89.8%; P⫽0.12). Conclusion: Our data suggest that in infertile couples with mild male-

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Abstracts

P-254 Can a successful testicular sperm recovery be predicted in 47,XXY Klinefelter patients? Vale´ rie Vernaeve, Catherine Staessen, Greta Verheyen, Andre´ Van Steirteghem, Paul Devroey, Herman Tournaye. Dutchspeaking Brussels Free Univ (Vrije Univ Brussel), Brussels, Belgium. Objective: To assess the availability of predictive factors for successful sperm retrieval in 47,XXY Klinefelter patients. Design: Retrospective, consecutive case series. Materials and Methods: We performed sperm recovery procedures in 50 non-mozaic Klinefelter patients who did not receive androgen substitution therapy. The predictive power of clinical parameters such as age, largest testicular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivity index for successful testicular sperm retrieval was analyzed using the receiver operating characteristics (ROC) curve analysis. Results: In 24 out of these 50 patients (48%) testicular spermatozoa were recovered. The mean FSH and testosterone values in patients with sperm was 31.2 IU/L and 3.1 ng/ml vs. 40.4 IU/L and 3.2 ng/ml in patients without sperm. The mean testicular volume of the largest testis in patients with sperm found was 4.2 ml vs. 3.6 ml in patients with no sperm found. The best discriminating age was 31 years (sensitivity 75.0%, specificity 61.5%) with

Vol. 80, Suppl. 3, September 2003