Can a successful testicular sperm recovery be predicted in 47,XXY klinefelter patients?

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  • total tail swelling response, and also for specific swelling patterns devel-oped. Swelling patterns were described as those spermatozoa exhibitingmaximal ( 50% tail length swelling) or minimal ( 50% tail lengthswelling) swelling of the tail region with or without associated spermmotility.

    Results: In the HOS solution, the most predominant patterns were max-imal swelling/non-motile (increased from 376.2% at 0 min, to 548.1%after 30 min of exposure), and minimal swelling/immotile (decreased from20.78.1% at 0 min, to 133.2% after 30 min of exposure). In the H-SSSsolution, the most predominant swelling patterns were minimal swelling/immotile (decreased from 493.7% at 0 min, to 343.4% after 30 min ofexposure) and minimal swelling/motile (increased from 25.05.7% at 0min, to 395.5% after 30 min of exposure). The tendency of the minimalswelling/non-motile pattern was to decrease during incubation, while theswelling motile pattern tended to increased with incubation. In the controlsample, motility and spontaneous sperm swelling remained stable through-out the incubation period.

    Conclusion: The results obtained in this study provide additional evi-dence to support the role of protein supplementation to delay the swellingresponse, which permits the development of swelling patterns in a non-abrupt manner. The findings suggest that spermatozoa exhibiting the min-imal tail swelling patterns are better fit for regulating their internal envi-ronment due to a higher membrane activity, which must be necessary torespond to the hypoosmotic stress as evidenced in this study. The evaluationof the behavior and the various tail swelling patterns developed may lead toimproving the criteria for evaluating the swelling response, its clinicalapplication in cases of intracytoplasmic sperm injection and its relationshipto other sperm qualitative characteristics.

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    Value of split intracytoplasmic sperm injection/insemination for mildmale 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 usedadjunct to in vitro fertilization (IVF) for male-factor infertility when fertil-ization failure is suspected, but the specific sperm parameters in which ICSIshould be performed are not clear. The purpose of this study was to assessthe value of the allocation of some eggs to ICSI and others to conventionalinsemination (split ICSI/insemination) in IVF cycles in which semenparameters are mildly abnormal, or when complete fertilization failure hasoccurred in a previous IVF cycle in patients with normal semen parameters.

    Design: Retrospective study in an academic reproductive technologyprogram.

    Materials and Methods: IVF cases performed between September 1, 1996and March 31, 2003 in which split ICSI/insemination was performed werereviewed. During this time period, split ICSI/insemination was offered toinfertile couples enrolled for IVF when the total motile sperm count wasbetween 10 million and 20 million (mild male factor), or when completefertilization failure had been encountered in a previous IVF cycle despite anormal semen analysis. Ovarian stimulation and egg retrieval were per-formed in the standard fashion, and oocytes were randomly assigned toeither ICSI or conventional insemination, using a concentration of 105motile sperm/mL. For each patient, rates of fertilization and cleavage, andthe embryo quality on day 3 after egg retrieval were compared between thetwo oocyte cohorts.

    Results: A total of 21 split ICSI/insemination cycles were performed inwomen 29 to 40 years of age (mean 33.7). Eighteen cycles had beenperformed because of mild male factor infertility, and three cycles becauseof previous unexpected fertilization failure. A mean of 18.4 eggs wereretrieved per patient (range 5-36). There were no differences between ICSIand insemination oocyte goups with respect to total number of eggs allo-cated (ICSI: 9.5, INS: 8.4; P0.61) or number of mature eggs allocated(ICSI: 8.4, INS: 6.5; P0.13). Fertilization occurred in both oocyte groupsin 10 patients, and in the ICSI group only in 11 patients. Oocytes random-ized to ICSI yielded a higher fertilization rate per mature egg (ICSI: 74.3%,INS18.0%; P0.0001), and the percentage of mature eggs that ultimatelyyielded an 8-cell embryo three days after egg retrieval was substantiallyhigher with ICSI (ICSI14.1%, INS8.5%; P0.036). There was nodifference in the cleavage rates of fertilized eggs obtained in either group(ICSI95.5%, INS89.8%; P0.12).

    Conclusion: Our data suggest that in infertile couples with mild male-

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

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    WITHDRAWN

    P-254

    Can a successful testicular sperm recovery be predicted in 47,XXYKlinefelter patients? Valerie Vernaeve, Catherine Staessen, Greta Ver-heyen, Andre Van Steirteghem, Paul Devroey, Herman Tournaye. Dutch-speaking Brussels Free Univ (Vrije Univ Brussel), Brussels, Belgium.

    Objective: To assess the availability of predictive factors for successfulsperm 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 substitutiontherapy. The predictive power of clinical parameters such as age, largesttesticular volume, FSH, FSH/LH ratio, testosterone and androgen sensitivityindex for successful testicular sperm retrieval was analyzed using thereceiver operating characteristics (ROC) curve analysis.

    Results: In 24 out of these 50 patients (48%) testicular spermatozoa wererecovered. The mean FSH and testosterone values in patients with spermwas 31.2 IU/L and 3.1 ng/ml vs. 40.4 IU/L and 3.2 ng/ml in patients withoutsperm. The mean testicular volume of the largest testis in patients withsperm found was 4.2 ml vs. 3.6 ml in patients with no sperm found. The bestdiscriminating age was 31 years (sensitivity 75.0%, specificity 61.5%) with

    S206 Abstracts Vol. 80, Suppl. 3, September 2003

  • an area under the ROC curve (AUC) of 0.67. The best discriminating FSHvalue was 33.2 IU/L (sensitivity 68.2%, specificity 70.8%) with an AUC of0.68. The best discriminating testosterone value was 2.2 ng/ml (sensitivity70.6%, specificity 43.5%) with an AUC of 0.51. The best discriminatingFSH/LH ratio was 1.4 (sensitivity 47.1%, specificity 82.6%) with an AUCof 0.59. The best discriminating androgen sensitivity index (LH x testos-terone) was 76.8 (sensitivity 87.5%, specificity 40.9%) with an AUC of0.61. Ninety-four percent of the men in whom sperm was found had anormal facial hair pattern compared to 93% in whom no sperm wasrecovered (NS). Seventeen percent of the men with successful testicularsperm extraction had gynecomastia compared to 31% of the men with failedtesticular sperm extraction (NS).

    Conclusion: As in the general population of men with non-obstructiveazoospermia, there are currently no factors predicting successful spermretrieval in this subpopulation of patients with non-mozaic Klinefeltersyndrome.

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    Pregnany outcome after IVF/ET among couples who have elevatedDNA fragmentation determined by the sperm DNA integrity assay(SDIa). Carolyn B. Coulam, Peter Alhering, Herman Rodriguez, LeventKeskintepe, Geoffrey Sher, Roumen Roussev. Sher Institute for Reproduc-tive Medicine/RPL and Millenova Immunology Lab, Chicago, IL; SherInstitute for Reproductive Medicine, St. Louis, MO; Sher Institute forReproductive Medicine, Las Vegas, NV; RPL and Millenova ImmunologyLab, Chicago, IL.

    Objective: To determine pregnancy outcomes of couples undergoing invitro fertilization (IVF) and embryo transer (ET) in whom the male partnershave elevated DNA fragmentation index (DFI) measured by the SDIa.

    Design: Prospective observational study with retrospective analysis.Materials and Methods: Two hundred ten couples undergoing IVF/ET at

    the Sher Institutes for Reproductive Medicine in whom the male partner hadSDIa performed served as the study patients. Before insemination, mor-phologically normal and motile spermatozoa selection was done by Percollgradient and then swim up. All oocytes collected at the time of retrievalwere inseminated with a single spermatozoon by intracytoplasmic sperminjection (ICSI). Pregnancy outcomes were documented as ongoing preg-nancy, early pregnancy loss and not pregnant. An ongoing pregnancy was apregnancy demonstrating normal embryonic size and heart rate at 8 weeksgestation. Early pregnancy loss included chemical pregnancy losses andclinical pfregnancy losses prior to 8 weeks gestation. An elevated DFImeasured by SDIa was DFI greater than 25%. The frequency of ongoingpregnancies, early pregnancy losses and no pregnancies after IVF/ET withICSI were compared between those couples with DFI 25% and those25%.

    Results: Among the 210 couples, 101 (48%) had ongoing pregnancies, 30(14%) had early pregnancy losses and 79 (38%) were not pregnant afterIVF/ET with ICSI. Sixty (29%) of the male partners had DFI25% and 150(71%) had DFI 25%. Among 60 couples in whom the male partner hadDFI 25%, 29 (48%) had a ongoing pregnancy, 14 (24%) had an earlypregnancy loss and 17 (28%) were not pregnant. These values comparedwith those in whom the 150 male partners had DFI 25% as follows:ongoing pregnancy 74 (49%), early pregnancy loss 16 (11%) and notpregnant 60 (40%). No differences in pregnany rates were noted when DFI25% (P0.3). However, a significant difference in early pregnancy lossrates were observed when DFI 25% was compared with DFI 25%(P0.01). The odds ratio was 2.916 (95% conficence interval 1.264-6.729).

    Conclusion: DFI 25% measured by the SDIa does not affect preg-nancy rates after IVF/ET with ICSI but does predict early pregnancy loss.

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    Elevated sperm fragmentation index measured by the sperm DNAintegrity assay (SDIa) is associated with chemical pregnancy losses afterIVF/ET. Carolyn B. Coulam, Roumen G. Roussev. Sher Institute forReproductive Medicine/RPL and Millenova Immunology Lab, Chicago, IL;Millenova Immunology Lab, Chicago, IL.

    Objective: To evaluate the contribution of sperm quality to chemicalpregnancy loss rates after in vitro fertilization (IVF) and embryo transfer(ET).

    Design: Retrospective study.Materials and Methods: Chemical pregnancy losses after IVF/ET from

    January 1, 2003, and April 1, 2003, were studied for the frequency ofabnormal sperm quality. Sperm quality was measured as the percentage offragmented DNA (DFI) in the SDIa.

    Results: Among 56 chemical pregnancy losses, 28 male partners hadSDIa performed. DFI25% was present in 13 men (46%) and 25% in 15men (54%). When these values were compared with results of 68 menundergoing IVF/ET who did not have chemical pregnancy losses, 17 (25%)had DFI 25% and 51 (75%) had DFI 25%. The differences weresignificant (P0.05). The odds ratio was 2.6 with the 95% confidenceinterval of 1.1-6.5.

    Conclusion: Chemical pregnancy loss is associated with elevated DFImeasured in the SDIa. Couples experiencing chemical pregnancy lossesshould have an SDIa performed.

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    Erectile dysfunction: Seminal characteristics of men undergoing infer-tility treatment using viagra. Panayiotis M. Zavos, Michel Abou-Abdal-lah, Khalied Kaskar, Panayota N. Zarmakoupis-Zavos. Andrology Instituteof America/Kentucky Ctr for Reproductive Medicine & IVF, Lexington,KY; Clin Dr. Rizk, Beirut, Lebanon.

    Objective: Erectile dysfunction (ED) is the inability to attain and maintainpenile erection sufficient to permit satisfactory intercourse and afflictsapproximately 10% of the adult US men. This is more and more evident inmen that are asked to produce seminal specimens on demand for infertilityevaluation and treatments. Recently, sildenafil citrate (Viagra(r)) has beenconsidered as an effective treatment for erectile dysfunction (ED). Initialstudies have shown that when Viagra(r) is administered to men with ED, itcan bring about erection and subsequent ejaculation. It has also beenrecommended for use to treat temporary erectile dysfunction due to stress onthe day of in vitro fertilization (IVF). The objective of this study was toevaluate the quantitative and qualitative characteristics of ejaculates in menof reproductive age with ED undergoing infertility evaluation and theirsuitability for intrauterine insemination (IUI) or other forms of AssistedReproductive Technologies (ARTs).

    Design: Prospective study.Materials and Methods: A total of 3 patients with ED received Viagra(r)

    and produced a total of 18 ejaculates for evaluation and sperm preparationfor IUI. Each ejaculate was produced at intercourse via the use of the MaleFactor Pak. Seminal specimens were assessed and processed via the ZSC-IImethod for IUI. Each processed specimen was evaluated for its appropri-ateness for IUI.

    Results: Sperm quantitative and qualitative measurements after produc-tion at intercourse were within normal range (WHO standards) and whenspecimens were processed for IUI, the sperm quantity and quality wasadequate to cause adequate conception. The results are shown in the tablebelow.

    Conclusion: The results in the current study show for the first time, thatnot only does sildenafil citrate help males with erectile dysfunction but italso reports the seminal characteristics of ejaculates produced at intercourse,along with semen preparation for use in subsequent intrauterine insemina-tions or ARTs. Sperm obtained after administering sildenafil citrate showednormal values according to WHO criteria. Not only were the sperm of goodquality, but also a high motile fraction could be isolated for intrauterineinsemination using the ZSC-II technology. It appears that Viagra(r) can bean effective tool for the treatment of reproductive age ED males undergoinginfertility workup or treatment in an IUI or ART program. The ejaculatesproduced and the processed specimens for IUI were of adequate quality toestablish a pregnancy in the treated couples.

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    Repeated testicular sperm aspiration may provide good results in maleinfertility management. Mauro Bibancos de Rosa, Lia M. Rossi, Patrcia

    FERTILITY & STERILITY S207

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