DESIGN: Retrospective study.MATERIALS AND METHODS: We analyzed retrospectively obstructive

azoospermia with ICSI cycle between January 1, 2003 and December 31,2005 in Chang Gung Memorial Hospital. A total of fifty-six azoospermia pa-tients underwent ICSI-ET programs. We divided into four groups accordingto the procedures of sperm retrieval: MESA-fresh, MESA-thawed, TESE-fresh, and TESE-thawed. Parameters including normal fertilization rate, im-plantation rate, pregnancy rate and live-birth rate were analyzed.

RESULTS: In a total of fifty-six couples with azoospermia, 28 patients ofMESA-fresh, 9 of MESA-thaw, 14 of TESA-fresh, 5 of TESA-thaw were en-rolled. The overall normal fertilization rate and implantation rate were 59.8%and 19.7%. The overall pregnancy rate and live birth rate were 42.9% and30.4%. No significant differences were found in fertilization rate, implanta-tion rate, pregnancy rate or live birth rate among the azoospermia group ornon-azoospermia group (control group).There was little difference in normalfertilization rate and implantation rate using MESA and TESE (61.3% vs.57.1%, 19.7% vs. 17.5%, P<0.05).However, the TESE and MESA had sim-ilar clinical pregnancy rate, and live birth rate. The clinical pregnancy rateand live birth rate were significantly higher in the azoospermia using freshMESA and TESE in comparison to thawed MESA and TESE. In 18 casesof clinical pregnancy, there was no congenital anomaly and only one casehad twin to twin transfusion syndrome and aborted at gestation age of twenty.

TABLE. Outcome in comparing MESA with TESE

FERTILITY & STERIL

MESA (n ¼ 37)

ITY�

TESA (n ¼ 19)

P

Normal fertilization rate

61.30% 57.10% 0.018 Implantation rate 22.70% 13.80% 0.025 Pregnancy rate 43.24% 42.11% 0.871 Live birth rate 29.73% 36.84% 0.329

CONCLUSIONS: The use of fresh MESA and TESE in good candidatesfor azoospermia in ICSI cycles resulted in reasonable pregnancy and livebirth rates.

Supported by: None.

P-833

SPERM PENETRATION ASSAY (SPA) WITH GRADIENT PREPA-RATION IS PREDICTIVE OF PREGNANCY OUTCOME INCONTROLLED OVARIAN HYPERSTIMULATION WITH INTRA-UTERINE INSEMINATION (COH/IUI) CYCLES. D. C. Merryman,C. Y. Gibbs, V. L. Houserman, C. A. Long, M. C. Allemand, K. L. Honea.ART Fertility Program of Alabama, Birmingham, AL.

OBJECTIVE: The SPA is utilized as a diagnostic tool to predict the fertil-izing ability of human sperm using zona-free hamster oocytes. The SPA ismeasured by the sperm capacitation index (SCI), the average number ofsperm penetrations per oocyte. Sperm can be prepared for the SPA by severaldifferent methods. The objective of this study was to review the pregnancyoutcome in COH/IUI cycles in relation to the SCI after sperm preparationby gradient (gSCI).

DESIGN: This retrospective study was designed to review the outcome ofall COH/IUI cycles in relation to gSCI. Outcome was evaluated by deliveryrate (ODR), defined as the number of ongoing pregnancies and/or deliveriesper COH/IUI cycle.

Maternal age

ALL <35 R35

Gradient SCI (gSCI)

<14 R14 <14 R14 <14 R14 COH/IUI cycles 109

1

175

1

58

2

99

2

51

3

76

3

Delivery rate (ODR) 7.3% 22.9% 10.3% 28.3% 3.9% 15.8%

1P<0.001, 2P<0.01, 3P<0.05.

MATERIALS AND METHODS: The data consisted of 284 cycles duringthe period January 2004 through March 2007. All cycles were included in thestudy and grouped according to gSCI as well as maternal age. Sperm prepara-tion for the SPAwas by gradient. Ovarian stimulation consisted of human men-opausal gonadotrophin or follicle stimulating hormone or a combination of thetwo. Sperm preparation for IUI was performed by spin down when total motilesperm (TMS) was<20 million or gradient when TMS was R20 million. Chy-motrypsin was added to the spin down in conjunction with an abnormal SPA or

motility parameters. Conventional methods were used for the IUI. Chi squaretest was used for statistical analysis with significance defined as P<0.05.

RESULTS: Cycles with a gSCI R14 were compared to cycles with a gSCI<14. The ODR was 22.9% vs. 7.3% (P<0.001). Furthermore, the cycleswere grouped by maternal age<35 and R35. The ODR in the<35 age groupwas 28.3% vs. 10.3% (P<0.01) while the ODR in the R35 age group was15.8% vs. 3.9% (P<0.05) for gSCI R14 vs. <14.

CONCLUSIONS: 1. Gradient preparation in the SPA is significantly pre-dictive of ODR in COH/IUI cycles. 2. Patients with a gSCI <14 have a sig-nificantly decreased ODR in COH/IUI cycles. 3. Patients should becounseled regarding other treatment options including IVF and ICSI whenthe gSCI is <14.

Supported by: None.

P-834

IVF WITH ANTISPERM ANTIBODIES THE WAY FORWARD?M. Poli, D. T. Keane, E. V. Mocanu. Human Assisted Reproduction Ireland,Rotunda Hospital, Dublin, Ireland.

OBJECTIVE: We set to establish the influence of Antisperm Antibodies(ASAB) presence on outcome of Assisted Reproductive Technology(ART), in particular if the laboratory technique used in males with ASABcan impact on outcome. Our null hypothesis was that the outcome of ARTtreatment is independent of the laboratory technique used when more than50% but less than 100% ASAB are present.

DESIGN: This is a retrospective, database and single chart review of allcycles of ART undertaken in a tertiary referral centre during a period of 8years.

MATERIALS AND METHODS: All cycles where 100% ASAB werepresent were excluded from the study as ICSI was the norm. For the purposeof this study we only focused on cycles of treatment where the male had be-tween 50% and 99% ASAB present. The ASAB testing was performed byusing direct IgG MAR test (Microm UK). We compared fertilisation, cleav-age, pregnancy, implantation and miscarriage rates in IVF and ICSI cycles.

RESULTS: From our data fertilisation, cleavage and implantation rates arecomparable in the two groups (IVF and ICSI) with 74.3% vs. 74.3%, 88.8%vs. 90.7% and 11.5% vs. 12.1% respectively. Similarly, no difference in de-livery rates was noted between the two groups (25% in IVF vs. 22.3% inICSI). As regards the early pregnancy outcomes, we saw a higher than ex-pected difference in miscarriage rates between IVF (15%) and ICSI (26.5%).

CONCLUSIONS: Our study identified comparable fertilisation, cleavage,implantation and pregnancy rates in patients with 50% to 99% ASABs irre-spective of the laboratory technique used. This is contrary to previous reportsand stresses the need for further prospective, randomised and multicentreresearch. Acknowledging that ICSI technique increases the risk of geneticabnormalities our findings become even more relevant for clinical practice.

Supported by: None.

P-835

REPEATED MEASURES ANALYSIS OF THE EFFECT OF LEUKO-CYTOSPERMIA AND DENSITY GRADIENT CENTRIFUGATIONON SPERM NUCLEAR DNA FRAGMENTATION AND MITOCHON-DRIAL ACTIVITY. R. M. Fariello, P. T. del Giudice, R. P. Bertolla,D. M. Spaine, V. Ortiz, A. P. Cedenho. Department of Surgery, Division ofUrology, Human Reproduction Section, Sao Paulo Federal University, SaoPaulo, Brazil.

OBJECTIVE: Leukocytospermia results in production of reactive oxygenspecies (ROS). ROS may decrease spem DNA integrity and mitochondrialactivity. Semen processing may enhance release of ROS through centrifuga-tions. Thus, we set out to assess the effect of leukocytospermia and semenprocessing on DNA fragmentation and mitochondrial activity.

DESIGN: Prospective controlled study.MATERIALS AND METHODS: Patients were divided in control (n¼ 41)

or study group (at least 1�106 neutrophils/mL, n¼ 22). Semen was analyzed(WHO, morphology by Kruger’s strict criteria). An alkalyne Comet assaywas used and 200 cells were graded I (high DNA integrity) to IV (highDNA fragmentation). Mitochondrial activity was assessed by a method inwhich active mitochondria precipitate DAB. Cells were classified as I (all ac-tive) to IV (all inactive). Semen was processed using Percoll, and motility,DNA integrity, and mitochondrial activity were analyzed pre and post-pro-cessing. A respeated measures ANOVA was used, and when differenceswere found, Tukey’s HSD test was used. Data are presented as Mean; Stan-dard Deviation.

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