spermia (OA) there are two methods to retrieve spermatozoa for ICSI, percu- taneous epididymal sperm aspiration (PESA) or testicular sperm extraction. (TESE).
transmission and perpetuation of the disease. The goal of our study was to evaluate the HPV infection in the semen in order to assess its influence in the semen quality as well as in the seminal oxidative stress. DESIGN: Case-control study. MATERIALS AND METHODS: The viral infection and the classification of the virus subtypes were determined by nested-PCR technique. Sperm concentration and motility were evaluated manually according to the World Health Organization (WHO) criteria and sperm morphology evaluated according to the WHO and Tygerberg’s strict criteria. The enzymatic activities of Superoxide Dismutase (SOD) and Catalase (CAT) were determined by spectrophotometry technique. The presence of leukocytospermia was assessed by a myeloperoxidase test. RESULTS: Sixty-eight men were analyzed, from which 30 were positive for DNA-HPV and 38 were negative for DNA-HPV. Eight out of the positive cases had HPV infection with the subtypes 16 or 18, which are considered with high prevalence for oncogenic risks. Sperm morphology was significantly lower in patients with HPV infection compared to patients without HPV infection (P ¼ 0.02). No differences were detected in sperm concentration (P ¼ 0.09) and motility (P ¼ 0.08) between patients with and without HPV infection. In patients with HPV infection, CAT levels were higher than in patients without HPV infection (P ¼ 0.03). Catalase levels were negatively correlated with sperm morphology according to the WHO criteria (P ¼ 0.02) and Tygerberg’s strict criteria (P ¼ 0.03). Leukocytospermia levels were not correlated with the presence of seminal HPV infection (P ¼ 0.09). CONCLUSIONS: Seminal oxidative stress may be related to the pathophysiology of infertility in patients with seminal HPV infection. Patients with HPV infection have higher damage to sperm morphology without increasing the leukocytospermia levels. Further studies are needed to confirm our results. Supported by: None.
tion of euploid blastocysts for transfer may positively impact outcome for couples with male factor infertility. Supported by: None.
P-257 PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA) OR TESTICULAR SPERM EXTRACTION (TESE) FOR MEN WITH OBSTRUCTIVE AZOOSPERMIA: A REVIEW OF 6 YEARS. P. Reyes, R. Santos, P. Diaz, A. Martinez, P. Pasquale, J. Sepulveda. Fertility Center, Centro de Fertilidad IECH, Monterrey, Mexico; Yale Fertility Center, New Haven, CT. OBJECTIVE: For patients with confirmed diagnosis of obstructive azospermia (OA) there are two methods to retrieve spermatozoa for ICSI, percutaneous epididymal sperm aspiration (PESA) or testicular sperm extraction (TESE). In this study we assessed six years of ART outcomes for patients using epididymal or testicular sperm for their ICSI cycle. DESIGN: Retrospective analysis of 6 years of PESA/TESE procedures. MATERIALS AND METHODS: A total of 67 patients treated from January 2002 to December 2007, were evaluated. The patients were divided into Group I (PESA n¼36) and Group II (TESE n¼31). The ovarian stimulation protocols were not different between groups with majority consisting of late luteal phase GnRH-agonists or follicular phase GnRH antagonist. The data were statistically analyzed by chi-square and ANOVA. RESULTS: The overall results are summarized in the table. TABLE 1. Group I vs Group II
Factor P-256 MALE FACTOR INFERTILITY AND THE INCIDENCE OF CHROMOSOMALLY COMPLEX EMBRYOS. H. Cook-Andersen, J. M. Stevens, W. B. Schoolcraft, M. G. Katz-Jaffe. University of Colorado Health Science Center, Aurora, CO; Colorado Center for Reproductive Medicine, Lone Tree, CO. OBJECTIVE: The male gamete delivers to the future embryo several important genetic features including a haploid paternal genome and RNA molecules required during early embryogenesis. Sperm dysfunction involving these features may result in either meiotic or mitotic chromosomal abnormalities thus having a significant impact on reproductive outcome. This study investigated the type and incidence of embryo aneuploidy derived from male factor infertile couples. DESIGN: Retrospective observational study. MATERIALS AND METHODS: 21 couples from the Colorado Center for Reproductive Medicine with male factor infertility alone underwent an IVF cycle with preimplantation genetic testing on day 3. Couples with advanced maternal age and/or known abnormal karyotype were excluded. Mean maternal age was 32.42.4 years with a mean day 3 FSH of 6.81.7. Male parameters included a mean sperm count of 16.319.2 mil/ml, mean motility of 39.323.9% and a mean paternal age of 36.05.9 years. On day 3 of embryonic development, a single blastomere was biopsied from each embryo and fixed for FISH (5-9 chromosomes). Results were obtained for a fresh day 5 transfer. RESULTS: On average, 17.14.9 oocytes were retrieved and fertilized by ICSI. Fertilization and cleavage rates were 76.5% and 99.1% with an average of 12.33.7 embryos biopsied on day 3. Over half of all embryos (54.7%) demonstrated abnormalities for the 5-9 chromosomes tested. Of the abnormal embryos, 17.0% involved single monosomies and 14.9% single trisomies. The majority of abnormal embryos (68.1%) demonstrated chromosomally complex divisions, 17.7% involving 2 chromosomes and 50.4% involving R3 chromosomes. Couples with more than half of their embryos demonstrating chromosomally complex divisions had a lower average sperm count (mean 12.314.2 v. 26.327.2 mil/ml). Close to one third of the chromosomally complex embryos progressed to the blastocyst stage without obvious quality differences. An overall blastocyst rate of 54.3% was observed with a mean of 2.10.7 blastocysts transferred. Implantation, pregnancy and live birth rates were 50.0%, 57.1% and 55.0%, respectively. CONCLUSIONS: Embryos from couples with male factor infertility alone displayed a high number of chromosomally complex divisions with close to one third of these reaching the blastocyst stage. These data suggest the selec-
FERTILITY & STERILITYÒ
Female age FSH LH E2 Plolactine Male Age Follicles>15 Day 10 E2 day 10 Day Oocyte retrieval Total oocytes IVF/ICSI Fertilized Oocytes Fertilization rates Embryo transfer day Number of embryo transferred Number of Pregnancies Gestacional sacs Implantation rate
Group I
Group II
P Value
31.84.2 6.62.1 5.074.06 42.728.9 17.39.2 38.59.4 7.44.2 22812161 12.51.08 11.26.5 9.035 6.063.7 65.920.3 2.8.78 2.8.82
30.5.6 6.22.3 4.31.6 40.225.8 19.210.5 38.38.8 8.55.4 23551330 12..765 13.46.1 10.94.9 6.23.7 59.122.8 2.8.71 2.8.71
0.317 0.512 0.322 0.714 0.458 0.939 0.377 0.881 0.643 0.163 0.128 0.825 0.2 0.78 0.96
20 .760.89 26.8030.1
10 .5.7 18.3030.4
0.084 0.212 0.265
The implantation rate was 27% and 17.6% respectively (p¼0.15).The fertilization rate was significantly higher for the group I 67% versus 57.3% (p
