Infertility: Therapy/Evaluation

Moderated Poster 57

Wednesday, June 2, 2010 10:30 AM-12:30 PM

1920ISOLATED TERATOSPERMIA DOES NOT APPEAR TO PREDICTCLINICAL PREGANCY FOLLOWING IN VITRO FERTILIZATIONOR IN VITRO FERTILIZATION WITH INTRACYTOPLASMICSPERM INJECTION: A SYSTEMATIC REVIEW ANDMETA-ANALYSIS

James Hotaling*, Seattle, WA; James Smith, Mitchell Rosen, SanFrancisco, CA; Thomas Walsh, Seattle, WA

INTRODUCTION AND OBJECTIVES: Current data is conflict-ing with regard to the role of sperm morphology in predicting assistedreproductive technology (ART) pregnancy outcomes. We performed asystematic review and meta-analysis to provide a concise statementregarding the specific impact of isolated teratospermia on clinicalpregnancy after IVF and ICSI.

METHODS: We conducted a systematic review and meta-analysis of data from the literature from years 1970 to 2009 usingteratospermia and fertilization or IVF or in vitro fertilization as thekeywords. For data extraction isolated, severe teratospermia was de-fined by strict Kruger criteria as less than 5% normal forms andotherwise normal semen parameters (WHO). Outcome was defined asclinical pregnancy per number of treatment cycles. Odds ratios (ORs)were used as the measure of risk and were calculated using therandom effects model.

RESULTS: A total of 31 studies were identified and five metinclusion criteria. Isolated teratospermia did not lead to a significantlydecreased chance of pregnancy with ART. The Odds Ratio (OR) forIVF success with teratospermia compared to non-teratospermic con-trols was 1.03 with a 95% Confidence Interval (CI) of 0.90-1.21. OR forsuccessful pregnancy with IVF-ICSI was 0.94 (95% CI 0.63-1.42).

CONCLUSIONS: Isolated severe teratospermia does not ap-pear to predict decreased pregnancy rates in IVF alone or IVF-ICSI.

Source of Funding: None

1921SIGNIFICANCE OF ANTI-CHLAMYDIA TRACHOMATIS IGMANTIBODY IN INFERTILE OR SUBFERTILE MEN: IMPACT OFANTIMICROBIAL THERAPY ON SEMEN PARAMETERS

Jin Ho Choe*, Hana Yoon, Joong Shik Lee, Young Min Joo, Ju TaeSeo, Seoul, Korea, Republic of

INTRODUCTION AND OBJECTIVES: Chlamydia infection inthe genitourinary tract is associated with male infertility and subfertility.We sought to estimate the prevalence of anti-chlamydial antibodies ininfertile men and examined the effect of antimicrobial therapy on theirsperm parameters.

METHODS: Males who visited a fertility clinic (n�2,196) werescreened for serum anti-Chlamydia trachomatis IgM antibody andsubjected to computer-assisted semen analysis. Patients who werepositive for the antibody or had borderline levels received one single1,000 mg dose of oral azithromycin. Total motile sperm counts (TM-SCs; semen volume x sperm count x percentage of motile sperm x 106)were compared before and after treatment. TMSC changes in patientswith initial asthenozoospermia (�50% motility) were also assessed.

RESULTS: The anti-chlamydial antibody prevalence was21.6% (474/2,196; positive in 12.8% and borderline in 8.8%). TMSCbefore and after treatment was evaluated in 198 patients, of whom 129initially exhibited asthenozoospermia. After treatment, the TMSC rosesignificantly in antibody-positive patients (215.7x106 vs. 255.6x106,n�123, p�0.008) and antibody-borderline patients (145.8x106 vs.184.9x106, n�75, p�0.049). After treatment, there was also a marked

rise in the TMSC of antibody-positive asthenozoospermic males(127.8x106 vs. 203.9x106, n�73, p�0.001) and antibody-borderlineasthenozoospermic males (106.2x106 vs. 162.1x106, n�56, p�0.015).

CONCLUSIONS: The prevalence of anti-Chlamydia trachoma-tis IgM antibody in adult males could be higher than expected. Appro-priate antimicrobial therapy in patients with anti-chlamydial antibodyimproves TMSC. Therefore, it may be prudent to screen subfertile menfor Chlamydia trachomatis-mediated genitourinary tract infections.

Source of Funding: None

1922OUT-OF-POCKET FERTILITY COSTS: DATA FROM APROSPECTIVE INFERTILITY COHORT IN THE UNITED STATES

James F. Smith*, Michael Eisenberg, Shana Millstein, RobertNachtigall, Natalia Sadetsky, Patricia Katz, San Francisco, CA

INTRODUCTION AND OBJECTIVES: While various estimatesof fertility care costs have been made, most are based upon resourceutilization or billing estimates rather than actual out-of-pocket expenseto an individual. This study documents the total out-of-pocket cost offertility care among a prospective cohort of infertile couples followed for18 months.

METHODS: Fertility outcomes and key demographic and med-ical data were determined through questionnaires, interviews, andmedical record abstraction. The infertility cohort was assembled from 8community and academic reproductive endocrinology clinics. Inter-views were conducted at enrollment, and at 4, 10, and 18 months. Costdiaries with entries for the out-of-pocket costs of provider visits, medi-cations, transportation, and “other” (e.g. adoption, legal fees, cryo-preservation, psychological support, and child care) were completed by371 participants.

RESULTS: The mean out-of-pocket cost was $9,592 (median$4,112, range 0-$73,180) among all participants. Provider visits werethe largest expense (mean $6,504, range 0-$57,620), followed bymedications (mean $1,670, range 0-$19,452), and “other” (mean$1,414, range 0-$60,439). Transportation costs were minimal. Couplesusing no cycle-based treatment spent the least ($1,534) followed bythose using medications for ovarian stimulation without IUI ($2,008), IUIwith or without ovarian stimulation ($3,302), IUI followed by IVF($16,042), and IVF alone ($16,550). Couples with isolated male factorinfertility ($10,731) and combined male and female factors spent themost ($13,012) compared to female factor only ($8,435) and no iden-tifiable infertility factors ($2,512). Insurance coverage was associatedwith lower out-of-pocket fertility expenses ($8,479 vs. $10,540); how-ever, this difference did not achieve statistical significance.

CONCLUSIONS: The out-of-pocket cost of fertility care is re-lated to the complexity of the treatments utilized, and to a lesserdegree, the infertility diagnosis. Combined male and female factorgenerated the highest expenses followed by isolated male factor aloneand female factor alone. Insurance coverage ameliorated this expenseslightly but not to a significant degree. These data provide usefulinformation to guide clinicians and patients in assessing the costs ofdifferent infertility treatment options.

Source of Funding: Grant HD37074 from the National Institutefor Child Health and Human Development (NICHD/NIH)

1923MORBID OBESE MEN PRESENT POOR SPERM QUALITY ANDWHILE HORMONAL AND SEXUAL FUNCTIONS IMPROVE IT ISNOT REVERSED AFTER GASTRIC BYPASS – A LONG TERMFOLLOW UP

Leonardo O. Reis*, Ricardo D Saade, Elintom A Chaim, Laurione COliveira, Adriano Fregonesi, Ubirajara Ferreira, Campinas, Brazil

INTRODUCTION AND OBJECTIVES: The effects of weightloss on sexual function, hormones and mostly on fertility have not beenwell studied. We evaluate the impact of lifestyle modifications andgastric bypass in this context focusing sperm quality.

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METHODS: We prospectively studied 20 morbidly obese menfor 24 months, divided in two groups: 10 patients underwent life stylemodifications (exercise and diet) for 4 months and subsequently gastricbypass, group A; and 10, group B, kept on weekly follow up. None ofthe men were taking PDE5 inhibitors. All patients underwent IIEF-5questionnaire, serum estradiol, prolactin (PRL), luteinizing (LH) andfollicle-stimulating (FSH) hormones, free and total testosterone (FT andTT) and espermogram at baseline (time 0), surgery- 4 months latterbaseline (time 1) and final evaluation- 24 months (time 2).

RESULTS: From times 0 to 1, group A presented a mean BMIreduction of 12.6 (p�0.0001), while group B, 2.1 (p�0.05). The BMIreductions between times 0 to 2 were 24.7 (p�0.0001) and 0.7(p�0.05) for groups A and B, respectively. BMI average between thetwo groups was similar at time 0 (p�0.2142), and different at times 1(p�0.0033) and 2 (p�0.0006). Increase in IIEF-5 score (p�0.0469), TT(p�0.0349) and FSH levels (p�0.0025), and reduction in PRL level(p� 0.0001) were observed in group A from times 0 to 2 and 1 to 2.There were no changes from times 0 to 1. Comparing groups A and Bat time 2, IIEF-5, TT and FT increased significantly on group A (p�0.0224, p�0.0043 and p�0.0149, respectively). Regarding espermo-gram profile, there was no significant difference among parametersbetween groups A and B at TIMES 0, 1 and 2, or among TIMES 0, 1and 2 for groups A and B.

CONCLUSIONS: Surgery induced weight loss increased sex-ual function quality measured by IIEF-5 questionnaire, increased TT,FT and FSH and reduced PRL levels and did not interfere on thespermogram profile. The hormonal impact verified could justify thesexual function improve. Lifestyle modifications impacted BMI withouthormonal, sexual or spermogram impact in morbid obese. New studiesare warranted in the field, mostly considering birth rate as primaryend-point regarding fertility.

Source of Funding: FAEPEX - UNICAMP

1924APPROACH TO LEUKOCYTOSPERMIA IN A COMMUNITYPRACTICE SETTING: INCIDENCE, RESPONSE TO EMPIRICTHERAPY, FINDINGS ON SEMEN CULTURE.

Eric Seaman*, West Orange, NJ

INTRODUCTION AND OBJECTIVES: Leukocytospermia(LCS) is recognized as contributing factor to the generation of reactiveoxygen species which can cause oxidative stress damage. Oxidativestress damage in turn is recognized as a potential cause of abnormalsemen parameters and abnormal sperm function. This study wasperformed to assess the incidence of LCS in a private practice setting,correlation to the presence of bacteria in the semen, identification of themost common bacteria and their drug sensitivities and finally theresponsiveness of LCS to empiric therapy.

METHODS: This study is a retrospective analysis of the resultsof 1208 semen analyses performed on 778 patients. Analyses wereperformed according to WHO guidelines using Kruger strict criteria toassess sperm morphology. The presence of white blood cells in thesemen was determined on specimens with a greater than 1 million/milliliter “round cells” by peroxidase test (Leucoscreen, ConceptionTechnologies, San Diego, CA). Semen specimens positive by peroxi-dase test were submitted for bacterial culture. When present, patientswith LCS were treated empirically with an antibiotic, anti-inflammatoryand an antioxidant: levofloxacin, naproxyn, Vitamin E. Patients whoreturned for follow up underwent repeat semen analysis.

RESULTS: LCS was identified in 30% of specimens submitted.Of specimens with LCS, 40% had a positive bacterial culture. Of thosespecimens, the two most frequent bacterial isolates were enterococcus(65%) and E. Coli (15%), both of which were uniformly sensitive totreatment with levofloxacin. Of 369 patients treated empirically, 299returned for follow up analysis. Among them, 62% had resolution ofLCS. Among patients with resolution, improvment in sperm density,motility or morphology were noted in 49%, 45% and 40% respectively.

CONCLUSIONS: The incidence of LCS in the infertile popula-tion studied was substantial. A considerable number of specimenswith LCS had positive bacterial cultures. The majority of bacterialisolates were sensitive to treatment with levofloxacin. Follow up afterempiric therapy revealed the majority of patients to have resolution ofLCS. This number is significantly higher than the rate of spontaneousresolution of LCS noted in the literature. Almost half of patients withresolution of LCS were noted to have improvement in certain seminalparameters.

Source of Funding: None

1925MALE INFERTILITY AFTER KIDNEY TRANSPLANTATION

Magdy EL-Bahnasawy*, Esam Elsawy, Mohamed Abol-Ghar, OsamaGheith, Nabil Hasan, Mansoura, Egypt

INTRODUCTION AND OBJECTIVES: Multiple risk factors cancontribute to male infertility after kidney transplantation including hor-monal disturbances, graft function, immunosuppressive drugs andother comorbidity factors. Our aim is to investigate the impact of theprevious factors on male fertility in our infertile male transplant recipi-ents.

METHODS: The study included 43 patients referred from thekidney transplantation followup clinic with the complaint of primary orsecondary infertility. Patients were investigated after thorough historytaking and clinical examination by semen analysis, hormonal profile(FSH,LH,prolactin and total testosterone) and scrotal duplex ultrasonog-raphy. TRUS � endorectal MRI were requested in patients with lowsemen volume.

RESULTS: Very poor semen parameters were seen in thiscohort of patients. Azoospermia was detected in 17 patients(39.5%)while severe oligoasthenospermia was seen in other 10patients(23.3%).There was no significant impact of either transplantduration or pre-transplant hemodialysis duration on testicular size orsperm concentration. However longer transplant duration(more thanone year) was found necessary to significantly improve FSH andprolactin abnormalities. Graft function was significantly correlated withinfertility duration, FSH and LH but not with prolactin, testicular size orsperm concentration. FSH was shown to significantly correlate withtesticular size and sperm concentration. There was also good correla-tion between testosterone level and sperm concentration. Cyclosporin-based immunosuppressive protocols were associated with significantlybetter sperm concentration than other protocols(p�0.02). In 16 casesthere were positive TRUS findings mainly prostatic cysts; 8 of themwere further confirmed by endorectal MRI. Moreover varicocele wasdetected in 17 cases(6 unilateral and 9 bilateral).

CONCLUSIONS: Infertile male kidney transplant recipientshave mostly very poor semen parameters. Cyclosporin based immu-nosuppression have less deleterious effect on sperm density. Graftfunction is fairly correlated with FSH and LH levels and with infertilityduration. Varicocele and/or prostatic cysts are present in a significantnumber of these patients. Prospective study on a larger number ofpatients to assess accurately the impact of kidney transplantation-related comorbidities on male fertility is warranted.

Source of Funding: None

1926GENDER RATIO AND INFERTILITY IN A PROSPECTIVE U.S.COHORT

Michael Eisenberg*, Michael Schembri, Mary Croughan, SanFrancisco, CA; Thomas Walsh, Seattle, WA

INTRODUCTION AND OBJECTIVES: In recent years, a trendtowards a declining proportion of male births has been noted in manyindustrialized countries including the United States. Some have hypoth-esized that increased rates of male and female subfertility may con-

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