October 17-21 2015 Baltimore Maryland

to touch test notable for a 44% fertilization rate. On day 5, one expanded blastocyst,
B/B, was transferred with a negative pregnancy test. In the second cycle,
17 mature oocytes underwent ICSI with sperm that responded to
Pentoxifylline, with a 47% fertilization rate. Two B/B expanded blastocysts
were cryopreserved due to concern for ovarian hyperstimulation in the female
partner. Among all three cycles, fertilization rate was 43.5%.
CONCLUSIONS: SVSA is a reasonable option to retrieve sperm in
wounded warriors or trauma patients with pelvic or perineal injuries.
Supported by: This research was Supported, in part, by the Program in
Reproductive and Adult Endocrinology, NICHD, NIH.
O-26 Monday, October 19, 2015 11:30 AM
EVALUATION OF REPRODUCTIVE SYSTEM ANATOMY AND
GONADAL FUNCTION IN PATIENTS WITH PRUNE-BELLY
SYNDROME. M. Cocuzza, a B. C. Tiseo, a R. Park, a G. P. Padovani, a
R. H. Baroni, b A. Tavares, a F. T. Denes, a M. Srougi. a a Division of Urology,
Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo,
Brazil; b Radiology Institute, Hospital das Clinicas, University of Sao Paulo
Medical School, Sao Paulo, Brazil.
OBJECTIVE: To report the first series of Prune-belly syndrome (PBS) patients
that were submitted to surgical treatment during early childhood
focusing in the evaluation of reproductive system anatomy and gonadal function.
To date, PBS patients were diagnosed as infertile and fertility was often
given lowest priority. Their infertility is multifactorial and is probably related
to the undescended testes, prostatic hypoplasia and retrograde ejaculation.
There are no documented cases of unassisted paternity; few successful pregnancies
have been reported through assisted reproduction, but all using
epididymal or testicular sperm extraction.
DESIGN: Series of case analysis.
MATERIALS AND METHODS: We accessed 30 patients with PBS from
our service that were submitted to any surgical procedure during their
childhood and now are at least 14 years old. Patient records were accessed
to identify age at orchidopexy. All patients were submitted to pelvic MRI in
order to evaluate anatomical findings of reproductive system, including
prostate size, characteristics of seminal vesicles and vas deferentia. Serum
levels of LH, FSH, testosterone and also creatinine were evaluated. Sperm
analysis was conducted and analysis of the urine after masturbation when
needed.
RESULTS: We contacted 18 patients. Of those, 15 had reliable data from
patient records including physical examination and hormone profile. The
average of age of this group at evaluation is 18.2 years. The average age at
orchidopexy was 17 months and an average follow-up was 17.4 years. All
had normal physical development and stable anatomy and function of the reconstructed
urinary tract with an average creatinine of 1.64 mg/dL. Fourteen
patients had both testes in scrotum, and the testicular volume varied from
2.1cc to 9.4cc, averaging 6.9cc. Eight patients collected semen with a sperm
count of 5.07 million/mL, whereas motile sperm was found in 62.5%
including three in the ejaculate and two in urine after masturbation. Average
hormones levels were LH: 5.3 mg/dL, FSH: 6.9 mg/dL, total testosterone:
531.2 mg/dL and free testosterone: 450.6 mg/dL. MRI revealed prostates hypoplastic
in 55.6% and absent in 22.3%, while 55.6% had absence of at least
one of the seminal vesicles. There was no vasal abnormality.
CONCLUSIONS: Our data enlightens findings in patients with PBS that
were not described yet. A high prevalence of hypoplastic or absent prostate
and seminal vesicle abnormalities was observed in our patients; those findings
may represent their main cause of infertility. Probably, early orchidopexy
increases testicular function salvage preserving their fertility
potential patients leading to the finding of motile sperm in the ejaculate or
in urine after masturbation. The next step is to provide a better understanding
of their fertility potential improving quality of life.
O-27 Monday, October 19, 2015 11:45 AM
THE EFFECTS OF TRANSVERSE AND LONGITUDINAL
INCISION OF TUNICA ALBUGINEA IN MICRODISSECTION
TESTICULAR SPERM EXTRACTION. T. Ishikawa, K. Yamaguchi,
R. Nishiyama, Y. Takaya, K. Kitaya, H. Matsubayashi. Reproduction Clinic
Osaka, Osaka, Japan.
OBJECTIVE: The optimal technique of sperm extraction would be
minimally invasive and avoid destruction of testicular function without
compromising the chance of retrieval adequate numbers of spermatozoa to
perform ICSI. In general, the tunica albuginea should be opened on an equatorial
plane because antimesenteric incision increases the risk of testicular
devascularization and may adversely affect access to the seminiferous tubules.
To demonstrate the differences of sperm retrieval rate (SRR) and postoperative
complication between transverse or longitudinal incision of tunica
albuginea in microdissection testicular sperm extraction (micro TESE).
DESIGN: A retrospective study.
MATERIALS AND METHODS: A total of 1080 patients (including 970
46XY males with NOA and 110 Klinefelter syndrome (KS) patients) underwent
micro TESE were subjected to sperm retrieval procedures. All operations
were performed by one surgeon (TI). Karyotyping test was
performed on a sample of blood to all patients. SRR and postoperative
complication were analyzed in the 960 patients with transverse incision
(group T) and the 120 patients with longitudinal incision (group L). Ninety
and 20 non-mosaic KS cases each were included in group T and group L,
respectively.
RESULTS: Testicular sperm were successfully retrieved by micro-TESE
in 415 of 960 (43.2%) NOA (including 47 of 90 KS: 52.2%) and 56 of 120
(46.7%) NOA (including 10 of 20 KS: 50%) patients with group T and group
L incision in micro TESE, respectively. There was no significant difference
of sperm retrieval rate with either approach. No patients had postoperative
complications such as major hematoma or leakage of seminiferous tubules
through this series. The hospital stay was all the same in both groups
(a-day-surgery). For the 46XY males with NOA patients, after micro-
TESE, the testosterone level did not drop significantly in both group T and
group L. In addition, there were no significant differences in the levels of
testosterone between group T and group L for the 46XY males with NOA
patients. Of the KS patients who underwent micro TESE, the mean serum
testosterone level showed an average decline of 30-35% from baseline
when assessed at 1, 3, and 6 months after micro-TESE, but no significant differences
were also shown in the levels of testosterone between group T and
group L.
CONCLUSIONS: There were no significant differences between transverse
or longitudinal incision for SRR and postoperative complication in
micro TESE. We should take care of the hypogonadism in KS patients after
even microdissection procedure by either transverse or longitudinal incision.
O-28 Monday, October 19, 2015 12:00 PM
COMPARISON OF SEMEN QUALITY BETWEEN UNIVERSITY
AND PRIVATE CLINIC LABORATORIES. O. Khan, a C. F. Jensen, b
J. Sonksen, b M. Fode, b T. Shah, c D. A. Ohl. a a Urology, University of Michigan,
Ann Arbor, MI;
b Urology, Herlev University Hospital, Herlev,
Denmark; c Obstetrics and Gynecology, University of Michigan, Ann Arbor,
MI.
OBJECTIVE: Obtaining an ejaculate and performing a semen analysis
(SA) is an essential first step in evaluating the infertile man. Based on the
SA the physician determines the nature of further evaluation and treatment.
Multiple treatment options are available and range from simple counseling to
the more complicated and expensive assisted reproduction techniques
(ART). The objective of this study was to investigate inter-laboratory variation
in semen quality between private ART laboratories and university-based
ART laboratories respectively.
DESIGN: Clinical retrospective study.
MATERIALS AND METHODS: IRB approval was obtained to retrospectively
evaluate patients who had undergone a SA at both the University
of Michigan Center For Reproductive Medicine and private practice IVF
clinics. When more than one SA was available from both clinics the SA
with the highest total motile sperm was selected for analysis. Major semen
parameters from both SA’s were compared using Wilcoxon signed-rank
test.
RESULTS: A total of 20 men aged 35 6 (mean SD) years were
included in the study. Table 1 shows comparisons of the major semen parameters
obtained at the two laboratories. Morphology was reported significantly
lower at the private clinics.
CONCLUSIONS: In this small series, morphology was significantly lower
in semen analyses performed at private IVF clinics. Since sperm morphology
under 5% is commonly used to recommend IVF with ISCI, underestimation
of sperm morphology at private clinics may lead to over-utilization of high
level assisted reproductive techniques at these sites.
FERTILITY & STERILITY Ò
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