DESIGN: Retrospective study.MATERIALS AND METHODS: All fresh, non-donor in conventional

IVF without ICSI cycles performed from January 2012 to December 2013(n¼838) were included in this study. The patients were divided into twogroups: Study group (A group): A total of 115 patients underwent subnormalsperm count (R5 and <20 � 106/mL). Control group (B group): A total of723 patients underwent normal sperm count R20 � 106/mL). Both groupsbecame normal count after sperm treatment.

RESULTS: Patient characteristics were similar between two groups. Ineach group, age (A group: 35.3�3.6; B group: 35.7�4.0 P¼0.73), basalFSH (7.4�2.6; 7.3�3.7mIU/ml P¼0.76), duration of rFSH (9.0�2.3;9.1�3.2day P¼0.81), and endometrial thickness (10.1�2.0; 10.1�2.1mmP¼0.41) did not show significant differences. There were no significant dif-ferences between two groups in the number of MII oocytes (10.8�6.6;10.1�6.2 P¼0.93), fertilization rate (85.2%; 88.8% p¼0.64), pregnancyrate (57.4%; 54.8% P¼0.85), and ongoing pregnancy rate (49.6%; 49.2%P¼0.70).

CONCLUSION: Subnormal sperm group could obtain the same fertiliza-tion rate and pregnancy rate as those of normal group in conventional IVFwithout ICSI. Generally, ICSI is carried out for subnormal sperm becausethe possibility of fertilization may decline. But the safety of ICSI has notbeen proved yet and according to our results, ICSI was not necessarilyneeded in case of subnormal sperm. Therefore, it seems that conventionalIVF without ICSI is sufficient as a fertilization method for subnormalsperm.

P-189 Tuesday, October 21, 2014

MEN WITH A COMPLETE ABSENCE OF NORMAL FORMS (0%)ON STRICTMORPHOLOGY EXHIBIT HIGH RATES OF SUCCESSWITHOUT IN VITRO FERTILIZATION. J. R. Kovac,a R. P. Smith,b

M. Cajipe,c J. Scovell,c R. Ramasamy,c J. Dupree,c G. Langille,c

D. J. Lamb,c L. I. Lipshultz.c aUrology of Indiana, Carmel, IN; bUniversityof Virginia, Charlottesville, VA; cBaylor College of Medicine, Houston, TX.

OBJECTIVE: In couples with infertility, an abnormal strict morphology of0% normal forms (NF) is often used as a criterion to proceed rapidly to in-vitro fertilization (IVF). A paucity of data exists examining reproductive suc-cess for these couples outside of IVF. We investigated the outcomes of menwith 0% NF to determine success of natural conception (NC) & intra-uterineinsemination (IUI) compared to IVF.

DESIGN: Cohort study on patients from a high volume, tertiary, infertilityclinic from 2010-13.

MATERIALS AND METHODS: A total of 24 men with 0% NF(strict Kruger criteria) were identified with 18 randomly selected men>4% NF used as controls. Patient charts were reviewed & men contacted& administered an IRB-approved telephone questionnaire to ascertainoutcomes.

RESULTS: Average age of men & spouses in the 0%NF& control cohortswas not significantly different. Men with 0% NF revealed normal levels ofLH, FSH, testosterone & estradiol. As expected, FSH was significantlyhigher in men with 0% NF (p¼0.04). Semen analysis demonstrated similarvolumes in men with 0%NF compared to controls while forward progression(2�0.1 vs. 2.4�0.1, p¼0.0003), density (7�1.4 vs. 50�7, p<0.0001) & totalmotile counts (7�1.8 vs. 59�9, p<0.0001) were different. Of those men with0%NF, 42% (n¼10/24) achieved pregnancy. A total of 29% (n¼7/24) did notrequire IVF (NC¼25%, n¼6/24; IUI¼4.2%, n¼1/24). IVF was used in12.5% (n¼3/24). Controls achieved pregnancy on 78% of occasions(n¼14/18) of which 72% (n¼13/18) did not require IVF (NC¼67%,n¼12/18; IUI¼5.5%, n¼1/18). IVF was used in 22% of control men (n¼4/18). Only one case was for primary infertility (5.5%) while 3 were for sec-ondary infertility following a natural birth (17%). In men with 0% NF &the first pregnancy was conceived without IVF (n¼7), 100% had successon subsequent occasions (n¼7/7). In control men with sequential birthswhere the first pregnancy was conceived without IVF (n¼6), 50% (n¼3/6)went on to require IVF with subsequent pregnancies.

CONCLUSION:Menwith 0%NF conceivedwithout IVF in 29% of cases.Control men had success 72% of the time. Strict morphology provides impor-tant information about the process of spermatogenesis but should not be usedto predict fertilization potential. In men with severe teratozoospermia &where maternal age allows, alternative modalities may be considered priorto immediate IVF.

Supported by: JRK is Supported by a Male Reproductive Health Research(MHRH)Career Development Physician Scientist Award (K12) (HD073917-

e202 ASRM Abstracts

01) from the Eunice Kennedy Shriver National Institute of Child Health andHuman Development (NICHD) Program to DJL.

P-190 Tuesday, October 21, 2014

THE EFFECTS OF SPERM CONCENTRATION ON IN VITRO EM-BRYO DEVELOPMENT. B. Tilley,a G. Navarrete,a S. Chantilis,a,b

K. Lee,a,b M. Thomas,a,b R. Gada,a,b S. Purcell,a M. Meintjes.a,c aDallasFertility Center, Dallas, TX; bDallas-Ft. Worth Fertility Associates, Dallas,TX; cFrisco Institute for Reproductive Medicine, Frisco, TX.

OBJECTIVE: To determine if decreased sperm concentration used in con-ventional inseminationwould affect normal and abnormal fertilization rate orsubsequent in vitro embryo development.DESIGN: Prospective sibling oocyte study.MATERIALS AND METHODS: Patients were< 41 years old or using

donor oocytes, hadR 8 oocytes retrieved,<2 previous cycles, and used freshejaculated sperm. Oocytes were divided equally into four different concen-trations of motile sperm: (A) 0.15x10̂6/mL, (B) 0.10x10̂6/mL, (C)0.075x10̂6/mL, and (D) 0.05x10̂6/mL. Odd numbers of oocytes went tothe greatest sperm concentration first. Spermwas added 6 hours post retrievaland fertilization assessed 18 h later. Fertilization took place in 200ul drops ofP-1 + 5mg/mLHSA (Irvine) and embryos were cultured in G1/G2 (Vitrolife)+ 10% SSS (Irvine) all under oil in humidified 6%CO2 and 5%O2. Normaland abnormal fertilization, day 5 blastocyst formation per 2PN, number offreeze quality blastocysts per 2PN, and number transferred per 2PN wereanalyzed by ANOVA. Differences between treatments were assessed usingFisher’s LSD. Odds of obtaining low fertilization, defined as <50% 2PN,were calculated using logistic regression.RESULTS: A total of 533 oocytes were retrieved from 25 patients. Overall

normal and abnormal fertilization rates were 73.7 and 14.3%; respectively.Overall, implantation and clinical pregnancy rates were 57.5% and 62.5%;respectively, with an average number of embryos transferred of 1.7. Theodds of insemination resulting in low fertilization were not increased bydecreasing sperm concentration. Treatment group means � SE are shownin the table below. No significant differences between treatment groupswere observed for any variable.

Treatment Oocytes 2PN Abnormal Blastocyts ET Cryo

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2, No. 3, Suppleme nt, Septe

A

144 7 4.8�5.0 16.4�4.4 48.5�6.4 1 8.4�4.9 1 3.4�4.4 B 137 7 9.3�5.0 10.5�3.1 52.2�6.5 1 1.4�3.2 2 5.3�5.6 C 130 6 8.5�5.1 16.1�3.9 41.7�3.9 1 1.5�4.7 1 3.3�4.9 D 122 7 2.3�5.7 14.2�5.7 43.4�5.7 1 1.9�4.8 1 7.3�4.2

CONCLUSION: Decreasing sperm concentration to only 50,000 motilesperm/mL for conventional insemination does not significantly affect normalor abnormal fertilization. However, decreased sperm concentration did notresult in any improvement in embryo development either.

P-191 Tuesday, October 21, 2014

SPERM DEATH AFTER FERTILIZATION ON CONVENTIONALIVF CAN BE A GOOD PREDICTION OF IVFOUTCOMES. S. J. Kwak, I. H. Park, K. H. Lee, S. G. Kim,H. G. Sun, Y. Y. Kim, J. H. Lee, J. Y. Park. Infertility Lab., Mamapapa&-Baby Obstetrics and Gynecology, Ulsan, Republic of Korea.

OBJECTIVE: Live and motile sperm is usually observed after fertilizationin the culture dish, but interestingly dead and immotile spermwas sometimesobserved. However, the association of sperm death after fertilization in theculture dish and IVF outcomes have not yet reported. In this study, we inves-tigated relationship association of IVF outcomes and sperm death in the cul-ture dish after fertilization on conventional IVF.DESIGN: Retrospective cohort study.MATERIALS AND METHODS: We analyzed 472 cycles from patients

aged under 40 years undergoing conventional IVF from January 2012 toDecember 2013. After fertilization, the patients were classified dependingon sperm condition in the culture dish into two groups : group A (n¼435):high percentage of the living sperm with hyperactivated motility, group B

mber 2014