P-231

Initial findings using gene sequence analysis for CFTR mutations in atrisk fertility patients. Lauri D. Black, Paul J. Turek. CA Pacific MedicalCtr, San Francisco, CA; Univ of CA, San Francisco, San Francisco, CA.

Objective: Detection rates with DNA analysis for CFTR (Cystic FibrosisTransmembrane Conductance Regulator) gene mutations vary widely depend-ing on patient ancestry. In addition to routine common mutation testing andconformation-sensitive gel electrophoresis (CSGE) of specific exons, genesequencing is now clinically available. We studied the ability of gene sequenceanalysis to define mutations in an at risk population of infertile couples.

Design: Prospective study of CFTR mutations in infertile men withcongenital bilateral absence of the vas deferens (CBAVD) and their partnersreferred for genetic counseling and testing.

Materials/Methods: Genetic counseling was provided and informed con-sent was obtained prior to genetic testing for CFTR mutations. Six coupleswho presented with CBAVD were studied. A combination of two mutationanalysis techniques were used to determine CFTR mutations, includingcommon mutation analysis (variable detection rate based on ancestry) andCSGE analysis (variable detection rate based on ancestry). Gene sequenceanalysis was also offered (approximately 99% detection rates regardless ofancestry). Indications for sequencing were: a) negative CFTR mutationanalysis results by other methods, b) assumed low detection rates with othermethods due to patient ancestry, and c) patient choice.

Results: See table.

CFTR Mutation Analysis Results for Men with CBAVD and Their Partners

Male/FemaleAncestry

CommonMutation 5T CSGE Sequence Female Partner

OfferPGD?

Cauc/Cauc† Neg (31) Neg — Het P750L Het deltaF508 (com) YesAsian/Asian Neg (31) Het‡ Neg Neg Het R74W (CSGE) NoAsian/Asian Neg (31) Neg — Het V201M Pending (sequence) TBD§

Indian/Indian Neg (31) Het — Het 1717-4A3G Pending (sequence) TBDAsian/Asian — Neg — V5201/3601-3C3A Neg (sequence) NoCauc/Ashken� — Het — DeltaF508/R117H Het G551D (com) Yes† Cauc � Caucasian (European ancestry) � Ashken � Ashkenazi (Eastern European)Jewish ancestry ‡ Het � heterozygous (carrier) § TBD � To Be Decided

Conclusions: Gene sequence analysis detects CFTR mutations in at riskcouples in whom other CFTR mutation analyses were negative. For menwith CBAVD, providing the highest detection rates for CF gene mutationsis critical for informed decision making regarding reproductive genetic risksand assisted reproduction options, such as preimplantation genetic diagno-sis.

Supported by: Not applicable.

P-232

Self-controlled comparison of clinical outcome after ICSI treatmentsusing ejaculated, epididymal and testicular sperm in the same coupleswith azoospermic infertility. Jin Hyun Jun, Sang Jin Song, Chun KyuLim, Dong Mi Min, Sun Hee Lee, Yong Seok Park. Lab of ReproductiveBiology and Infertility, Samsung Cheil Hosp, Sungkyunkwan Univ, Sch ofMedicine, Seoul, South Korea.

Objective: It has been reported that the clinical outcome is not signifi-cantly different in ICSI treatments using ejaculated (EJ), epididymal (EP)and testicular (TE) sperm. However, these reports analyzed the mixed datafrom different couples. The purpose of this study was to compare thefertilization rate (FR) and delivery rate (DR) following ICSI treatmentsusing EJ, EP and/or TE sperm from the same couple. We evaluated thesuitability of sperm source for achievement of successful delivery in theazoospermic infertility.

Design: Retrospective analysis of clinical ICSI data in a university basedhospital.

Materials/Methods: Clinical data in 231 cycles in 79 couples among5,569 cycles of ICSI performed from 1994 to 2001 were included in thisstudy. The subjects were carried out consecutive ICSI cycles (average�2.9)with two or three kinds of sperm from the same male partner with azoosper-mic infertility. EJ sperm were obtained after surgical correction of obstruc-tion or from non-obstructive azoospermic patients. For statistical analysis,

they were classified following groups. Group I: ICSI with EJ and EP sperm(9 cycles of 4 couples), Group II: ICSI with EJ and TE sperm (49 cycles of14 couples), Group III: ICSI with EP and TE sperm (173 cycles of 64couples). The FR per injected oocyte according to the sperm source in thesame couple was statistically compared by paired t-test. The DR per coupleaccording to the sperm source was calculated by adding up the outcome offresh and frozen-thawed embryo transfer cycles, and analyzed by Fishersexact test or 2-test.

Results: Overall FR per injected oocyte and DR per couple were 66.6%(1598/2397) and 44.3% (35/79), respectively. FRs of EJ, EP and TE spermfrom mixed couples were not significantly different: 64.2 � 22.7%, 66.9 �24.4% and 68.5 � 26.1%, respectively (p �0.05). In the statistical analysisof Group I and Group II, the FR and DR were not significantly different.However, the FR and DR with TE sperm (74.7 � 18.1% and 39.1%) weresignificantly higher than those of EP sperm (67.4 � 24.1% and 12.5%) fromthe same male partner in Group III (p �0.05).

Conclusions: These results show that TE sperm may be more effectivethan EP sperm in the clinical outcome of the consecutive ICSI treatmentswith different kinds of sperm in the same couple. It may be related to thepossible damage of EP sperm in the poor environment of epididymalobstruction. We suggest that TE sperm is more suitable for successfuldelivery in the azoospermic infertility.

Supported by: Dep of Ob & Gyn, Samsung Cheil Hospital, Sungkyunk-wan University, School of Medicine.

P-233

When is too little enough? Pregnancy rates with low total motile spermcount approach normal rates with intrauterine insemination (IUI).Kristen Elsa Cain, Nassim Virji, Amy Henris, Gabriel A. San Roman.Reproductive Science Assoc, Mineola, NY.

Objective: The objective of this study was to determine if total motilesperm count (TMC) is predictive of IUI success.

Design: A retrospective evaluation of 671 patients undergoing insemina-tion with their partner’s semen as treatment for infertility during 2001.

Materials/Methods: Age, TMC, and pregnancy rate (PR) from 671 womenundergoing 1315 IUI cycles from January 1 through December 31, 2001 wereanalyzed. Patients were grouped as (1) �5 million TMC (n�380), (2) 5–9million TMC (n�272), (3) 10–19 million TMC (n�416), (4) 20–49 millionTMC (n�358), and (5) �49 million TMC (n�63). Because the TMC were notnormally distributed, statistical analysis of data was performed using nonpara-metric analysis of variance by ranks (Kruskal-Wallis), and analysis of signifi-cant differences was followed up by post hoc analysis (Dunn’s method forgroup comparison). TMC were presented as medians and interquartile (25%and 75%) ranges. In group (1), 155 IUIs were followed by a second IUI the nextday.

Results: The overall pregnancy rate for the group was 14.9%. There wasno difference in age among the groups. The PR(%) for the groups were 12.6,14.3, 16.5, 16.8, and 9.5, respectively. The PR for group (1) patients with 2IUIs was 13.5% (n�21). The median TMC in this group was 1.2 million(0.6–2.0) for the first IUI and 1.0 million (0.4–3.6) for the second IUI. PRfor group (1) patients with 1 IUI was 12.0% (n�27). By Dunn’s method forbetween-group comparisons, all groups were different with regard to TMCexcept (4) and (5) (p �0.05). By chi-square, there were no differences in PRamong the groups (p �0.05).

Conclusions: Our findings suggest that insemination is an adequate treat-ment for couples with TMC �5 million. It is unclear if repeating insemi-nation in the same cycle is beneficial even with low TMC.

Supported by: Reproductive Science Associates, Mineola, New York.

P-234

Intracytoplasmic sperm injection (ICSI) results according to azoosper-mia etiology. Edson Borges Jr., Lia Rossi-Ferragut, Claudia Chagas Rocha,Fabio F. Pasqualotto, Tsutomu Aoki, Assumpto Iaconelli Jr. Fertility-Assisted Fertilization Ctr, Sao Paulo, Brazil.

Objective: The purpose of this study was to assess laboratory and clinicaloutcome with the ICSI procedure using the epididymal and testicularspermatozoa from different types of azoospermia.

Design: Retrospective study.Materials/Methods: Two hundred fifty-seven ICSI cycles (212 patients)

S192 Abstracts Vol. 78, No. 3, Suppl. 1, September 2002