Materials and methods: Two hundred and thirty-eight patients (age

Abstracts of the 15th Annual meeting of the ESHRE, Tours, France 1999

Materials and methods: Two hundred and thirty-eight patients (age: 32.1 years ± 6.8 SD) underwent antegrade sclerotherapy because of infertility (n = 165), or scrotal symptoms (n = 73). According to clinical classification, three cases were subclinical, 20 were grade I, 76 grade II, and 139 grade III. Duplex scanner evidenced venous basal reflux in 232 patients, while in six patients only a prolonged reflux during Valsalva manoeuvre was present. After an inguinal anaesthetic block, the funicular cord is exposed out of the scrotum and both external and internal funicular tunicae are opened, entering the funicular fat. Here the large veins of the ventrolateral compartment (which drain into the internal spermatic vein and have no topographic relation to the testicular artery) are identified. One or more veins are isolated and a butterfly needle 23-25 G is inserted After adopting proper measures to avoid the reflux of sclerosing medium in the testis, we infuse 1-4 ml Athoxysclerol 3%, while the patient is making a long Valsalva manoeuvre Results: Approximately, two veins per patient are injected (range 1-6), using 2.6 ml Athoxysclerol 3% (range 1-4 ml). At a follow-up by clinical examination and duplex-scanner after 3 months at least (mean 3.6 months, range 3-16 months), 173 patients out of 195 (88.7%) were free from varicocele and venous reflux, while a persistent varicocele was shown in 22 patients. No correlation was shown between surgical results and the grade of varicocele or the dose of sclerosing medium used. On the other hand, the prevalence of surgical failure differed significantly between the two surgeons' teams (6 of 93 versus 17 of 99: P = 0.02). In 66 infertile men controlled by seminal examination 6 months later, the total sperm count increased from 63.3 X 106/ejaculate (median) to 85.8 X 106/ejaculate (P = 0.04), the forward motility ('a + b' according to WHO, 1992) from 15% (median) to 21% (P = 0.02) and normal forms (WHO, 1992) from 11% (median) to 15% (P = 0.001). Referring to complications, we observed one left (chemical?) orchitis and six cases of transient hydrocele with funicular inflammation. All the complications were observed in the first 6 months of our experience with this procedure and none occurred since. Discussion: Varicocele correction in infertile males represents an attempt to improve seminal parameters. Therefore we have to look for the easiest, cheapest, and best tolerated surgical procedure. Based on this experience, we can state that the antegrade sclerotherapy of varicocele is easier and cheaper than both the Ivanissevich procedure and the retrograde sclerotherapy we have used till now on >2300 patients. The low risk of testicular damage (0.4% in our filed cases, 0.1 % in Tauber's >4000 observed cases), has not been considered yet as a motivation to refuse this procedure among our patients. P-012. Sperm parameters and the choice of assisted reproductive techniques Hafez S.M.F., Mahdy N.H., Hanno A.G. and Sahwi S.

International Fertility Center, Alexandria, Egypt Introduction: The aim of this study was to determine the impact of the different independent variables [count, motility

morphology (using Krugger's strict criteria) and acrosome morphology] on fertilization and pregnancy, and to establish a sperm fertility scoring system for a more objective choice of assisted reproductive techniques (ART). Material and methods: A retrospective analysis of 80 assisted conception cycles: 18 successful AIH cycles, 30 IVF cycles and 50 ICSI cycles in which 12 or more oocytes were retrieved and a minimum of three oocytes were inseminated to test for sperm fertilizing capacity. The different parameters of recovered spermatozoa after a sequential Percoll swim-up preparation technique were assessed and scored: count out of 3, motility out of 10, morphology 4, and acrosome 4 (i.e. total fertility score out of 21). AIH was attempted using total sperm yield. For IVF cycles and sperm fertilizing capacity assessment in ICSI cycles, oocyte insemination counts were 50100 000 spermatozoa/ml. Results: Stepwise logistic regression of fertilization as the dependent showed the motility to be the most important parameter affecting fertilization followed by morphology (OR = 5.29 and 3.22 respectively, model X 2 1 =38.45, P < 0.05). On the other hand, after utilizing appropriate ART, stepwise logistic regression of pregnancy as the dependent showed the morphology to be the most important parameter affecting pregnancy followed by motility (OR = 1.42 and 4.47 respectively, model X 2 1 = 16.467, P < 0.05). Computer-based cut-off points of the proposed fertility score for the occurrence of fertilization and pregnancy by AIH and IVF were 12 and 14 respectively. Sperm samples with scores ~ 10 showed total fertilization failure. While samples with scores > 10 to < 14 were capable of fertilization in 5/12 cases (41.76%). On the other hand, when ICSI was used to overcome fertilization failure sperm samples with fertility score as low as 4 were capable of achieving pregnancy. Conclusion: Motility is the most important parameter affecting fertilization, while on utilizing ICSI to overcome fertilization failure, morphology became the most important predictor for the achievement of the ultimate goal 'pregnancy'. The proposed fertility score when applied to post-preparation sperm samples offer a more objective choice of the appropriate ART.

P-013. Influence of time after vasectomy on the outcome of ICSI with testicular spermatozoa De Croo 1.1, Van der Elst J.1, Comhaire F.2 , Everaert K.3, De Vries M. I , De Sutter p.l and Dhont M.I 1Infertility Centre, Department of Obstetrics and Gynaecology, 2Departement of Internal Medecine, and 3Department of Urology, Ghent University Hospital, De Pintelaan 185, 9000 Ghent

Introduction: Three per cent of vasectomized men present for surgical reversal when they have renewed child wish. Results are best if reversal is done within 10 years. But even then the vasovasostomy is not always successful and does not lead to return of spermatozoa in the ejaculate. For these patients intracytoplasmic sperm injection (ICSI) in combination with epididymal sperm aspiration (MESA) or testicular sperm 145

Abstracts of the 15th Annual Meeting of the ESHRE, Tours, France 1999

extraction (TESE) is the only possibility to father their own genetic children. The aim of this retrospective analysis was to determine whether time after vasectomy has influence on the outcome of ICSI with testicular spermatozoa. Materials and methods: Between 1 January 1995 and 31 December 1998, 58 fresh TESE-ICSI cycles were carried out in cases of failed vasectomy reversal. The time after vasectomy was < 10 years in 13 cycles (group 1), between 10 and 20 years in 35 cycles (group 2) and ;:::20 years in 10 cycles (group 3). Following an open testicular biopsy under local anaesthesia, testicular spermatozoa were isolated by mincing the testis biopsy. ANOVA, Newman-Keuls post-test, and Chisquare were applied for statistical analysis. Results: Male (but not female) age was different between the three groups. Fertilization rates were significantly higher in group 1 (74.3%) and group 2 (80.3%) than in group 3 (51.3%). The percentage of good-quality embryos was significantly higher in group 1 (81.1%) and group 2 (79.3%) compared with group 3 (62.7%). Pregnancy rate in group 1 was higher than in groups 2 and 3, but significantly so. Embryo implantation rate was lower in group 3 but not significantly so. Time after vasectomy