P-398 Wednesday, October 21, 2015 TREATMENT WITH COMBINED ANTIOXIDANT FORMULATION BEFORE ICSI IMPROVES PREGNANCY RATE IN COUPLES WITH OBSTRUCTIVE AZOOSPERMIA. S. Gulati, R. Chattopadhyay, B. Ghosh, S. Yasmin, S. Ghosh, G. Bose, P. Chakraborty, B. Chakravarty. Assisted Reproduction, Institute of Reproductive Medicine, Kolkata, India. OBJECTIVE: To evaluate the efficacy if any, of a combined antioxidant formulation, in couples with obstructive azoospermia after failed intra cytoplasmic injection (ICSI) cycle. DESIGN: A single centre prospective cohort study of 210 patients with azoospermia was performed from February 2012 to March 2015. MATERIALS AND METHODS: Patients with documented azoospermia were divided into non-obstructive (NOA) (group A; n ¼ 98) and obstructive (OA) (group B; n ¼ 112) counterpart. Absence of sperm (n¼15) and unsatisfactory endometrium (n ¼ 3) were the exclusion criteria in either arm/s. Testicular sperm extraction (TESE) followed by ICSI confirmed pregnancy in 25.3% (n ¼ 21) and 32.11% (n ¼ 32) in group A and B respectively. Patients who failed TESE/ ICSI cycles were treated with a combined antioxidant formulation comprising L-carnitine, CoQ10, zinc, folic acid, vitamin B12 and selenium for 6 months. A placebo-controlled normozoospermic group comprising 75 patients was maintained as controls. ROS-TAC score was determined as biomarker of oxidative stress (OS) from homogenized testicular tissue by standard methods before and after the treatment. Mitochondrial membrane potential (Djm), sperm DNA fragmentation were evaluated by flow-cytometry and comet assay respectively. Study was approved by Institutional Review Board. Statistical comparisons were performed by Stata10.0. The main outcome was clinical pregnancy rate. RESULTS: 62 patients with NOA and 77 patients with OA were treated with combined antioxidant therapy followed by TESE/ICSI. Improvement in sperm morphology was observed in 8.06% (n ¼ 5) in group A compared to 63.64% (n ¼ 49) cases in group B. ROS-TAC score decreased significantly in group B only than controls (33.1  6.2 vs. 52.0  7.1; p < 0.04). Djm and rate of apoptosis improved considerably after antioxidant regimen. Fertilization rate was significantly lower (p< 0.04) in NOA group (56.45%) than the OA group (74.32%). The clinical pregnancy rate was 27.42% (n ¼ 17) and 41.55% (n¼32) in NOA and OA cohorts respectively. This was statistically significant adjusting for age with an odds ratio of 1.06 (95% CI 1.20-3.20, p<0 .008). CONCLUSIONS: Prolonged stasis due to obstruction may increase OS thereby reducing the fertilization potential of the sperm. Combined antioxidant treatment may overcome this scenario by improving clinical pregnancy rate in obstructive azoospermic patients who pursue ART after TESE/ICSI failure in first cycle. References: 1. Kumar R. Medical management of non-obstructive azoospermia. Clinics (Sao Paulo). 2013 Feb; 68(Suppl 1): 75-79. 2. Singh AK, Tiwari AK,Singh P et al., MULTIVITAMIN AND MICRONUTRIENT TREATMENT IMPROVES SEMEN PARAMETERS OF AZOOSPERMIC PATIENTS WITH MATURATION ARREST Indian J Physiol Pharmacol 2010; 54 (2) : 157-163. P-399 Wednesday, October 21, 2015 TOO MUCH OF A GOOD THING? HIGH MOTILE SPERM CONCENTRATIONS MAY REDUCE CONVENTIONAL INSEMINATION IN VITRO FERTILIZATION (CI-IVF) BIRTH. N. Doyle,a G. Patounakis,b T. Han,c R. Stillman,c A. DeCherney,b K. S. Richter.c a Ob/Gyn, Medstar Health, Washington DC, DC; bNational Institutes of Health, Bethesda, MD; cShady Grove Fertility, Rockville, MD. OBJECTIVE: To test the hypothesis that post-wash motile sperm concentration in CI-IVF is associated with outcome. DESIGN: Retrospective review. MATERIALS AND METHODS: All 2010-2013 CI-IVF cycles were reviewed. Fertilization (2pn per retrieved oocyte), availability of embryos suitable for transfer or cryopreservation, and live birth per transfer were evaluated by generalized estimation equations (GEE) analysis accounting for multiple cycles per patient. Potential confounders were included in adjusted models as appropriate. RESULTS: 5,712 cycles by 4,590 patients were available for analysis. Motile sperm concentration used for insemination ranged from 1.2 to 160.8 million motile sperm per mL (MMS/mL, mean ¼ 18.2  7.5 SD, median ¼ 17, lower decile ¼ 10.9, upper decile ¼ 27.6). There was a small but statistically significant positive asso- FERTILITY & STERILITYÒ ciation between motile sperm concentration and fertilization (b¼0.12, p¼0.007, adjusted for age, BMI, diagnoses, number of oocytes retrieved, and numbers of trigger day follicles R 16mm, 14-15.9mm and 12-13.9mm), with fertilization rates rising from 56% to 60% from lowest to highest motile sperm concentrations. Motile sperm concentration and the availability of embryos suitable for transfer or cryopreservation were not related (p¼0.59). Unexpectedly, we found a significant negative association between motile sperm concentration and birth (b¼-0.010, p¼0.014), adjusted for age, BMI, ethnicity, diagnoses, duration of stimulation, endometrial thickness at trigger, number of oocytes retrieved, numbers of trigger day follicles R 16mm, 14-15.9mm and 12-13.9mm, transfer stage (cleavage or blastocyst), assisted hatching and number of embryos transferred. GEE analysis of motile sperm concentration categorized as ‘‘low’’ (28 MMS/mL, n¼377) indicated that compared to moderate concentrations (estimated marginal mean birth ¼ 40.2%), birth rates were significantly higher with low sperm concentrations (44.9%, p¼0.049) and lower with high sperm concentrations (34.6%, p¼0.043). CONCLUSIONS: We found no clinically significant adverse effects of low motile sperm concentration for CI-IVF (within the range used). Rather, results suggest that insemination with high motile sperm concentrations actually reduce birth rates per embryo transfer, with a 10% difference between low and high concentration groups. This possibility warrants further study and confirmation because if accurate the clinical implications are significant, as sperm concentration appeared to be suboptimal in 90% of cycles, and a simple protocol adjustment (diluting the sample) might improve outcomes. Supported by: This work was Supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. P-400 Wednesday, October 21, 2015 PREDICTIVE VALUE OF POSTWASHED TOTAL PROGRESSIVELY MOTILE SPERM COUNT USING CASA ESTIMATES IN 1524 DONOR AND 6871 NON-DONOR INTRAUTERINE INSEMINATION CYCLES. V. Libby,a B. Reed,a S. N. Babayev,a M. Ezzati,a T. K. Ha,a O. Tan,a D. D. McIntire,a B. Carr,a K. Doody.b aUT Southwestern Medical Center, Dallas, TX; bCenter for Assisted Reproduction. OBJECTIVE: To determine whether post-washed total progressively motile sperm count (TPMSC) obtained by CASA estimates could predict biochemical pregnancy and live birth rates in donor and non-donor IUI cycles. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All donor and non-donor IUI cycles at the Center for Assisted Reproduction in Dallas, Texas from January 1999 through December 2011 were reviewed. Both pre- and post-washed semen assessments were performed using the CASA system (Hamilton Thorne Research, Beverly, MA, USA) and TPMSC and TMSC were calculated. Density gradient centrifugation was utilized to isolate motile sperm. Statistical analyses were performed using SAS software. 1,524 IUI cycles with donor sperm and 6,871 IUI cycles with non-donor sperm were analyzed. Patient characteristics, cycle characteristics and pre-washed and post-washed semen parameters were included in analysis. The main outcome measures were biochemical pregnancy and live birth rates (LBR). RESULTS: Mean age of patients using donor sperm was significantly higher than patients using non-donor sperm (34.2 vs 32.2, respectively, P<0.001). The previously observed discriminatory threshold of TPMSC value of more than 0.51 million to predict biochemical pregnancy and live birth in cycles using non-donor sperm was not observed in cycles with donor sperm. After adjusting for female age, there was no statistically significant difference in biochemical pregnancy rate or LBR among different strata of TPMSC within the donor group. On the other hand, after adjustment for confounders using Cochran-Mantel-Haenszel method, the odds ratio of LBR in the donor group, as compared to the non-donor group, was 1.47 (95% CI: 1.26, 1.72). Live Birth Rate Per Cycle by TPMSC Using Donor and Non-Donor Sperm. – TPMSC 0-0.5 million 0.51-1 million 1.01-5 million 5.01-10 million 5.01-10 million Adjusted* Live Birth Rate Per Cycle – – Donor Non-donor P-value Odds Ratio (95% CI) 1/7 (14%) 4/16 (25%) 82/441 (19%) 108/688 (16%) 73/369 (20%) – 34/584 (5.8%) 34/323 (10.5%) 190/1601 (11.9%) 152/1146 (13.3%) 525/3808 (13.8%) – 0.346 0.073 <0.001 0.148 0.002 <0.001 2.70 (0.32, 23.03) 2.83 (0.87, 9.28) 1.70 (1.28, 2.25) 1.21 (0.93, 1.59) 1.54 (1.17, 2.02) 1.47 (1.26, 1.72) * After adjusting for TPMSC categories, there is a significant difference in LBR per cycle between donor and non-donor sperm groups. e241