Group II (82.3, 55.6%), Group III (42.5, 3 9.7%), (p,0.0001). When themen were separated into groups by their partner’s age,,35 or $35, nosignificant differences were found in count, motility or normal headmorphology.

Conclusions: Seminal parameters in men over the age of 40 presenting toan IVF facility tended to be normal except for strict morphology. Therewere no age-dependent changes observed in sperm count, motility, and stricthead morphology. The positive correlation between percent tail defects andage implies that these abnormalities increase with age. Furthermore, therewere no significant differences in the parameters when the men werestratified by female age (, or $35). The low percentage of normal headmorphology (Kruger) may be a contributing cause of this population’sinfertility, a result of their age, or due to the poor discriminative value of theKruger analysis.

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Analysis of Simultaneous Testicular Histopathology, Wet Preparation,Touch Print Cytology and Sperm Recovery in Nonobstructive Azoo-spermic Males. S. Kahram, M. Samlı, T. Evrenkaya, K. Yakın, E. Do¨n-mez, S. Sertyel. Istanbul Memorial Hospital Reproductive Endocrinology& ART Unit, Istanbul, Turkey.

Objective: Multiple testicular sperm extraction may enhance the diagnos-tic accuracy of testicular failure and increases the number of sperm cellsretrieved. This study questions how many non-obstructive azoospermic(NOA) males generate sufficient number of spermatozoa to be used in ICSI.In order to predict the sperm presence or absence in NOA males, testicularhistopathology, wet preparation and touch print cytology were performedsimultaneously and the results were compared.

Design: Prospective clinical trial.Materials and Methods: Multiple testicular biopsies were performed in

three hundred and sixty-three NOA males. Simultaneous diagnostic testic-ular sperm extraction (TESE) and touch print cytology were executed toevaluate sperm presence or absence. During TESE, simultaneous his-topathologic and touch-print cytologic examinations were performed andthe detected sperm cells were frozen and stored for a later use. Histopatho-logic scoring was based on Johssen’s semiquantitative criteria.

Results: Out of 363 NOA cases, 46% were found to have complete germcell aplasia (CGCA; group A), while 37% had incomplete GCA andmaturation arrest with focal spermatogenesis (IGCA1MA; group D). Sevenpercent had complete MA (group B) and 4% was found to have completeGCA-MA (group C). Hypospermatogenesis was observed only 6% (groupE). The mean number of total testicular biopsies was 9.8 in patients withcomplete MA while this number was only 2.8 in patients with hiposper-matogenesis (,0.05). The rate of sperm recovery in relation to testicularhistopathology was very dramatic in the groups a, b, c compared to thegroups d, e and f (p,0.001 abc, def). The overall sperm recovery rate wasonly 1.3% in 979 testicular tissues biopsied (13/979). The sensitivity andspecificity were found to be higher with touch print cytology in terms ofspermatogenesis than the evaluation with wet preparation (98.6% vs. 72%and 96.8% vs. 89%). (p,0.0001). The positive negative predictive value(PPV, NPV) was also found to be higher with touch print cytology (90% vs.53%, 96.8% vs. 89%). Only 13% sperm recovery rate was obtained inpatients with less than 5% hypospermatogenesis with histopathology. Thisrate was found to be 40% when the level of hypospermatogenesis was morethan 10%. Sperm recovery in patients with different level of hypospermato-genesis was found significantly different (p,0.001).

Conclusion: Patients with hypospermatogenesis need less biopsies thanpatients with complete SCO and maturation arrest. Touch printing is morepredictive than wet preparation in diagnosis of spermatogenesis. A previousmultiple testicular biopsy for histopathology and diagnostic TESE mayexclude patients from ovulation induction and ICSI.

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Relationship Between Hyperactivation and Fertilization Rate of IVF-ET. 1Y. Shimizu,1T. Aso,1R. A. Bronson.1Department of Obstetrics andGynecology, Tokyo Medical and Dental University, Tokyo, Japan,2Depart-ment of Obstetrics and Gynecology, State University of New York at StonyBrook, Stony Brook, NY.

Objectives: Hyperactivation is recognized as a part of the process ofcapacitation. In this study, we analyzed the relationship between the per-centage of hyperactivated sperm and fertilization rate during IVF-ET.

Design: Motility parameters of sperm utilized for insemination duringIVF-ET were analyzed using a computer-assisted sperm analyzer HTM-IVOS.

Materials and Methods: Forty five couples who underwent conventionalIVF-ET therapy were included in this study. Motility parameters of spermutilized for insemination during IVF-ET were analyzed 20 minutes afterejaculation and also after 60 minutes swim up. The rate of hyperactivatedsperm were calculated according to two criteria: 1) that of Burkman (VCL:curvilinear velocity.100 mm/s, LIN: linearity,65%, ALH: amplitude oflateral head displacement.7.5mm). 2) that of Mortimer (VCL.100mm/s,LIN ,60%, ALH .5 mm).

Results: The rate of hyperactivated sperm was greater in good fertiliza-tion group (21.56 11.5%: M6 S.D. fertilization rate.30%, n532) thanpoor fertilization group (13.86 15.6%: fertilization rate,30%, n513)when analyzed after swim up (p,0.05), but there was no difference whenanalyzed before swim up. When we used the Mortimer’s criteria as hyper-activation, no difference was detected. As to other motion parametersanalyzed, VCL and ALH were greater in the good fertilization group whenanalyzed after swim up, but not before swim up. The rate of hyperactivatedsperm was greater in normozoospermic group than in oligozoospermicgroup, but not between normozoospermic and asthenozoospermic groupwhen analyzed after swim up.

Conclusion: The hyperactivated motility was a good parameter for fer-tilizing potential of sperm when analyzed after 60 minute swim up.

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The Histologic Effects of TESE on the Testicle in Men With Nonob-structive Azoospermia. J. A. Tash, P. N. Schlegel. Department of Urol-ogy, The New York Presbyterian Hospital-Cornell Medical Center, NewYork, NY.

Objectives: Testicular sperm extraction (TESE) is a therapeutic techniquethat has revolutionized the treatment of severe male infertility presenting asnonobstructive azoospermia. However, the procedure is not without sideeffects involving at least a transient effect on spermatogenesis. The purposeof this study was to analyze the effects of TESE on the testicle by system-atically comparing the ratio of seminiferous tubule volume to interstitialspace in each of two paired histologic specimens taken from the same testisbefore and after TESE. We also evaluated the effect of TESE on the numberof germ cells seen within the tubules for each paired specimen.

Design: Paired testicular biopsy specimens taken from seven patientswith nonobstructive azoospermia before and after TESE were analyzed.Each patient had undergone at least two TESE procedures at the same siteon the testicle. Therefore, comparisons could be made between the two setsof data.

Materials and Methods: A morphometric analysis of the testicular histol-ogy was performed for all testicular biopsy samples using a standardized,validated technique. First, a quantitative evaluation of interstitial volumewas done with a 121-point grid over multiple fields of the testicularspecimen slides. The second step of the analysis involved a comparison ofthe number of germ cells per tubule in each set of specimens. Both student’st-test and Wilcoxon matched pairs tests were used for analysis.

Results: In the first set of TESE specimens, interstitium comprised 30,367of 63,525 grid points, or 47.8% of the specimen area. This increased to34,888 points, or 54.9%, in the second set of specimens. This increase ininterstitial tissue and corresponding decrease in seminiferous tubular vol-ume was statistically significant (P,0.00042). Our data also showed a5.48% decrease in the number of germ cells per tubule in each data set (from3222 to 2887, p50.25), which suggests a trend toward a lower number ofgerm cells per tubule in the second biopsy specimens.

Conclusions: These findings support our clinical observation that TESEcauses an increase in interstitial tissue volume within the testicular paren-chyma adjacent to the biopsy site. This reflects a potentially adverse localeffect of TESE on spermatogenesis which may have important clinicalconsequences.

S242 Abstracts Vol. 74, No. 3, Suppl. 1, September 2000