Materials and Methods: Twenty frozen semen samples were obtained Fragment Length Polymorphism (RFLP) method.

RFLP) method. The statistical risk of

from 16 subjects (cancer patients, n⫽6 and male infertility patients enrolled MTHFR genotype was assessed by SAS 8.1.
in an ART program, n⫽10) who required disposal of their samples stored in Results: When we compared MTHFR genotype between infertile patients
our sperm bank. Each sample was evaluated for motile sperm count, percent and control subjects, the frequency of MTHFR 677TT mutation showed
and progressive motility, viability and morphology (strict criteria). Wil- 16.7% (P⫽0.0207, N⫽63) in infertile males (N⫽377), instead no signifi-
coxon signed-rank test was used to test for statistical differences in sperm cance of A1298C variation (P⫽0.4119). We further analyzed the 677TT
parameters. frequency after classifying infertile males into two groups (explained group
Results: There was a significant decrease in all sperm parameters after the indicates infertile males with any Yq deletion or chromosome disorder, and
thaw-refreeze process. Motile sperm count, percent sperm motility, progres- unexplained group). The relative risk of the 677TT genotype was signifi-
sive sperm motility, viability and morphology decreased from 5.8 mil- cantly higher in the unexplained infertile group (P⫽ 0.0164), instead no
lion/mL to 1.9 million/mL (P⬍0.01), 38.3% to 20.2% (P⬍0.01), 28.4% to significance in the explained group (P⫽ 0.3089). Specially, the unexplained
11.5% (P⬍0.01), 38.7% to 19.3% (P⬍0.01), and from 5.3% to 4.3%, group with severe OAT had statistically significant in MTHFR 677 TT
respectively. There was no difference between cancer and ART patients genotype (24.4% (P⫽0.0140), odd ratios; 3.16, 95% CI; 1.22-8.21).
regarding the outcome of the refreeze-thaw process. Conclusion: The MTHFR 677TT genotype may be independent genetic
Conclusion: Normal and viable motile sperm can be obtained after risk factor for male infertility, especially with severe OAT.
thaw-refreeze sperm using the standard vapor freezing method. The number Key Words: male infertility/ MTHFR/ pyrosequencing/ severe OAT.
of good quality spermatozoa are adequate for in vitro fertilization using This study was supported by a grant of the Korea Health 21 R&D Project,
intracytoplasmic sperm injection. Therefore, leftover frozen-thawed speci- Ministry of Health & Welfare, Republic of Korea (01-PJ10-PG6-01GN13-
mens can be refrozen for future use. This approach has benefits specially for 0002).
cancer patients who urge to start the chemotherapy/radiotherapy and cannot
freeze multiple specimens.
P-325

P-323 Pregnancy rates following varicocele repair without seminal improve-

ment. Peter C. Fretz, Jill Blaine, John Milleman BS, Amy E. T. Sparks, Jay
The effect of varicocelectomy on men with painful varicoceles. Alex- I. Sandlow. Univ of Iowa, Iowa City, IA.
ander Epelbaum, William Blank. SUNY Downstate, Brooklyn, NY.
Objective: Nearly one-third of patients fail to improve following varico-
Objective: Varicoceles can be the cause of chronic scrotal pain. However, cele repair. However, there have not been any reports to date as to the
this cause is usually not considered in the differential diagnosis by most outcome of these couples. Therefore, our objective was to determine the
physicians. Varicocelectomy is one of the options in treating men presenting pregnancy rate in patients who have undergone varicocele repair without
with painful varicoceles. There is limited data in the literature supporting subsequent improvement in seminal parameters.
this treatment modality. We evaluated the effect of varicocelectomy done Design: Retrospective chart review of patients undergoing varicocele
for patients presenting with a painful varicocele. repair.
Design: Retrospective review. Materials and Methods: Following IRB approval, follow up was obtained
Materials and Methods: We performed a retrospective chart review to from patients who underwent varicocele repair from 7/95 through 3/02.
identify all men who had undergone varicocele ligation from February 1998 Only clinically significant varicoceles (no subclinical) were repaired. Data
to August 2001 by a single surgeon at a university outpatient center. Only was gathered from chart review, mail survey, and patient self-report. Pa-
those patients who had undergone a surgical ligation of a varicocele for pain tients without pre and postoperative seminal fluid analyses (SFA), as well as
were included in our study. Chart review was performed to document pregnancy follow up, were excluded. Follow up of at least one year was
patient age, grade and location of varicocele, duration and quality of pain, required to be included in pregnancy data, unless pregnancy was achieved
response to conservative therapy and surgical ligation. Each varicocelec- earlier. Significant seminal improvement was defined as at least a 50%
tomy was performed using a microsurgical subinguinal technique by the increase in any of the following: motile sperm/ml, sperm/ml, or % motility.
same surgeon at the university outpatient center. Results: A total of 285 patients underwent varicocele repair in the defined
Results: We identified 62 patients who presented with chronic scrotal study period. Complete follow up was available for 133 patients. A total of
pain secondary to a varicocele. All patients were initially treated with 89 (67%) of these patients had a significant improvement in at least one of
conservative therapy which consisted of nonsteroidal analgesic medications, their seminal parameters and 44 (33%) did not. Of the 133 patients, 49
scrotal support and limitation of physical activity. There were 55 patients (37%) achieved natural conception and 84 (63%) did not. Of those 84, 59
available for follow up, of which 2 (3.2%) patients had complete resolution went on to in vitro fertilization, with 36 (61%) achieving pregnancy.
of symptoms with conservative therapy and 51 (82.3%) underwent a vari- However, of the 44 patients who did not demonstrate significant improve-
cocelectomy for a painful varicocele. Of the 51 patients who underwent a ment in at least one of the above parameters, 10 (23%) achieved natural
varicocelectomy, 44 (86.3%) had complete resolution of symptoms and conception. There were no significant differences in male or female ages
remained pain free at postoperative evaluations. Two (3.9%) patients had between the groups with and without improvement.
partial resolution of their symptoms and in 5 (9.8%) patients the pain did not Conclusion: Repair of clinically significant varicoceles results in a rea-
resolve after surgery. sonable chance of natural conception, even in patients who do not demon-
Conclusion: Varicoceles may be the cause of chronic scrotal pain. Var- strate significant improvements in their postoperative seminal parameters.
icocelectomy is an excellent modality for men presenting with a painful This rate is higher than previously reported pregnancy rates of approxi-
varicocele, who fail to respond to conservative treatment. mately 15% for untreated varicoceles. Therefore, couples should be coun-
seled to continue attempts at conception following repair, despite lack of
seminal improvement, unless time is of the essence.
P-324
The C677T polymorphism in methylenetetrahydrofolate reductase P-326
(MTHFR) gene associates with unexplained male infertility with severe
OAT. Suman Lee, Yu-Mi Jeong, Sook-Hwan Lee, Kwang Yul Cha, Tae- Leydig and sertoli cell secretory function in men with Y-chromosome
Gue Chung, Tae-Ki Yoon. Pochon CHA Univ, Seoul, Republic of Korea. microdeletions. Apostolos J. Kaponis, Nikolaos Kanakas, Yasuyuki Mio,
Ikuo Miyagawa, Nikolaos Sofikitis. Tottori Univ Sch of Medicine, Yonago,
Objective: To determine whether MTHFR (C677T and A1298C) geno- Japan; MFC, Mio Fertility Clin, Yonago, Japan; Ioannina Univ Sch of
type is associated with male infertility. Medicine, Ioannina, Greece.
Design: Clinical and controlled study.
Materials and Methods: We enrolled 377 infertile (281 azoospermia, 59 Objective: We evaluated the Leydig and Sertoli cell secretory function in
severe OATs, 26 OATs, 11 etc.) and 396 healthy fertile males and checked men with microdeletions in AZFc area of Y chromosome.
their karyotyping and Yq deletion, and analyzed the C677T and A1298C Design: A prospective, controlled study.
mutations in the MTHFR gene by pyrosequencing and PCR-Restriction Materials and Methods: Participants in the current study were eight

FERTILITY & STERILITY威 S229