were categorized as follows: Abnormal (Abnl) any parameter below WHO 5, Gap at least one parameter below WHO 4 but none below WHO 5, and Normal (Nl) all parameters above WHO 4. Univariate and multivariate ana- lyses were performed. RESULTS: 1680 subjects met inclusion criteria and were categorized as follows: Abnl 1383 (82%), Gap 272 (16%), and Nl 25 (1.5%). 873 subjects (751 Abnl and 114 Gap) had a 2 nd semen analysis upon which 43% Gap were downgraded to Abnl while only 14% of Abnl were recategorized as Gap. Multivariate analysis revealed Gap subjects were 45% more likely to change categories on subsequent testing as compared to Abnl and subjects with an untreated varicocele were .57 as likely to change categories as subjects without varicocele. CONCLUSION: A sizable percentage of men fall into the gap between WHO 4 and WHO 5 minimum reference values and these men have sub- stantial odds of falling below WHO 5 on subsequent testing. Men with varicoceles are less likely to change categories. The small number of pa- tients with normal semen results per WHO 4 in study population dem- onstrates that referrals are heavily influenced by published reference limits. P-997 Thursday, October 17, 2013 A SUBSET OF MEN WITH SERTOLI CELL ONLY PATTERN (SCO) HAVE POOR OUTCOMES, EVEN WITH MICRODISSECTION TESTICULAR SPERM EXTRACTION (MTESE). B. M. Berookhim, P. N. Schlegel. Urology, Weill Cornell Medical College, New York, NY. OBJECTIVE: To describe prognosis for specific cohorts of men with SCO undergoing mTESE. DESIGN: Retrospective clinical study. MATERIALS AND METHODS: A review was performed of the last 1494 patients with nonobstructive azoospermia (AZ), confirmed by analysis of 2 centrifuged semen samples, who underwent mTESE at a single center after a sample obtained on the day of planned mTESE confirmed AZ. Patients with complete AZFa or AZFb microdeletions were excluded. Testis volume was measured by physical examination with an orchidometer, and was aver- aged in patients undergoing bilateral mTESE. FSH was obtained within 2 months prior to mTESE. Only patients with 100% SCO on diagnostic biopsy were included. Differences in sperm retrieval rates (SRR) were compared us- ing a chi-square analysis. RESULTS: 670 patients with mean age 34.1 Æ 6.5 years were analyzed. Mean testis volume was 8.2 Æ 4.8 cc. Mean FSH was 25.4 Æ 14.6 mU/ mL. Overall SRR was 43.6%, with a clinical pregnancy rate of 45.6% and live birth rate of 25.4% among those with successful retrieval. SRR was significantly higher among patients with testis volume <15cc compared to R 15cc (45.6% vs 32.4%, p ¼ 0.03) and for patients with FSH R 15 mU/ mL compared to FSH <15 mU/mL (considering men with both low and normal volume testes). SRR stratified by FSH levels are presented in the ta- ble. Men with FSH of 10-15 mU/mL and normal testes had the worst prog- nosis, with an SRR of only 5.9%. Testis Vol <15cc Testis Vol R 15cc FSH <15 FSH R 15 p value FSH <10 FSH 10-15 FSH R 15 p value n 114 482 12 17 45 SRR (%) 34.2 48.8 0.005 33.3 5.9 42.2 0.024 CONCLUSION: Although SCO on diagnostic biopsy can allow sperm retrieval with mTESE at our center, a subset of men with intermediate FSH levels and larger testis volume have a very poor prognosis for sperm retrieval. These men appear to have less heterogeneity within the testis, with a uniform pattern of SCO seen on microdissection. Supported by: James Buchanan Brady Foundation of Cornell’s Depart- ment of Urology and the Reeves Foundation provided support for this study. P-998 Thursday, October 17, 2013 THE ROLE OF MODERATE LEUKOCYTOSPERMIA IN INFER- TILE MEN. S. Alshahrani, R. Sharma, D. Durairajanayagam, E. Sabanegh, A. Agarwal. Cleveland Clinic, Cleveland, OH. OBJECTIVE: Leukocytospermia (>10 6 WBC/mL) has been associated with abnormal sperm characteristics. Our aim was to investigate the effect of moderate leukocytospermia (0.1-1 X 10 6 WBC/mL) on the oxidative stress markers as a potential cause of male infertility. DESIGN: We retrospectively examined the medical records of 211 infer- tile men referred to the andrology clinic. MATERIALS AND METHODS: Patients were divided into group A: no seminal leukocytes, group B: moderate leukocytospermia, and group C: leu- kocytospermia. Patients with varicocele or infections were excluded. Semen parameters (WHO 2010), seminal ROS (chemiluminescence assay), total antioxidant capacity (TAC by colorimeter) and sperm DNA damage (TUNEL assay) were evaluated in all patients. RESULTS: Moderate leukocytospermia and leukocytospermia were de- tected in 36 (18%) and 22 patients (10%) respectively. Semen parameters did not show any significant differences. ROS was significantly higher in pa- tients with leukocytospermia and moderate leukocytospermia compared to non-leukocytospermic group (P < 0.001). Patients with moderate leukocyto- spermia showed significant sperm DNA damage compared to non-leukocy- tospermic group (P ¼ 0.04). The effect of moderate leukocytospermia on semen quality Parameter WBC (X 10 6 WBC/mL) 0 (n¼153) 0.1 -1 (n¼36) > 1 (n¼22) Concentration (x10 6 /mL) 53Æ6 69Æ8 39Æ4 Motility (%) 48.4Æ17 47.3Æ25.7 49Æ19.6 Normal morphology (%) 3.4Æ3 3.6Æ3 4Æ3.8 TAC (micromoles trolox) 1966Æ676 1748Æ629 1988Æ832 ROS (RLU/sec/X10 6 sperm) 116.7(49;550) 944.8(127; 3315) a 61286.8(6905; 234876) a,b DNA damage (%) 20Æ17 26.5Æ19.6 a 24.6Æ17.5 The results are presented as mean Æ SD for all the parameters except ROS which is pre- sented as median (25 th ; 75 th percentile). a P <0.05 statistically significant compared to non-leukocytospermic group. b P <0.05 statistically significant compared to moderate leukocytospermic group. CONCLUSION: Moderate leukocytospermia may affect the fertility po- tential by inducing oxidative stress in infertile patients. P-999 Thursday, October 17, 2013 ICSI OUTCOMES IN MEN WITH EXTREME FORMS OF CRYPTO-/ AZOO-SPERMIA. T. Fields, a Q. V. Neri, a P. N. Schlegel, b Z. Rosenwaks, a G. D. Palermo. a a Reproductive Medicine - CRM, Weill Cor- nell Medical College, New York, NY; b Urology, Weill Cornell Medical Col- lege, New York Presbyterian Hospital, New York, NY. OBJECTIVE: To quantify the meaning and effort involved in an extensive search for spermatozoa in surgically retrieved and ejaculated samples yielding only immotile spermatozoa. DESIGN: During a 7 year period, a total of 507 TESE cycles and 2138 EJAC cycles were included in the study. We categorized cases according to motile vs immotile for each sperm source. We then ranked them in increasing sperm search time in relation to clinical outcome. MATERIALS AND METHODS: Extended sperm quest was performed with an inverted microscope in droplets under oil. Searches, often carried out by several embryologists, were grouped by 30min-1hr, 1-2hrs, 2-3hrs, and >3hrs, and compared to a control requiring less than 30mins. RESULTS: For the 2121 severe oligozoospermic cycles with motile ejac and 17 with completely immotile spermatozoa at the time of injec- tion, the fertilization rate was lower in the latter group (P¼0.0001) and only 47% of these cycles had conceptus replaced yielding an ongoing de- livery rate of 23.5% in comparison to 43.3% achieved with motile sper- matozoa. For the TESE, 440 motile and 67 immotile cases were analyzed. The immotile spermatozoa yielded a fertilization of 26.4%, remarkably lower than the motile cohort (P¼0.0001). Only 68.7% of the immotile group received a conceptus with a clinical pregnancy of 28.4% and an ongoing/delivery rate of 23.9%, also lower than the motile TESE spermatozoa (P<0.01). The increasing search time for both sperm sources did not seem to affect the ability to achieve a clinical pregnancy (at least 1 FHB identified). S436 ASRM Abstracts Vol. 100, No. 3, Supplement, September 2013