OBJECTIVE: The objective and purpose of this study are to examine, analyze, and make recommendations about the use of both the best interests of the child standard and the harm standard in the clinical psychotherapeutic evaluation and screening of applicants for infertility treatment. DESIGN: Review of the academic literature, case law, and legislation. MATERIALS AND METHODS: Bioethical, legal and policy analysis drawing on (1) recent scholarly monographs and academic articles covering the evaluative, administrative, and psychotherapeutic issues involved in screening applicants for infertility treatment and (2) case law and legislation construing and applying the best interests and harm standards. RESULTS: Several problems emerge from the application of the best inter- ests standard in the clinical evaluation of applicants for infertility treatment. First, the academic literature on the subject reveals a lack of precision in distinguishing the best interests of the child standard from the harm standard. Without question, exposing children to serious harm undermines their welfare. What does not promote a child’s welfare, however, does not of necessity harm the child. Using the best interests standard as the gatekeeper in assisted repro- duction fails to give adequate weight to the prospective parents’ interest in procreation as against society’s interest in child welfare. This is because, in the context of assisted reproduction, parental interests are not assumed to be subordinate to the child’s in the same way that they are in adoption and disputes over child custody, the contexts the best interests standard was designed to address. Second, the use of the best interest standard in decisions about access to assisted reproduction risks injecting an element of arbitrariness into the clinic’s gatekeeping function. The best interests standard was developed to afford decisionmakers a tool with which to make fact-specific inquiries into whether the interests of a particular child would be served by particular parents. The standard is thus not particularly well suited to clinical decisionmaking about children who have yet to be conceived and about whom little is known. To the extent clinics wish to prevent applicants who are unsuited to parenthood from gaining access to infertility treatment, they should adopt the harm stan- dard. The harm standard allows parental fitness to be measured through the application of widely accepted criteria. Its use in the clinical setting will lead to greater consistency and neutrality in decisions regarding access than will the use of the best interests standard. CONCLUSIONS: Clinicians evaluating applicants for infertility treat- ment should distinguish efforts to promote the best interests of children from efforts to prevent children from suffering serious harm. The harm standard should be employed to screen applicants for infertility treatment in the first instance, given that it takes into account both the interests of prospective parents and of society’s interest in child welfare. Use of the harm standard will protect applicants against unjustifiable denials of access to infertility treatment and will promote consistency and neutrality in decisions about who should be and who should not be eligible for assisted reproduction. Supported by: None. Monday, October 17, 2005 4:00 p.m. O-47 Dysthymic Mood Parameters Associate With Underlying Cause for Infertility. L. Pal, K. Bevilacqua, J. Norian, S. Bowen, J. Skorupski, N. F. Santoro. Albert Einstein College of Medicine, Bronx, NY; St.Luke’s Roos- evelt, NY, NY. OBJECTIVE: To determine if psychological stress levels vary with underlying etiology for infertility. DESIGN: Prospective. MATERIALS AND METHODS: Infertility patients are offered partici- pation in a prospective ongoing study. IRB approval was obtained. Patients presenting for baseline testing are administered a validated questionnaire evaluating mood status (POMS). 34 completed questionnaires were ana- lyzed. Etiology for infertility was elucidated from review of records (male, ovulatory, tubal, diminished ovarian reserve, unexplained, other). Question- naires were scored for moods (anger, depression, fatigue, confusion, vigor, total mood) by a trained psychologist (KB). Age was dichotomized as 35 and  35. Association between mood parameters & ovarian reserve (re- flected by maximal FSH levels) was evaluated using linear regression analysis. Associations between mood parameters & type of infertility were evaluated using multivariate linear regression analysis, after adjusting for age & history of ever being pregnant. RESULTS: Increasing psychological stress (higher scores for tension, anger, confusion, fatigue, total mood & lower scores for vigor) was asso- ciated with increasing maximal FSH . Significant positive association of maximal FSH with anger (p0.039), confusion (p0.037), & significant neg- ative association with vigor p=0.003) were noted in participants  35 compared to 35 years age. Significantly higher scores for total mood disturbance (p0.031), anger (p=0.011), tension (p0.036), fatigue(p0.028) & depression (p0.011) were reported by women with tubal infertility (fig1), after adjusting for other etiologies, prior pregnancy and age. Unexplained infertility was associated with significantly higher scores (fig2) for depres- sion (p0.017), tension (p0.005), anger (p0.006), confusion (p0.018), fatigue (p0.003) & total mood (p0.006) compared to other causes of infertility. Increasing age was inversely associated with dysphoric mood; significantly lower scores for total mood (p0.05), anger (p0.011), fatigue (p0.037) & tension (0.041) and a trend towards lower scores for confusion & depression were noted with increasing age. Prior history of conception was associated with significant reduction in tension (p0.024) & depression (p0.048), & a trend towards decreasing anger (p0.053) scores. CONCLUSIONS: Psychological burdens accompanying infertility are influenced by parameters of ovarian reserve. Older infertile patients are psychologically better able to deal with stresses associated with infertility. Tubal & unexplained infertility were associated with significantly higher psychological burden compared to other causes for infertility. Supported by: Supported in part by NIH 5K12 RR17672 (to LP) and CD 41978 (to NS) Monday, October 17, 2005 4:15 p.m. O-48 Woman Undergoing In Vitro Fertilization and Embryo Replacement Experience More Positive Emotion, Negative Emotion and Depressive Symptoms Than Comparable Normative Samples. A. Lee, A. L. Duck- worth, K. E. Elkind-Hirsch, M. E. Seligman, R. T. Scott Jr.. Reproductive Medicine Associates of New Jersey, Morristown, NJ; University of Penn- sylvania, Philadelphia, PA. OBJECTIVE: To explore and compare the depressive symptoms and emotionality of in vitro fertilization (IVF) and embryo recipient (ER) patients to those of age and gender matched populations. DESIGN: Cross-sectional, self-report questionnaire data were collected from women undergoing IVF (n=354) and ER (n=38) and compared with self-report data of normative samples. MATERIALS AND METHODS: Participants completed questionnaires in the waiting room surveying demographics, fertility history, and psycho- logical factors on Day 3 of their cycle treatment start date. Psychological questionnaires included the Positive and Negative Affect Schedule (PA- S20 Abstracts Vol. 84, Suppl 1, September 2005