2089 correspondence reflects improvements in patient care rather than case selection.In response to de Miguel-Yanes et al.: we did not evaluate the subgroup with diabetes in our initial analysis. However, in contrast with de MiguelYanes et al., after stratifying our sample according to the presence of diabetes we observed higher mortality for the subgroup of patients with diabetes, and this difference persisted over time.We agree with Hussain and Al-Omran that surgical volume is an important predictor of outcomes for abdominal aortic aneurysm repair. 1 In our previous work, we found that the relationship between hospital volume and outcomes was quite different for endovascular repair versus open repair and that experience with one type of repair did not carry over to improved outcomes in the other type of repair. We therefore did not conduct propensityscore matching for procedure volume in our analysis, since doing so would have been helpful only for comparisons of the same procedure, not for comparisons between different procedures.

Sperm DNA fragmentation is known to compromise male fertility. Previous findings have suggested the implication of oxidative stress in the etiology of this pathological condition. The present study was conducted to find out if the pathologically increased incidence of DNA fragmentation in ejaculated spermatozoa can be reduced by oral treatment with two antioxidants, vitamins C and E. Sixty-four men with unexplained infertility and an elevated (Ն15%) percentage of DNA-fragmented spermatozoa in the ejaculate were randomized between an antioxidant treatment (1 g vitamin C and 1 g vitamin E daily for 2 months) group and a placebo group. Sperm DNA fragmentation was evaluated by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling assay before and after treatment. No differences in basic sperm parameters were found between the antioxidant treatment and the placebo group before or after treatment. However, the percentage of DNA-fragmented spermatozoa was markedly reduced (P Ͻ .001) in the antioxidant treatment group after the treatment (9.1 Ϯ 7.2) as compared with the pretreatment values (22.1 Ϯ 7.7). No difference in the pretreatment and posttreatment incidence of sperm DNA fragmentation was observed in the placebo group. These data show that sperm DNA damage can be efficiently treated with oral antioxidants administered during a relatively short time period.Key words: Sperm DNA damage, ejaculated spermatozoa, TU-NEL assay, in vivo treatment, vitamin C, vitamin E. J Androl 2005;26:349-353E xcessive sperm DNA damage has been shown to compromise male fertility (Evenson et al, 1980(Evenson et al, , 1999Aitken, 1999; Carrel et al, 2003;Henkel et al, 2004;Tesarik et al, 2004a) and may predispose to genetic diseases, birth defects, and childhood cancer in the offspring (Fraga et al, 1996;Ji et al, 1997;Aitken et al, 2003). Several studies have pointed out a central role of oxidative stress, leading to the formation of reactive oxygen species, in the etiology of sperm DNA damage (Sikka et al, 1995;Twigg et al, 1998;Aitken and Krausz, 2001;Saleh and Agarwal, 2002;Aitken et al, 2003;Moustafa et al, 2004). These findings extended earlier original observations on the role of oxidative stress in the etiology of male infertility (Jones et al, 1979;Aitken and Clarkson, 1987). In vitro studies have demonstrated a protective effect of several antioxidants on sperm DNA integrity (Griveau and Le Lannou, 1994;Hughes et al, 1998;Lopes et al, 1998;Twigg et al, 1998;Donnelly et al, 1999;Dobrzynska et al, 2004).An improvement of basic sperm parameters by oral treatment with antioxidants has been reported in a number of studies (reviewed in Agarwal, 2004), but DNA damage Correspondence to: Dr January Tesarik, MAR&Gen, Gracia 36, 18002 Granada, Spain (e-mail: cmendoza@ugr.es).Received for publication September 16, 2004; accepted for publication December 9, 2004. DOI: 10.2164 has been addressed in only a few of them (Geva et al, 1996;Suleiman et al, 1996;Kodama et al, 1997;Comhaire et al, 2000;Keskes-Ammar et a...

These data show that ICSI with testicular spermatozoa provides the first efficient assisted reproduction treatment option for men with high levels of sperm DNA damage.

This retrospective study was undertaken to determine whether further developmental progression of two-pronucleated (2PN) zygotes can be predicted by a single, non-invasive examination of pronuclei, with the use of criteria based on the number and distribution of nucleolar precursor bodies in each pronucleus. The normal range of pronuclear variability was defined by analysis of zygotes giving rise to embryos transferred in 100%-implantation cycles (pattern 0). Morphological patterns differing from pattern 0 were classified as patterns 1-5. The frequency of developmental arrest of pattern 0 zygotes was only 8.5% as compared with 31.6, 21.9, 30.0, 20.5 and 24. 1% for patterns 1-5 respectively. Relationships of pronuclear patterns with blastomere multinucleation and cleaving embryo morphology were also noted. Clinical pregnancy was achieved in 22 of 44 (50%) treatment cycles in which at least one pattern 0 embryo was transferred, but only in two of 23 (9%) cycles in which only pattern 1-5 embryos were transferred. These data present new evaluation criteria which can be used to predict the developmental fate of human embryos as early as the pronuclear stage, without requiring repeated observations or an exact timing of pronuclear zygote inspection. Further prospective study is needed for clinical validation of these criteria.

No specific funding was obtained for this study. None of the authors have any competing interests to declare.