Human Reproduction, Vol 12, 1203-1213, Copyright © 1997 by Oxford University Press
P Vanderzwalmen, H Zech, A Birkenfeld, M Yemini, G Bertin, B Lejeune, M Nijs, L Segal, A Stecher, B Vandamme, E van Roosendaal and R Schoysman
Spermatid microinjection into oocytes has proven to be a successful
assisted reproduction procedure in the animal model and in the human
species, since in the latter a few full-term pregnancies were actually
obtained. Patients entering our spermatid injection study included those
with a total absence of spermatozoa in the testicular tissue
notwithstanding previous positive biopsies (n = 29): an obstructive problem
(n = 3), secretory azoospermia (n = 26), and those with total arrest at the
spermatogenesis level in previous explorative biopsies (n = 15). In the
latter group, absence of spermatids was recorded in four cases. Mature,
elongated, elongating and round spermatids (ROS) were injected in
respectively 3, 2, 3, and 32 attempts. A total of 260 metaphase II oocytes
were injected with ROS, 36 oocytes with spermatids at other stages of
maturity. The rates of oocytes showing two pronuclei (2PN) and two polar
bodies reached 22% and 64% respectively after injection of round or
elongated-mature spermatids. The fertilization rate after ROS injection was
influenced by the percentage of spermatozoa observed in a previous biopsy.
Patients with a positive preliminary biopsy had significantly more 2PN
(33%) when compared to those with a severe spermatogenic dysfunction and in
whom no spermatozoa were found (only 11%) (P < 0.05). Incubation of
oocytes in calcium ionophore after ROS injection had a positive effect on
the rate of 2PN formation (36 versus 16%). Ninety per cent of all the
normally fertilized oocytes cleaved. The percentage of grade A and B
embryos depended on the type of injected cells: 12% after ROS and 30% with
the other types of haploid cells. A total of 39 transfers resulted in five
pregnancies: three full term with healthy babies delivered (one after ROS
injection, and two after injection of an elongating and a mature
spermatid), one 4 months ongoing (after elongating spermatid injection) and
one miscarriage at 4 weeks (after elongated cell injection). Compared to
our conventional intracytoplasmic sperm injection- testicular sperm
extraction (ICSI-TESE) programme, the implantation rate after ROS injection
was very low (5.5 versus 10.5%).
ARTICLES
Intracytoplasmic injection of spermatids retrieved from testicular tissue: influence of testicular pathology, type of selected spermatids and oocyte activation
Schoysman Infertility Management Foundation, Vaartsraat, Vilvoorde, Belgium.
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