Human Reproduction, Vol 13, 104-110, Copyright © 1998 by Oxford University Press
S Kahraman, G Polat, M Samli, E Sozen, OD Ozgun, K Dirican and T Ozbicer
Recent studies have shown that the injection of spermatid cells into the
human oocyte can result in normal fertilization, embryo development and
even delivery of live, healthy offspring. In our study, 23 azoospermic
cases with severe spermatogenetic defects in their testicular biopsy are
presented. The serum follicle stimulating hormone (FSH) concentrations and
histopathological results of these males have been documented and compared
in terms of fertilization and embryo development. The mean FSH value of the
azoospermic males was 15.8 +/- 2.3 mIU/l, ranging from 1.6 to 39 mIU/l.
Elongated spermatids were used in three cases only, as these more mature
forms were mostly present in the testicular sample. In the remaining 20
cases, only round spermatids were found for use in intracytoplasmic sperm
injection (ICSI). The fertilization rate with two pronuclei was 31.3%. The
fertilization rate was found to be as high as 71% in three patients in the
elongating and elongated spermatids group and as low as 25.6% in the round
spermatid group. A few immature, non-motile spermatozoa were seen in only
two cases from the elongated spermatid group. However, in the remaining
cases, no spermatozoa were observed. The number of pronuclear (PN) arrest
was quite high when only round spermatids were used (36.1%). Total
fertilization failure was observed in two cases from the round spermatid
group with Sertoli cell only and germ cell aplasia. A total of three
pregnancies was achieved in 23 cases (13.0%), two from the elongated
spermatid group and one from the round spermatid group. One biochemical
pregnancy with a round spermatid resulted in an early spontaneous abortion
and surprisingly, the remaining pregnancies were achieved with elongated
spermatids resulting in multiple pregnancies. One twin and one triplet
pregnancy were established following four embryo transfers in each patient.
The twin pregnancy resulted in a live birth with two healthy babies;
unfortunately, the triplet pregnancy ended in an abortion at 11 weeks. The
use of testicular spermatids in the treatment of non-obstructive
azoospermia may give hope by offering a novel treatment model. In cases
with very severe spermatogenetic defect, even multiple pregnancies can be
achieved with elongated spermatid cells by yielding a high implantation
rate. However, the efficiency of round spermatids in achieving
fertilization and pregnancy was disappointing.
ARTICLES
Multiple pregnancies obtained by testicular spermatid injection in combination with intracytoplasmic sperm injection
Assisted Reproductive Techniques and Reproductive Endocrinology Unit, Sevgi Hospital, Ankara, Turkey.
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