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Ganeva R, Parvanov D, Vidolova N, Handzhiyska M, Ruseva M, Vasileva M, Nikolova K, Ivanova I, Shaban M, Shabarkova J, Hristova R, Miladinova M, Stamenov G. Sperm selection by zona adhesion improves assisted reproductive treatment outcomes. Andrology 2024. [PMID: 38225818 DOI: 10.1111/andr.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
BACKGROUND Zona pellucida is one of the main selective barriers for the spermatozoa before reaching the oocyte. Using native zona in the sperm selection prior to Intracytoplasmic Sperm Injection (ICSI) has been proven effective but inconvenient approach in In Vitro Fertilisation (IVF) laboratory. The application of autologous solubilised zonae pellucidae in the sperm selection prior to ICSI has not been studied yet. OBJECTIVES To compare the assisted reproductive treatment (ART) outcomes (implantation, pregnancy, live birth, and miscarriage rates) after ICSI performed with spermatozoa selected on their ability to adhere to immobilised solubilised zonae pellucidae and conventionally selected spermatozoa. MATERIALS AND METHODS In total, 500 couples fulfilled the inclusion criteria and 368 of them were included in the study. After random allocation, 192 couples had spermatozoa selected by sperm-zona adhesion for ICSI (study group) and 176 patients underwent standard ICSI (control group). In the study group, patients' own zonae were acid solubilised and immobilised on petri dishes. The partner's motile spermatozoa were placed in the dishes and the adhered spermatozoa were used for ICSI. For the control group, the conventional sperm selection by morphological criteria was applied prior ICSI. All women underwent frozen ET with euploid embryos. Chi square test was used to compare the data. RESULTS The sperm selection by zona adhesion resulted in significantly higher implantation rate (50.4% vs. 37.0%, p = 0.003), clinical pregnancy rate (43.8% vs. 33.3%, p = 0.018) and live birth rate (38.0% vs. 25.9%, p = 0.004) and significantly lower incidence of miscarriage (11.3% vs. 22.2%, p = 0.044) in comparison to the conventional method of the sperm selection. DISCUSSION AND CONCLUSION The application of solubilised zonae pellucidae in the sperm selection for ICSI benefits ART outcomes in couples with unexplained infertility. Moreover, sperm-zona selection significantly reduces the risk of miscarriages.
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Affiliation(s)
- Rumiana Ganeva
- Research and Development Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Dimitar Parvanov
- Research and Development Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Nina Vidolova
- Research and Development Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Maria Handzhiyska
- Research and Development Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Margarita Ruseva
- Research and Development Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Magdaleva Vasileva
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Kristina Nikolova
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Ivka Ivanova
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Miray Shaban
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Joanna Shabarkova
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Rayna Hristova
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Milena Miladinova
- Embryology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
| | - Georgi Stamenov
- Obstetrics and Gynecology Department, Nadezhda Women's Health Hospital, Sofia, Bulgaria
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Ganeva R, Parvanov D, Velikova D, Vasileva M, Nikolova K, Stamenov G. Sperm morphology and DNA fragmentation after zona pellucida selection. REPRODUCTION AND FERTILITY 2021; 2:221-230. [PMID: 35118392 PMCID: PMC8801029 DOI: 10.1530/raf-21-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/12/2021] [Indexed: 11/08/2022] Open
Abstract
Sperm DNA fragmentation (SDF) and sperm morphological defects can negatively affect ART outcomes. Consequently, there is a need for additional semen processing technique that accounts for sperm DNA status and morphology prior to ICSI. The objective was to evaluate the efficacy of an additional zona pellucida adhesion-based sperm selection for obtaining sperm populations with a high percentage of normal morphology and DNA integrity as compared to native semen and routine swim-up preparation. Semen samples from 78 normozoospermic men were subjected to swim up and placed in petri dishes coated with 48 acid-solubilized zonae pellucidae. Sperm DNA fragmentation and morphology were assessed in the native semen, the swim-up samples, and the zona-adhered spermatozoa from each patient. The mean sperm DNA fragmentation of the zona-selected spermatozoa (3.5 ± 0.7%) was significantly lower than the swim-up samples (15.3 ± 5.2%) (P < 0.001) and native semen (24.9 ± 7.1%) (P < 0.001). All of the samples had lower levels of DNA damage after additional selection by zona pellucida adhesion. Significantly higher percentage of sperm with normal morphology was observed after zona-adhesion selection (11.4 ± 3.9%) when compared to the swim-up samples (8.9 ± 4.3%) (P < 0.001) or the native semen (5.3 ± 3.2%) (P < 0.001). In 94% of the samples, the percentage of spermatozoa with normal morphology increased after the additional zona selection. This study demonstrates that sperm selection by additional zona-adhesion technique yields a significantly higher percentage of spermatozoa with normal morphology as well as a significantly decreased level of DNA fragmentation when compared to the native semen and the swim-up-only prepared samples. LAY SUMMARY High level of DNA folding known as sperm DNA fragmentation (SDF) inside each sperm and defects in the shape, size, and structure of the sperm can negatively affect assisted reproduction treatment (ART) outcomes. Consequently, there is a need for additional semen processing techniques that account for sperm quality prior to ART. Our team designed a simple technique using proteins from the coat around the egg (zona pellucida) to enhance sperm selection procedures based on natural sperm-egg interactions. Using this technique in combination with the most common techniques used in ART yields a significantly higher percentage of sperm with normal shape, size, and structure and a decreased level of DNA fragmentation. This sperm zona-selection technique would be beneficial if introduced in the ART practice to yield sperm with higher fertilization potential.
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Affiliation(s)
- Rumiana Ganeva
- Research Department, Nadezhda Women’s Health Hospital, Sofia, Bulgaria
| | - Dimitar Parvanov
- Research Department, Nadezhda Women’s Health Hospital, Sofia, Bulgaria
| | - Denitsa Velikova
- Andrology Department, Nadezhda Women’s Health Hospital, Sofia, Bulgaria
| | - Magdalena Vasileva
- Embryology Department, Nadezhda Women’s Health Hospital, Sofia, Bulgaria
| | - Kristina Nikolova
- Embryology Department, Nadezhda Women’s Health Hospital, Sofia, Bulgaria
| | - Georgi Stamenov
- Obsterics and Gynecology Department, Nadezhda Women’s Health Hospital, Sofia, Bulgaria
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Canepa P, Casciano I, De Leo C, Massarotti C, Anserini P, Remorgida V, Scaruffi P. A successful healthy childbirth and an ongoing evolutive pregnancy in a case of partial globozoospermia by hyaluronic acid sperm selection. Andrologia 2018; 51:e13178. [PMID: 30324675 DOI: 10.1111/and.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 02/03/2023] Open
Abstract
We here report a successful healthy childbirth and an ongoing evolutive pregnancy in a case of partial globozoospermia after selection of mature spermatozoa bound to hyaluronic acid (HA). The couple underwent two in vitro fertilisation (IVF) cycles. In the first attempt, 14 MII oocytes were retrieved. Randomly, seven oocytes were injected by conventional PVP-ICSI and seven by HA-ICSI. Fertilised oocytes were 2/7 and 4/7 after PVP-ICSI and HA-ICSI respectively. Transfer of two grade A embryos from HA-ICSI lead to birth of a healthy baby. The surplus embryo of the HA-ICSI group was vitrified at blastocyst stage. The two embryos from PVP-ICSI arrested their development. Two years after the childbirth, the vitrified blastocyst was transferred into the uterus, but implant failed. In the second cycle, 14 MII oocytes were retrieved and they were injected by HA-ICSI. Fertilised oocytes were 10 out of 14 injected oocytes. On day 5, two blastocysts were transferred into uterus and a single evolutive pregnancy is ongoing. On day 6, one blastocyst was vitrified. The remaining surplus embryos arrested their development. A healthy childbirth and an ongoing evolutive pregnancy in two consecutive ICSI attempts of the same couple suggest that HA sperm selection might assist in cases with partial globozoospermia.
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Affiliation(s)
- Pierandrea Canepa
- U.O.S. Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ida Casciano
- U.O.S. Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Paola Anserini
- U.O.S. Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Paola Scaruffi
- U.O.S. Physiopathology of Human Reproduction, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Chansel-Debordeaux L, Dandieu S, Bechoua S, Jimenez C. Reproductive outcome in globozoospermic men: update and prospects. Andrology 2015; 3:1022-34. [DOI: 10.1111/andr.12081] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/24/2015] [Accepted: 06/26/2015] [Indexed: 01/24/2023]
Affiliation(s)
- L. Chansel-Debordeaux
- Service de Biologie de la Reproduction-CECOS; CHU de Bordeaux; Centre Aliénor d'Aquitaine; Bordeaux France
| | | | - S. Bechoua
- Service de Biologie de la Reproduction-CECOS; CHU de Dijon; Maternité du Bocage; Dijon France
| | - C. Jimenez
- Service de Biologie de la Reproduction-CECOS; CHU de Bordeaux; Centre Aliénor d'Aquitaine; Bordeaux France
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Karaca N, Yilmaz R, Kanten GE, Kervancioglu E, Solakoglu S, Kervancioglu M. First successful pregnancy in a globozoospermic patient having homozygous mutation in SPATA16. Fertil Steril 2014; 102:103-7. [DOI: 10.1016/j.fertnstert.2014.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 04/03/2014] [Accepted: 04/03/2014] [Indexed: 10/25/2022]
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Kashir J, Sermondade N, Sifer C, Oo SL, Jones C, Mounce G, Turner K, Child T, McVeigh E, Coward K. Motile sperm organelle morphology evaluation-selected globozoospermic human sperm with an acrosomal bud exhibits novel patterns and higher levels of phospholipase C zeta. Hum Reprod 2012; 27:3150-60. [PMID: 22940771 DOI: 10.1093/humrep/des312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Does motile sperm organelle morphology examination (MSOME) affect levels and localization patterns of the oocyte activation factor phospholipase C zeta (PLCζ) in globozoospermic sperm with and without an acrosomal bud? SUMMARY ANSWER MSOME identified round-headed globozoospermic sperm with increased levels of PLCζ relative to sperm from the same sample that did not undergo MSOME, and identified novel patterns of PLCζ localization in sperm exhibiting an acrosomal bud. WHAT IS KNOWN ALREADY Absence or reduction in the level of PLCζ in the sperm head, abnormal localization patterning, or defective functional ability as a result of PLCζ gene mutation, have been linked to certain types of human male factor infertility in which oocyte activation is deficient. It has been determined that a subpopulation of sperm (1%) from a patient exhibiting 100% globozoospermia presented with an acrosome bud upon MSOME. A cycle of intracytoplasmic morphologically selected sperm injection, carried out with sperm exhibiting an acrosomal bud led to pregnancy and birth of a healthy baby boy, without the use of assisted oocyte activation (AOA). STUDY DESIGN, SIZE, DURATION Immunofluorescent analysis of PLCζ in globozoospermic sperm from three patients, before and after MSOME. PARTICIPANTS/MATERIALS, SETTING, METHODS Quantitative immunofluorescence was used to investigate PLCζ levels and localization patterns in individual sperm (n = 1 patient) identified by MSOME and isolated by micromanipulation, and presenting with and without the acrosomal bud. A secondary aim was to investigate levels and localization patterns of PLCζ in sperm before and after MSOME from two other globozoospermic men. MAIN RESULTS AND THE ROLE OF CHANCE Non-globozoospermic control sperm exhibited characteristic localization patterns of PLCζ immunofluorescence. Completely round-headed globozoospermic sperm from patients 1-3 were either devoid of PLCζ immunofluorescence, or exhibited an abnormal, punctate, pattern of PLCζ localization. PLCζ immunofluorescence in sperm exhibiting an acrosomal bud was observed in the midpiece with varying fluorescent intensity and was detected in 28.5% of such sperm. The majority of sperm with an acrosomal bud (43.0%) exhibited punctate patterns of PLCζ localization within the sperm head. A further 28.5% of sperm exhibited PLCζ in both the head and the midpiece. Total levels of PLCζ, and the proportions of sperm exhibiting PLCζ immunoreactivity, showed significant variance (P ≤ 0.05) amongst control [45.8 arbitrary units (a.u.) and 95.7%, respectively], non-MSOME-selected (25.9 a.u. and 46.1%, respectively) and MSOME-selected globozoospermic sperm (33.4 a.u. and 65.0%, respectively). Total levels of PLCζ immunofluorescence, and proportions of sperm exhibiting PLCζ immunoreactivity, in control sperm was significantly higher (P≤ 0.05) compared with non-MSOME-selected sperm, but not significantly different from MSOME-selected sperm. LIMITATIONS, REASONS FOR CAUTION The low numbers of sperm analysed may not be ideal for conclusive statistical analysis. Evaluation of the effects of MSOME on morphologically normal sperm would confirm conclusions. WIDER IMPLICATIONS OF THE FINDINGS The present findings provide hope for the future treatment of globozoospermia without the need for AOA, and provide further evidence for the clinical application of PLCζ as a therapeutic and prognostic tool. STUDY FUNDING/COMPETING INTEREST(S) The research described herein was funded by the Nuffield Department of Obstetrics and Gynaecology, University of Oxford. The authors report no conflict of interest.
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Affiliation(s)
- Junaid Kashir
- Nuffield Department of Obstetrics and Gynaecology, Level 3, Women's Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
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Perrin A, Coat C, Nguyen MH, Talagas M, Morel F, Amice J, De Braekeleer M. Molecular cytogenetic and genetic aspects of globozoospermia: a review. Andrologia 2012; 45:1-9. [DOI: 10.1111/j.1439-0272.2012.01308.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2012] [Indexed: 11/28/2022] Open
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Kashir J, Heindryckx B, Jones C, De Sutter P, Parrington J, Coward K. Oocyte activation, phospholipase C zeta and human infertility. Hum Reprod Update 2010; 16:690-703. [PMID: 20573804 DOI: 10.1093/humupd/dmq018] [Citation(s) in RCA: 167] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mammalian oocytes are activated by intracellular calcium (Ca(2+)) oscillations following gamete fusion. Recent evidence implicates a sperm-specific phospholipase C zeta, PLCζ, which is introduced into the oocyte following membrane fusion, as the responsible factor. This review summarizes the current understanding of human oocyte activation failure and describes recent discoveries linking certain cases of male infertility with defects in PLCζ expression and activity. How these latest findings may influence future diagnosis and treatment options are also discussed. METHODS Systematic literature searches were performed using PubMed, ISI-Web of Knowledge and The Cochrane Library. We also scrutinized material from the United Nations and World Health Organization databases (UNWHO) and the Human Fertilization and Embryology Authority (HFEA). RESULTS AND CONCLUSIONS Although ICSI results in average fertilization rates of 70%, complete or virtually complete fertilization failure still occurs in 1-5% of ICSI cycles. While oocyte activation failure can, in some cases, be overcome by artificial oocyte activators such as calcium ionophores, a more physiological oocyte activation agent might release Ca(2+) within the oocyte in a more efficient and controlled manner. As PLCζ is now widely considered to be the physiological agent responsible for activating mammalian oocytes, it represents both a novel diagnostic biomarker of oocyte activation capability and a possible mode of treatment for certain types of male infertility.
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Affiliation(s)
- J Kashir
- Nuffield Department of Obstetrics and Gynaecology, Level 3, Women's Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
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Geyter CD, Geyter MD, Behre HM. Assisted Reproduction. Andrology 2010. [DOI: 10.1007/978-3-540-78355-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Black M, Liu DY, Bourne H, Baker HWG. Comparison of outcomes of conventional intracytoplasmic sperm injection and intracytoplasmic sperm injection using sperm bound to the zona pellucida of immature oocytes. Fertil Steril 2009; 93:672-4. [PMID: 19878934 DOI: 10.1016/j.fertnstert.2009.08.063] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
Abstract
This study was to compare the outcomes of conventional (scientist-selected sperm) intracytoplasmic sperm injection (ICSI) and a modified ICSI using zona pellucida (ZP)-bound sperm. Although with 39 couples in each group there was no statistical significance in fertilization, embryo development, implantation, and fetal heart clinical pregnancy rates, the higher implantation and clinical pregnancy rates with ZP-bound sperm encourages further evaluation with larger numbers of subjects using sibling oocytes to determine if the ZP-bound sperm are biologically and functionally superior.
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Affiliation(s)
- Marlene Black
- Reproductive Services and Melbourne IVF, Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Parkville, Victoria 3052, Australia.
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Tejera A, Mollá M, Muriel L, Remohí J, Pellicer A, De Pablo JL. Successful pregnancy and childbirth after intracytoplasmic sperm injection with calcium ionophore oocyte activation in a globozoospermic patient. Fertil Steril 2008; 90:1202.e1-5. [DOI: 10.1016/j.fertnstert.2007.11.056] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Revised: 11/19/2007] [Accepted: 11/20/2007] [Indexed: 11/29/2022]
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Liu DY, Liu ML, Baker HWG. Enhancement of sperm-zona pellucida (ZP) binding capacity by activation of protein kinase A and C pathways in certain infertile men with defective sperm-ZP binding. Hum Reprod 2008; 24:20-7. [PMID: 18784086 DOI: 10.1093/humrep/den334] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Defective sperm-zona pellucida (ZP) binding (DSZPB) is a common cause of failure of fertilization in vitro. This study was to determine if DSZPB is caused by defective pathways upstream of protein kinase A (PKA) and C (PKC), or reduced protein tyrosine phosphorylation (TP). METHODS Infertile men with DSZPB and either normal sperm morphology (NSM) > or = 14% (n = 15) or < or =5% (n = 15) were studied. Sperm-ZP binding test was performed by incubation of motile sperm with oocytes for 2 h with or without dibutyryl cyclic AMP (dbcAMP, PKA activator) or phorbol myristate acetate (PMA, PKC activator). TP of capacitated sperm in medium was assessed by immunofluorescence with an anti-phosphotyrosine monoclonal antibody. RESULTS For normal sperm with normal sperm-ZP binding, both PMA and dbcAMP significantly enhanced sperm-ZP binding in a dose-response manner. Only dbcAMP, but not PMA, significantly increased TP of capacitated sperm. In DSZPB men with severe teratozoospermia (NSM < or = 5%), neither PMA nor dbcAMP enhanced sperm-ZP binding, despite dbcAMP significantly increasing the TP of capacitated sperm for all samples. In contrast, for DSZPB with NSM > or = 14%, PMA caused significantly increased sperm binding up to normal levels (> or =40 sperm bound/ZP) in five men, and dbcAMP had a similar result in two men. Again TP was significantly enhanced only by dbcAMP, but not by PMA. CONCLUSIONS There is defective signalling in pathways upstream of PKC and PKA in some men with DSZPB and normal semen analysis. Stimulation of TP by dbcAMP does not enhance sperm-ZP binding capacity in DSZPB men with low TP, regardless of sperm morphology.
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Affiliation(s)
- D Y Liu
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia.
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Yanagida K, Fujikura Y, Katayose H. The present status of artificial oocyte activation in assisted reproductive technology. Reprod Med Biol 2008; 7:133-142. [PMID: 29699294 PMCID: PMC5907121 DOI: 10.1111/j.1447-0578.2008.00210.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Intracytoplasmic sperm injection (ICSI) is the most effective treatment for achieving fertilization in assisted reproductive technology (ART). However, fertilization failure occurs. The incidence of fertilization failure after ICSI is 1-5%. Approximately 50% of fertilization failure cases could be attributed to the abnormality of sperm factor. As the fertilization fails after ICSI using mature sperm, round spermatids and globozoospermia, artificial oocyte activation may provide a means of improving fertilization rates in such cases. The oocyte activation treatments used in clinical research include calcium (Ca) ionophore treatment, electrostimulation and strontium treatment. In terms of the efficiency of oocyte activation, electrostimulation and Ca ionophore gave better outcomes than strontium treatment. Strontium treatment causes Ca2+ oscillations in mice, so it has been viewed favorably. However, in human oocytes calcium oscillation has not been observed. The fertilization rate after ICSI was low in the case of globozoospermia and wiht round spermatids. Some cases of pregnancy were achieved by ICSI alone and oocyte activation methods were not essential in these cases. Among the various oocyte activation methods currently used, it should be noted that issues of genetic safety have not been addressed for the combined use of these oocyte activation methods. (Reprod Med Biol 2008; 7: 133-142).
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Affiliation(s)
- Kaoru Yanagida
- Center for Infertility and IVF, International University of Health and Welfare Hospital, Nasushiobarashi, Tochigi, Japan
| | - Yoko Fujikura
- Center for Infertility and IVF, International University of Health and Welfare Hospital, Nasushiobarashi, Tochigi, Japan
| | - Haruo Katayose
- Center for Infertility and IVF, International University of Health and Welfare Hospital, Nasushiobarashi, Tochigi, Japan
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Liu DY, Baker HWG. Human sperm bound to the zona pellucida have normal nuclear chromatin as assessed by acridine orange fluorescence. Hum Reprod 2007; 22:1597-602. [PMID: 17369294 DOI: 10.1093/humrep/dem044] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of this study was to determine if only sperm with double stranded DNA could bind to the human zona pellucida (ZP). METHODS Sperm samples from 124 infertile men with a range of semen abnormalities were studied. Oocytes that had failed to fertilize in IVF or ICSI were used for the sperm-ZP binding test. A group of four oocytes were incubated for 2 h with 2 x 10(6)/ml motile sperm selected by colloidal silica gradient centrifugation (CSGC). After assessing the number of sperm bound per ZP, all sperm bound to the surface of the ZP of four oocytes were dislodged and placed on a glass slide. The double (green fluorescence) or single stranded (denatured, red fluorescence) DNA of sperm in semen, motile sperm selected by CSGC and ZP-bound sperm, was assessed by acridine orange (AO) fluorescence. RESULTS The percentage of sperm with green fluorescence was significantly correlated with normal sperm morphology in semen and after CSGC preparation. The proportion of sperm with green fluorescence was significantly higher in motile sperm selected by CSGC than ejaculated sperm. There were very few sperm (average <8%) with red fluorescence bound to the ZP, even in men who had very high (>70%) proportions of sperm with red fluorescence in their semen. CONCLUSION Sperm binding to human ZP is highly selective for double stranded DNA. Sperm with single stranded or denatured DNA bind less or do not bind at all to the ZP, probably because of defects of motility and, more especially, morphology.
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Affiliation(s)
- D Y Liu
- Department of Obstetrics and Gynaecology, University of Melbourne, Reproductive Services and Melbourne IVF, Royal Women's Hospital, Victoria 3053, Australia.
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Dam AHDM, Feenstra I, Westphal JR, Ramos L, van Golde RJT, Kremer JAM. Globozoospermia revisited. Hum Reprod Update 2006; 13:63-75. [PMID: 17008355 DOI: 10.1093/humupd/dml047] [Citation(s) in RCA: 184] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Globozoospermia is a rare (incidence <0.1%) but severe disorder in male infertility. Total globozoospermia is diagnosed by the presence of 100% round-headed spermatozoa lacking an acrosome. It is still unclear whether patients whose ejaculate contains both normal and globozoospermic cells (partial globozoospermia) suffer from a variation of the same syndrome. Apart from the fact that affected males suffer from reduced fertility or even infertility, no other physical characteristics can be associated with the syndrome. ICSI is a treatment option for these patients, although low fertilization rates after ICSI show a reduced ability to activate the oocyte. In globozoospermic cells, the use of acrosome markers has demonstrated an absent or severely malformed acrosome. Chromatin compaction appears to be disturbed but is not consistently over- or undercondensed. In some cases, an increased number of cells with DNA fragmentation have been observed. The analysis of the cytogenetic composition revealed an increased aneuploidy rate in some cases. Nonetheless, no increased number of spontaneous abortions or congenital defects has been reported in pregnancies conceived after ICSI. The pathogenesis of globozoospermia most probably originates in spermiogenesis, more specifically in acrosome formation and sperm head elongation. In several knockout mouse models, a phenotype similar to that in humans was found. Together with the occurrence of affected siblings, these findings indicate a genetic origin, which makes globozoospermia a good candidate for genetic analysis. More research is needed to elucidate the pathogenesis of human globozoospermia to further understand globozoospermia as well as (abnormalities in) spermiogenesis and spermatogenesis in general.
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Affiliation(s)
- A H D M Dam
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Ye H, Huang GN, Gao Y, Liu DY. Relationship between human sperm-hyaluronan binding assay and fertilization rate in conventional in vitro fertilization. Hum Reprod 2006; 21:1545-50. [PMID: 16595551 DOI: 10.1093/humrep/del008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sperm-hyaluronan-binding assay (HBA) is one of the commercial kits being marketed for routine testing of sperm maturity and fertility. However, there is no report of whether the HBA can provide additional information over standard semen analysis for sperm-fertilizing ability. The objective of this study was to investigate the relationship between HBA and fertilization rate in conventional IVF. METHODS A total of 175 IVF patients with > or = 3 mature oocytes inseminated were included in the study. Both the standard semen analysis and the HBA were performed on the same ejaculated sperm samples used for IVF treatments. Relationships between the semen analysis and the HBA results and fertilization rate were analysed by both the Spearman test and the multivariate logistic regression analysis. RESULTS Both total and progressive sperm motility and normal morphology were highly correlated with HBA scores. While both normal sperm morphology and HBA scores were statistically significantly related to fertilization rates, the HBA was less significant than normal sperm morphology. The HBA does not provide additional information for identifying patients with a poor fertilization rate. CONCLUSION HBA is highly significantly correlated with sperm motility and morphology but is less significant than sperm morphology in relation to the fertilization rate in IVF. Thus, the clinical predictive value of HBA for sperm-fertilizing ability in vitro is limited.
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Affiliation(s)
- Hong Ye
- Reproductive and Genetics Institute, Chongqing Obstetrics and Gynecology Hospital, Chongqing, China
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Caballero-Campo P, Chirinos M, Fan XJ, González-González ME, Galicia-Chavarría M, Larrea F, Gerton GL. Biological Effects of Recombinant Human Zona Pellucida Proteins on Sperm Function1. Biol Reprod 2006; 74:760-8. [PMID: 16407501 DOI: 10.1095/biolreprod.105.047522] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The initial interaction between gametes takes place at the level of the sperm surface and the zona pellucida (ZP), the extracellular matrix of the egg in mammals. Successful fertilization requires the proper molecular recognition of the ZP by the sperm. Recently, human ZP was demonstrated to be composed of four proteins: ZP1, ZP2, ZP3, and ZP4. The goals of this study were to determine the effects of recombinant human ZP2, ZP3, and ZP4 on human sperm acrosomal exocytosis and sperm motility. Exposure of sperm to ZP proteins, alone or in combination, promoted acrosomal exocytosis in a time-dependent manner. This effect occurred in parallel with a considerable decrease in progressive motility, coincident with an increase in nonprogressive sperm motility. An analysis of kinetic parameters of ZP-treated sperm demonstrated that a characteristic motility pattern could be defined by values of curvilinear velocity > 63.9 mum/s and linearity <or= 15.5%. A strong correlation between curvilinear velocity and the amplitude of lateral head displacement was also observed. The incidence of sperm having these particular kinetic parameters increased after exposure to ZP proteins. These studies of two processes involved in sperm penetration through the ZP confirm that zona glycoproteins promote acrosomal exocytosis and now establish an additional role for these components as modifiers of sperm motility.
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Affiliation(s)
- Pedro Caballero-Campo
- Center for Research on Reproduction and Women's Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104-6080, USA
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Liu DY, Garrett C, Baker HWG. Acrosome-reacted human sperm in insemination medium do not bind to the zona pellucida of human oocytes. ACTA ACUST UNITED AC 2006; 29:475-81. [PMID: 16480409 DOI: 10.1111/j.1365-2605.2006.00681.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the literature there is still confusion whether acrosome-reacted sperm in medium can initiate primary binding to human zona pellucida (ZP). The ability of acrosome-reacted sperm to bind to ZP in vitro can be deduced by measuring the acrosome reaction (AR) of ZP-bound sperm compared with sperm in medium after incubation under different conditions inhibiting the ZP-induced AR. Motile sperm from fertile men, normospermic men and infertile men diagnosed with disordered ZP-induced AR (DZPIAR) were selected by swim-up (2 x 10(6) in 1 mL medium) and incubated for 1-2 h with four oocytes from failed in vitro fertilization (IVF). The acrosome status of sperm was assessed using pisum sativum agglutinin labelled with fluorescein. The ZP-induced AR was inhibited in experiments using sperm from DZPIAR patients, hyper-osmotic medium (400 mOsm/kg) and medium containing soybean trypsin inhibitor (SBTI; 4 mg/mL). Pre-treatment with calcium ionophore was used to create a sperm population with elevated AR. In all experiments with factors inhibiting the ZP-induced AR, the AR was significantly lower for ZP-bound sperm compared with sperm in medium: DZPIAR patients 4% vs. 15%, hyper-osmotic medium 3% vs. 12%, SBTI 2% vs. 12% and SBTI 3% vs. 23% after treatment with calcium ionophore. In conclusion, acrosome-reacted sperm in vitro have significantly reduced, in fact probably zero ability to bind to the ZP.
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Affiliation(s)
- D Y Liu
- University of Melbourne Department of Obstetrics and Gynaecology, Reproductive Services, Royal Women's Hospital and Melbourne IVF, Vic., Australia.
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Machev N, Gosset P, Viville S. Chromosome abnormalities in sperm from infertile men with normal somatic karyotypes: teratozoospermia. Cytogenet Genome Res 2006; 111:352-7. [PMID: 16192715 DOI: 10.1159/000086910] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Accepted: 01/12/2005] [Indexed: 11/19/2022] Open
Abstract
Teratozoospermia is characterized by the presence of spermatozoa with abnormal morphology in sperm. This condition is frequently associated with infertility and intracytoplasmic sperm injection (ICSI) is frequently used as the treatment of choice. However, the use of ICSI has created consequential debate concerning the genetic risk for the offspring. Fluorescence in situ hybridization technique (FISH), allowing the specific identification of human chromosomes in sperm nuclei, has been used to study chromosome abnormalities in sperm from men with teratozoospermia and a normal karyotype. In this review, we present studies that have tried to determine if men with a normal blood karyotype but suffering from teratozoospermia present a higher aneuploidy frequency. The literature is limited to three forms of teratozoospermia. The first group consists of "polymorphic teratozoospermia", where a majority of spermatozoa display more than one type of abnormality. In this case, only a slight increase in aneuploidy frequency is observed, which cannot be differentiated from the results observed in oligo-astheno-teratozoospermia (OAT). The second group, named "globozoospermia", is characterized by round spermatic heads, absence of acrosome and disorganization of mid-piece and tail. In this case, some studies have shown a significant, but moderate, increase in the aneuploidy frequency for acrocentrics and sex chromosomes. The aneuploidy frequency remains low, also ICSI can be proposed to these patients, but few successes occur. The third group consists of "enlarged head teratozoospermia", where almost all spermatozoa have an enlarged head, multiple tail and abnormal acrosome. In this case a very high level of missegregation is observed, leading to nearly 100% aneuploidy. In this particular group, ICSI must be refuted, and patients have to be redirected to other possibilities, like sperm donation.
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Affiliation(s)
- N Machev
- Service de Biologie de la Reproduction SIHCUS-CMCO, CHU de Strasbourg, Schiltigheim, France
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McKenzie LJ, Kovanci E, Amato P, Cisneros P, Lamb D, Carson SA. Pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection with profound teratospermia. Fertil Steril 2004; 82:847-9. [PMID: 15482758 DOI: 10.1016/j.fertnstert.2004.03.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2003] [Revised: 03/16/2004] [Accepted: 03/16/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the pregnancy outcome of IVF with intracytoplasmic sperm injection (ICSI) in couples with profound teratospermia (Kruger's strict criteria of zero). DESIGN Retrospective analysis of 545 consecutive cycles of IVF/ICSI performed between January 2000 and January 2003. SETTING Tertiary care center. PATIENT(S) Of 545 IVF/ICSI cycles, 45 patients were identified with a semen strict morphology of 0 using Kruger's strict criteria. INTERVENTION(S) Ovarian down-regulation (Lupron) was followed by controlled ovarian stimulation exclusively with hMG. Embryo transfer was performed 2 days after transvaginal aspiration/ICSI. MAIN OUTCOMES MEASURE(S) Pregnancy outcomes and newborn/infant status. RESULT(S) Of 45 patients undergoing 54 treatment cycles, 21 patients were positive for pregnancy (38.9% pregnancy/cycle). No birth defects were noted at time of delivery and all infants had obtained appropriate developmental milestones at 1 year of age. CONCLUSION(S) Men with profound teratospermia (Kruger's strict criteria of zero) may achieve acceptable pregnancy rates after IVF/ICSI thereby alleviating the use of donor sperm in this group. Furthermore, no increased risk of birth defects is apparent in this small series.
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Affiliation(s)
- Laurie Jane McKenzie
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, Texas 77030, USA
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Liu DY, Garrett C, Baker HWG. Clinical application of sperm-oocyte interaction tests in in vitro fertilization--embryo transfer and intracytoplasmic sperm injection programs. Fertil Steril 2004; 82:1251-63. [PMID: 15533339 DOI: 10.1016/j.fertnstert.2003.10.057] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Revised: 10/20/2003] [Accepted: 10/20/2003] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To review the clinical value of sperm-oocyte interaction tests for the diagnosis and management of infertility by standard IVF or intracytoplasmic sperm injection (ICSI). DESIGN Review of recent publications on relationships among sperm-oocyte interaction tests, sperm characteristics, and results of IVF and determination of frequency of defective sperm-oocyte interaction in infertile men. MAIN OUTCOME MEASURE(S) Fertilization rates with IVF, sperm characteristics, sperm-zona pellucida (ZP) binding, ZP-induced acrosome reaction (AR), and sperm-ZP penetration. RESULT(S) Sperm defects associated with low sperm-ZP binding or impaired ZP-induced AR and sperm-ZP penetration are the major causes of failure of fertilization when all or most oocytes from a couple do not fertilize in standard IVF. There is a high frequency of defective sperm-ZP interaction in men with oligozoospermia (<20 x 10(6)/mL) and severe teratozoospermia (strict normal sperm morphology < or =5%). Sperm morphology correlates with sperm-ZP binding, and sperm concentration correlates with ZP-induced AR in infertile men with sperm concentrations >20 x 10(6)/mL. Defective ZP-induced AR may cause infertility in up to 25% men with idiopathic infertility. These patients require ICSI despite the normal standard semen analyses. CONCLUSION(S) Sperm-oocyte interaction tests are useful for diagnosis of subtle sperm defects that cause infertility in men without severe abnormalities of semen analysis. Pre-IVF diagnosis of these sperm defects will assist in the clinical assignment of patients to treatment with either standard IVF or ICSI.
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Affiliation(s)
- De Yi Liu
- Department of Obstetrics and Gynecology and Reproductive Services, The Royal Women's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
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De Geyter C, De Geyter M, Meschede D, Behre HM. Assisted Fertilization. Andrology 2001. [DOI: 10.1007/978-3-662-04491-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Galat VV. Investigation of assisted fertilization and biology of reproduction by sperm microinjection. Russ J Dev Biol 2000. [DOI: 10.1007/bf02758748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khalili MA, Kalantar SM, Vahidi S, Ghafour-Zadeh M. Failure of fertilization following intracytoplasmic injection of round-headed sperm. Ann Saudi Med 1998; 18:408-11. [PMID: 17344712 DOI: 10.5144/0256-4947.1998.408] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intracytoplasmic sperm injection (ICSI) is a very effective technique for the treatment of male factor infertility, even in severe cases. An exception to this rule is round-headed acrosomeless sperm, for which there is an extremely low success rate. The objective of this study was to report our first experience with ICSI using round-headed spermatozoa. MATERIALS AND METHODS A total of four infertile males with globozoospermia underwent the conventional ICSI program during the period from 1995 to 1997. Semen parameters were evaluated according to the WHO criteria. Twenty-eight oocytes were collected following conventional ovarian superovulation. RESULTS Volume, pH, and viscosity of the semen were within normal range. Sperm counts and progressive motility were from >1 to 90x10 6 mL, and from 0% to 60%, respectively. Distinct 100% acrosomeless morphology was observed with Giemsa staining. Twenty-two metaphase II oocytes (78.6% of the total) from four ICSI cases were injected with the husbandâs round-headed spermatozoa. Total fertilization failure was observed in all these cases. CONCLUSION The results clearly demonstrate the important role of normal head morphology in activating the oocytes, as well as the need to develop a modified but safe ICSI technique, which will be effective in overcoming this severe type of male infertility.
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Affiliation(s)
- M A Khalili
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Battaglia DE, Koehler JK, Klein NA, Tucker MJ. Failure of oocyte activation after intracytoplasmic sperm injection using round-headed sperm. Fertil Steril 1997; 68:118-22. [PMID: 9207595 DOI: 10.1016/s0015-0282(97)81486-0] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine the outcome of intracytoplasmic sperm injection (ICSI) with round-headed sperm (globozoospermia). DESIGN Retrospective analysis. SETTING In vitro fertilization laboratory with extensive ICSI experience. PATIENT(S) A patient couple with infertility because of globozoospermia seeking ICSI treatment. MAIN OUTCOME MEASURE(S) Fertilization, cleavage, and pregnancy rates. INTERVENTION(S) Intracytoplasmic sperm injection and calcium ionophore. RESULT(S) This couple experienced only 7% fertilization after ICSI in their first cycle. Treatment of the unfertilized oocytes with calcium ionophore 20 hours after ICSI-induced fertilization and cleavage of 70% of the oocytes. Embryo quality was fair to good. On the second cycle, 8 of the injected oocytes were treated with ionophore immediately after ICSI and the remaining 20 oocytes were untreated. Normal fertilization was achieved in 75% of the treated and 10% of the untreated oocytes. Treatment of these unfertilized oocytes with ionophore 20 hours after ICSI resulted in fertilization in 73%. Pregnancy was not achieved after either ICSI cycle. Ultrastructural analysis indicated multiple structural abnormalities in the sperm. CONCLUSION(S) These results indicate that the round-headed sperm from this patient were incapable of oocyte activation after ICSI. This may be the reason for the frequent ICSI fertilization failure seen with this condition. Current ICSI procedures may not always overcome the infertility associated with globozoospermia, and further study of the etiology of this condition is needed.
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Affiliation(s)
- D E Battaglia
- Department of Obstetrics and Gynecology, University of Washington, Seattle 98195, USA.
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Clarke GN, Bourne H, Baker HW. Intracytoplasmic sperm injection for treating infertility associated with sperm autoimmunity. Fertil Steril 1997; 68:112-7. [PMID: 9207594 DOI: 10.1016/s0015-0282(97)81485-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine whether intracytoplasmic sperm injection (ICSI) can be used to achieve normal fertilization, embryo cleavage, and pregnancies in cases of sperm autoimmunity. DESIGN A retrospective analysis of ICSI results in sperm antibody-positive and randomly selected antibody-negative groups. SETTING University- and hospital-based reproductive research laboratory and tertiary referral IVF program. PATIENT(S) Thirty-nine couples selected on the basis of a strongly positive result for sperm antibodies of immunoglobulin (Ig) G and/or IgA immunoglobulin class in the male partner and a control group of 140 antibody-negative couples. INTERVENTION(S) Human menopausal gonadotropin, hCG and Lucrin (Abbott Australasia, Kurnell, NSW, Australia) were given by injection. Oocyte collection was by transvaginal ovarian puncture. Blood was collected for beta-hCG measurement. MAIN OUTCOME MEASURE(S) Normal fertilization, embryo cleavage, establishment of clinical pregnancy, and delivery. RESULT(S) There were no significant differences in fertilization rates (62% versus 58%) or clinical pregnancy rates (19% versus 12%) between sperm antibody-positive and sperm antibody-negative patient groups. CONCLUSION Intracytoplasmic sperm injection is an effective treatment for patients with severe sperm autoimmunity.
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Affiliation(s)
- G N Clarke
- Department of Pathology, Royal Women's Hospital, Carlton, Victoria, Australia
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Abstract
OBJECTIVE To describe methods of sperm retrieval for intracytoplasmic sperm injection (ICSI) in patients with male factor infertility and to review the clinical results using sperm from the different sources. DESIGN The literature on sperm-obtaining methods and ICSI was reviewed. Studies related to this topic were identified through MEDLINE. RESULTS(S) This review describes the evolution of sperm retrieval methods. Sperm can be obtained by microepididymal sperm aspiration (MESA), percutaneous sperm aspiration (PESA), and testicular sperm extraction (TESE), from patients with congenital absence of the vas deferens or acquired vas obstruction. When ICSI is performed with ejaculated, epididymal, or testicular sperm, good fertilization and pregnancy rates are achieved without significant differences among the various sperm sources. The original percutaneous sperm aspiration method has been modified slightly and yields successful results. CONCLUSION(S) Viable pregnancies can be achieved with ICSI by using not only ejaculated sperm, but also epididymal and testicular sperm. Microepididymal sperm aspiration, percutaneous sperm aspiration, modified percutaneous sperm aspiration, and testicular sperm extraction can be considered standard procedures to treat male factor infertility.
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Affiliation(s)
- K Y Cha
- Infertility Medical Center, Cha General Hospital, Seoul, Korea
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