Pregnancies after ICSI using sperm with abnormal head-tail junction from two brothers: case report

We report ICSI pregnancies in two couples with a history of long standing primary infertility in which the sperm of the male partner were either acephalic or had abnormal head-midpiece attachments. The two couples, in which the men are brothers, underwent ICSI. Sperm were analysed by transmission electron microscopy and immunocytochemistry with an anti-MPM2 monoclonal antibody. The first couple underwent two ICSI cycles, each consisting of the injection of two mature oocytes and the transfer of two embryos. A successful pregnancy occurred after the second transfer and led to the birth to a healthy girl. The second couple underwent three ICSI cycles, each consisting of the injection of 18 oocytes and the transfer of two embryos; the last of these led to a triple ongoing pregnancy which included two identical twins. Caesarean section led to the birth of three fetal-growth restricted children. This case report demonstrates that ongoing pregnancies can be achieved in cases of abnormal development of the head-neck attachment. The genetic origin of this syndrome is generally accepted, but the phenotypic heterogeneity observed by light and electron microscopy among published cases suggests that there are a variety of genetic causes of this syndrome.

[Prevention of port-site metastasis after laparoscopy]

Port-site metastasis is a major complication of surgical laparoscopy for gynaecologic oncology. Aetiology of port-site metastases is multifactorial. Surgical conditions and laparoscopic environment were determinant. Several means of prevention were evaluated to prevent occurrence of port-site metastases. Aim of this review is to report optimal surgical conditions, laparoscopic environment and means of prevention to decrease risk of port-site metastases.

[Open laparoscopy: analysis of complications due to first trocar insertion]

OBJECTIVE

To evaluate the complications of open laparoscopy during the set-up of laparoscopy in gynecologic surgery.

DESIGN

Retrospective study performed between February 1994 and January 2001 in a University Centre.

PATIENTS AND METHODS

1,562 patients underwent open laparoscopies. Procedures were performed by 8 gynaecological surgeons. Peri- and postoperative complications were assessed and analysed.

RESULTS

Major injuries concerned gastrointestinal tract: 2 perforations with immediate diagnosis and one postoperative occlusion treated by delayed laparotomy (0.19%). No death occurred. No vascular injuries and no bladder complications were noted.

CONCLUSION

We recommend open laparoscopy because of its innocuity and easiness. Advantages concern decrease of major vascular injuries and early recognition of bowel injuries.