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.

a Case reportA 32 year old primipara was admitted for premature rupture of the membranes at 37 weeks of gestation. She had a history of miscarriage with curettage in association with previous pregnancy. She delivered a healthy male child. After manual delivery of the placenta, exploration of the uterus and oxytocin was required to control bleeding. Selective uterine artery embolisation was carried out because there was an adherent placental cotyledon in the left uterine horn causing uncontrollable bleeding.Selective catheterisation of the left internal iliac artery and superselective catheterisation of the left uterine arteries were performed using a 5F cobra-shaped catheter (Cobra; Terumo, Tokyo, Japan) and a 0.035-in. diameter hydrophilic polymer-coated guide wire (Radifocus; Terumo) from the contralateral groin. The angiography showed no anastomosis between the uterine and the ovarian artery and demonstrated an arterial tear with massive extravasation of contrast material in the uterine cavity. Bilateral free-flow embolisation was performed under fluoroscopic control using iodinated contrast media mixed with gelatine sponge pledgets (Curaspon; Curaspon Healthcare, Netherlands) particles obtained by scraping a piece of gelfoam with a surgical blade. No vascular spasm was observed.On day 21, the patient was readmitted for pelvic pain and abnormal bleeding. Vaginal examination revealed that half of the uterine cervix presented an abnormal colour suggestive of ischaemia. Pelvic magnetic resonance imaging revealed a bulky uterus with a small peripheral enhancement rim. The central portion of the organ was completely necrotic.Subtotal hysterectomy was performed. Both uterine artery pedicles were filled with thrombus. Surgical exploration also revealed a 5-cm necrotic area on the bladder wall (Fig. 1). Cystoscopic examination demonstrated mucosal deterioration and the necrotic portion was excised. Cystography on day 13 was normal. Two months after surgery, the cervix and the vagina were normal.Histological examination of the surgical specimens showed massive ischaemic necrosis of the whole uterus except the deep myometrium. Plurinuclear and giant cells occupying the vessels in the lower part of the uterus had phagocytosed small foreign bodies. Some vessels contained unusual weakly coloured star-shaped structures probably corresponding to the gelatine sponge particles used for embolisation. Vessels containing those structures were less dilated, smaller in diameter and thicker-walled than other vessels. Examination of bladder tissue demonstrated complete disappearance of the mucosa together with ischaemic changes throughout the wall. DiscussionPostpartum haemorrhage is the leading cause of maternal mortality throughout the world.1 Various management strategies have been proposed including embolisation to preserve the uterus. Selective arterial embolisation allows localisation of the bleeding site even in cases involving coagulopathy and is feasible after ligation of the internal iliac artery. 2Endoluminal embolisation...

The aim of this study was to describe the association between various percentages of macronuclear spermatozoa (MNSs), sperm chromosomal abnormalities, and reproductive failure in 4 patients. One patient had a familial history of perinatal deaths. Patients were selected according to the coexistence of normal-sized spermatozoa and MNSs (19%, 22%, 29.5%, and 49.7%). Fluorescent in situ hybridization (FISH) on spermatozoa and semiautomated analysis of nuclear surface were assessed. All patients were characterized by an oligoasthenozoospermia. Three patients had a prevalence of irregular MNSs and prevalence of nondisjunction at the first meiotic division. One patient had a prevalence of regular MNSs and a prevalence of nondisjunction at the second meiotic division. FISH also showed a high rate of polyploidy and various rates of aneuploid sperm. The percentage of sperm with abnormal chromosome complements (25.6%, 43.6%, 51.4%, 71.7% with 3-color FISH) was higher than the percentage of MNSs. A population of apparently normal-sized spermatozoa that could be used for intracytoplasmic sperm injection (ICSI) was aneuploid. Sperm nuclear surface analysis revealed either a shift toward elevated values or distinguished 2 sperm subpopulations: normal and macronuclear. Patients underwent 7 ICSI cycles. The fertilization rate was low for 3 patients (50%, 40%, 50%) and normal for 1 patient (83.3%). Pregnancy rate per transfer was low (14.3%). The present study shows that the macronuclear phenotype can manifest a variety of clinical aspects. It is also shown that mild rates of MNSs impair fertility and constitute a risk of chromosomal abnormality for the embryos and a risk of perinatal death. We suggest conducting FISH on spermatozoa and genetic counseling for a couple when the percentage of MNSs reaches 20% in at least 1 spermiogram.

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The aim of this prospective study was to assess the prevalence of antiphospholipid antibodies (aPL) in women who had undergone in vitro fertilization (IVF) and the relationship between aPL and IVF outcome. A total of 101 infertile women with at least three unsuccessful IVF attempts were consecutively included in this study. Samples were collected in the follicular phase of a spontaneous ovarian cycle 2 months after the last ovulation induction treatment. Age-matched healthy fertile women (n = 160) were included as controls. All were evaluated for the presence of lupus anticoagulant (LA), antibodies (IgG, IgA, IgM) to cardiolipin (aCL), beta2-glycoprotein I (abeta2GPI), and phosphatidylethanolamine (aPE). Out of the 101 infertile women, 40 were persistently positive for aPL, showing a prevalence significantly higher than in controls (39.6% versus 5%, P < 0.0001). Among aPL, aPE were found with a significantly higher prevalence compared with LA, aCL, and aP2GPI (67.5% versus 0%, 15%, and 40%, respectively). Interestingly, aPE were found in 70% of the cases in the absence of the other aPL. The predominant isotype of aPL was IgA, in particular for abeta2GPI. Finally, no significant association was found between the presence of aPL and IVF outcome. This prospective study shows aPE as the most prevalent aPL in infertile women and IgA as more common than IgG and IgM. However, our results do not support an association between aPL and IVF outcome.