Globozoospermia is a rare and severe type of teratozoospermia characterized by the presence of round-headed, acrosomeless spermatozoa with cytoskeleton defects. Current data support a negative relationship between globozoospermia and intracytoplasmic sperm injection (ICSI) outcomes, revealing the need to perform exhaustive studies on this type of sperm disorder. The aim of this study was to evaluate different structural, functional and molecular sperm biomarkers in total globozoospermia with proper embryo development after ICSI. The combination of field-emission scanning electron microscopy (FE-SEM) and transmission electron microscopy (TEM) allowed us to identify and correlate eight morphological patterns with both types of microscopy. Additionally, results reported a high percentage of coiled forms, with cytoplasmic retentions around the head and midpiece. By fluorescent microscopy, we detected that most of the sperm showed tubulin in the terminal piece of the flagellum and less than 1% displayed tyrosine phosphorylation in the flagellum. Moreover, we did not detect chaperone Heat shock-related 70 kDa protein 2 (HSPA2) in 85% of the cells. Overall, these findings provide new insights into globozoospermia, which could have potential implications in improving sperm selection methods for assisted reproductive techniques.

OBJECTIVE: To characterize the impact of state IVF insurance mandates on embryo transfer practices in terms of mean number of embryos per transfer and utilization of fresh versus frozen embryo transfers.MATERIALS AND METHODS: Data from the 2018 CDC ART Fertility Clinic Success Rates Report and the National ART Surveillance System (NASS) were used to calculate the number of embryos transferred per procedure and number of fresh and frozen embryo transfers. Data were stratified into two groups, ''Comprehensive'' and ''Non-comprehensive,'' based on the degree of IVF coverage mandated by state laws. Two-sample t-test and chisquare test were used to compare mean number of embryos transferred per procedure and frozen transfers as a share of all transfers, respectively, according to mandate status.RESULTS: In 2018, 456 clinics reported data to the CDC. Comprehensive IVF mandates were identified in 6 states. Mean number of embryos per transfer was significantly lower in states with comprehensive IVF mandates compared to states without these mandates among all transfer types. On age-group sub-analysis, this difference remained significant among transfers performed in younger age groups. Significantly more embryos were transferred in fresh than frozen embryo transfers. Significantly fewer frozen transfers as a share of all embryo transfers were performed in states with comprehensive IVF mandates.CONCLUSIONS: Comprehensive IVF insurance mandates were associated with a significantly lower mean number of embryos transferred per procedure. More embryos were transferred in fresh compared to frozen embryo transfers. Frozen embryo transfers accounted for smaller share of embryo transfers in states with comprehensive IVF mandates.

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