Live birth achieved despite the absence of ejaculated spermatozoa and mature oocytes retrieved: a case report

Abstract

The most common reason for in vitro fertilization (IVF) cycle cancelation is a lack of quality gametes available for intracytoplasmic sperm injection (ICSI). Here we present the successful fertility treatment of the couple affected by obstructive azoospermia combined with suboptimal response to controlled ovarian stimulation. Since the conventional approach appeared ineffective to overcome both partnersˈ specific problems, the targeted interventions, namely, (1) pharmacological enhancement of sperm motility and (2) polarized light microscopy (PLM)-guided optimization of ICSI time, were applied to rescue the cycle with only immature oocytes and immotile testicular sperm retrieved. The treatment with theophylline aided the selection of viable spermatozoa derived from cryopreserved testicular tissue. When the traditional stimulation protocol failed to produce mature eggs, non-invasive spindle imaging was employed to adjust the sperm injection time to the maturational stage of oocytes extruding a polar body in vitro. The fertilization of 12 late-maturing oocytes yielded 5 zygotes, which all developed into blastocysts. One embryo was transferred into the uterus on day 5 post-fertilization, and another 3 good quality blastocysts were vitrified for later use. The pregnancy resulted in a full-term delivery of a healthy child. This case demonstrates that the individualization beyond the standard IVF protocols should be considered to maximize the chance of poor-prognosis patients to achieve pregnancy with their own gametes.

Sperm Selection Procedures for Optimizing the Outcome of ICSI in Patients with NOA

“…Ebner et al reported that when frozen/thawed testicular sperm samples from TESE were treated with theophylline, sperm motility improved in most cases, and the clinical pregnancy rate increased from 23% to 53% [ 45 ]. The positive effect of theophylline on sperm motility has also been demonstrated in other studies [ 62 , 63 ]. Although there is concern that motility-enhancing chemicals may have toxic effects on embryo development [ 64 ], no evidence of anomalies in offspring has been shown for either theophylline or pentoxifylline [ 63 , 65 ].…”