Successful childbirth after intracytoplasmic morphologically selected sperm injection without assisted oocyte activation in a patient with globozoospermia

Abstract

We here report a successful pregnancy and healthy childbirth obtained in a case of total globozoospermia after intracytoplasmic morphologically selected sperm injection (IMSI) without assisted oocyte activation (AOA). Two semen analyses showed 100% globozoospermia on classic spermocytogram. Motile sperm organelle morphology examination (MSOME) analysis at ×10,000 magnification confirmed the round-headed aspect for 100% of sperm cells, but 1% of the spermatozoa seemed to present a small bud of acrosome. This particular aspect was confirmed by transmission electron microscopy and anti-CD46 staining analysis. Results from sperm DNA fragmentation and fluorescence in situ hybridization analyses were normal. The karyotype was 46XY, and no mutations or deletions in SPATA16 and DPY19L2 genes were detected. Considering these results, a single IMSI cycle was performed, and spermatozoa were selected for the absence of vacuoles and the presence of a small bud of acrosome. A comparable fertilization rate with or without calcium-ionophore AOA was observed. Two fresh top-quality embryos obtained without AOA were transferred at Day 2 after IMSI, leading to pregnancy and birth of a healthy baby boy. This successful outcome suggests that MSOME may be useful in cases of globozoospermia in order to carefully evaluate sperm morphology and to maximize the benefit of ICSI/IMSI.

Correlation between sperm DNA fragmentation index and CMA3 positive spermatozoa in globozoospermic patients

“…Although previous investigations could determine DNA fragmentation level in very few patients (Table 2), in terms of quantity, this is the largest study in fully globozoospermic men, performed to find out any correlation between DNA damage level and CMA3 positive sperm cells with round head. Several studies were so far able to evaluate DNA damage level in only one patient, using different techniques including SCSA and comet assay (Larson et al, 2001), TUNEL assay (Vicari et al, 2002;Taylor et al, 2010;Perrin et al, 2011b;Sermondade et al, 2011), SCD (Tejera et al, 2008), and AOT (Egashira et al, 2009). Compared with those of fertile controls in Larson's and Sermondade's studies, further investigations on two and six *Correction added on 26 May 2015, after first online publication: sentence structure corrected.…”

“…The introduction of ICSI provided a fertility treatment for patients suffering from globozoospermia (Palermo et al, 1992). However, fertilization rates in ICSI remained severely reduced, mostly because of the inability of the round-headed spermatozoa to trigger oocyte activation (Hamberger et al, 1998;Sermondade et al, 2011).…”

“…Although, there have been some studies about correlation between round head spermatozoa and high levels of sperm DNA damage and protamine deficiency (Tejera et al, 2008;Egashira et al, 2009;Brahem et al, 2011;Sermondade et al, 2011), these reports were in limited number of patients, mostly in a case report.…”

Intracytoplasmic Sperm Injection – Factors Affecting Fertilization

“…The IMSI procedure improved embryo development and the laboratory and clinical outcomes of sperm microinjection in the same infertile couples with male infertility and poor embryo development over the previous ICSI attempts [23]. A successful childbirth after IMSI without assisted oocyte activation in a patient with globozoospermia has been reported [24]. Randomized large-scale trials are needed to confirm the beneficial effects of IMSI in couples with poor reproductive prognoses [25].…”

Assessment of Human Sperm Cells Morphological Parameters

“…Using the high magnification (6000Â and more) by the inverted computerized microscope, it is possible to observe the morphological abnormalities in spermatozoa, which are not visible with magnification 400Â (Figure 1). The neck, tail, midpiece, mitochondria, acrosome and post-acrosomal lamina and the nucleus of spermatozoon are morphologically examined in live motile spermatozoa [19][20][21][22][23][24][25]. …”