Case presentation
The couple presented with 4 years of primary infertility. The
33-year-old woman had been assessed by a gynaecologist, and no
contributing female factors were detected. After physical examination,
the 34-year-old man was normal in the male reproductive system,and no
significant respiratory symptoms were observed. His history provided no
further information of clinical problems,and lymphocyte karyotype was
46, XY. Analysis of microdeletions of azoospermia factor genes on Y
chromosome was normal.However,after repeated semen analyses by light
microscope, the man was subjected to complete immotility and totally
abnormal tail, namely MMAF with short, cureled, bent, coiled, absent
flflagellum(Figure1A). According to the World Health Organization
guidelines,Semen analyses showed sperm densities of 11-21 million/mL,
volumes of 2.6–3.6 mL, and sperm vitality of 39% with normal pH.The
sperm flagellar displayed curled 64%, bent20%, short 7%, absent 3%,
coiled 2%, irregular 4%(Table1). The couple had not previously
attempted IVF.
A long protocol for ovulation induction was administrated by the daily
administration of recombinant FSH (200 IU/day) following pituitary
desensitisation with GnRH agonist. and cumulus-oocyte complexes were
retrieved transvaginally 36 h later under ultrasound guidance after
administration of 10,000 IU of human chorionic gonadotrophin (HCG).
Oocytes were identified and maintained in culture under 6% CO2 in
humidified air at 37°C .
After the oocyte retrieval procedure,cumulus-oocyte complexes were
digested by using hyaluronidase (10 IU/ml). 22 of the 24 oocytes were
confirmed as being at the metaphase II stage of meiosis . 10 mature
oocytes were injected with ejaculated sperm and other 12 of them were
vitrifed in the event of future ICSI attempts with testicular
serpmatozoa. In the fresh cycle,6 of the 10 microinjected oocytes were
fertilized with ejaculated sperm(Table1).On day 3 , two good quality
embryos in culture were transferred. the other four non-good quality
embryos did not develop to blastocyst after six days . Pregnancy was not
achieved after 14 days of embryos’ transfer.
Seven months later, the couple returned to the clinic in order to try
again with their frozen oocytes and fresh testicular
spermatozoa.Testicular spermatozoa were obtained by needleaspiration.
Compared to ejaculated sperm,there was nothing changed about the
testicular spermatozoa morphology,which showed that all were 100%
immotile and curled or bent back on itself. Testicular sperm with
comparatively normal morphology were injected to 12 warmed oocytes,
which survied sucessfully after thawing. Nine two-pronuclei and
one-pronuclei oocytes were obtained at 16 h post-ICSI.cleavage was
observed in eight oocytes.on day 3,two 8-cell embryos with <
20% fragmentation were transferred.two of the remaining 6 embryos
developed to blastocyst after D6,and a grade of 5BB blastocyst was
frozened(Table1).Twelve days after transfer, the βHCG concentration was
80 mIU/dl. But a gestational sac with fetal heartbeat was not observed 3
weeks later.
Fortunately,offspring were obtained in the last attempt after transfer
the frozen blastocyst of 5BB. A normal female baby was delivered,with a
birth weight of 3050g and a length of 53cm.