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1.
Madgar Igael; Seidman Daniel S.; Levran David; Yonish Michal; Augarten Arye; Yemini Ziva; Mashiach Shlomo; Dor Jeboshua 《Human reproduction (Oxford, England)》1996,11(10):2151-2154
In all, 58 couples suffering from infertility because of congenitalbilateral absence of the vas deferens underwent a total of 67combined microsurgical epididymal aspiration or testicular spermextraction (TESE) and in-vitro fertilization (TVT) treatments.The oocytes recovered were inseminated by either the microdropletIVF technique (n=20), subzonal insemination (SUZI; n= 10) orintracyto-plasmic sperm injection (ICSI; n= 37). Of the ICSIcycles, 12 were performed using spermatozoa obtained by TESE.Fertilization rates for epididymal spermatozoa were significantlyhigher for SUZI (17.9%, 17/95) and ICSI (34.4%, 137/398) thanfor microdroplet IVF (5.2%, 18/343) cycles. The proportion ofcycles in which fertilization was achieved was higher in theSUZI (80%) and ICSI (95%) cycles than in the IVF cycles (45%).Delivery or an ongoing pregnancy was achieved in one (5%) IVFcycle, two (20%) SUZI cycles and seven (18.9%) ICSI cycles.SUZI or ICSI using epididymal or testicular spermatozoa significantlyimproved the oocyte fertility rate. The ICSI procedure was especiallyadvantageous in patients for whom spermatozoa were obtainedfrom a testicular biopsy. 相似文献
2.
Nijs M.; Vanderzwalmen P.; Vandamme B.; Segal-Bertin G.; Lejeune B.; Segal L.; van Roosendaal E.; Schoysman R. 《Human reproduction (Oxford, England)》1996,11(10):2180-2185
Sometimes spermatozoa from ejaculate, epididymis or testis showa total absence of motility. For some patients, however, veryfew spermatozoa with very poor motility can be found after severalhours of incubation (initially immotile spermatozoa). Othersamples show no motility at all even after extended culture(totally immotile spermatozoa). Intracytoplasmic sperm injection(ICSI) is the only method available to select and retrieve asingle immotile or initially immotile spermatozoon and injectit into the oocyte. A total of 103 patients with asthenozoospermiaunderwent ICSI in this study. It was shown that initially immotileand totally immotile spermatozoa, whatever their origin, havethe capacity to fertilize an oocyte after ICSI. No significantdifference could be observed between the fertilizing capacityof testicular or epididymal spermatozoa. Totally immotile ejaculatedspermatozoa, however, fertilized significantly fewer oocytesafter ICSI when compared with initially immotile ejaculatedspermatozoa. Embryos of lower quality tended to be producedwhen totally immotile spermatozoa of any origin were used, comparedwith embryos resulting from initially immotile spermatozoa.Ongoing pregnancies were conceived after ICSI with initiallyimmotile spermatozoa from any origin and totally immotile spermatozoaretrieved from testis only. One biochemical pregnancy was theresult of embryo transfer after ICSI with totally immotile ejaculatedspermatozoa. No supernumerary embryos could be cryo-preservedfor patients with totally immotile spermatozoa from ejaculateor epididymis. For a Kartagener patient, subzonal insemination(SUZI) seemed to be a better approach for obtaining fertilizationand pregnancy than ICSI because no fertilization occurred afterICSI on sibling oocytes. Hence a healthy pregnancy was obtainedafter SUZI. 相似文献
3.
Successful pregnancy after spermatid injection 总被引:9,自引:7,他引:2
Bernabeu R; Cremades N; Takahashi K; Sousa M 《Human reproduction (Oxford, England)》1998,13(7):1898-1900
We present nine cases of spermatid intracytoplasmic injection for the
treatment of non-obstructive azoospermia. In eight cases, no elongated
spermatids or spermatozoa were found in previous spermiograms or testicular
biopsies. In these patients, treatment was performed using ejaculated (n =
6) and testicular (n = 2) retrieved round spermatids (Sa type). In cases
where ejaculated round spermatids were used, they were isolated on the day
before oocyte retrieval and left in culture for 24 h before
intracytoplasmic sperm injection (ICSI). No pregnancy was obtained in
either group, although culturing seemed to increase the fertilization rate.
In one other case, elongated spermatids were observed in the previous
spermiogram and thus a normal ICSI procedure was scheduled. However, on the
day of oocyte retrieval, no spermatids could be recovered from fresh
sequential ejaculates, and a testicular open biopsy was then performed.
Both round and elongated spermatids were found in the testicular tissue,
but only the more mature germinal cells (Sb2) were injected. From this
case, a normal pregnancy was obtained which resulted in the birth by
Caesarean section at 37 weeks of gestation of a normal healthy baby girl,
weighing 2700 g.
相似文献
4.
We report two cases of infertility treatment in couples where males suffered from Kartagener's syndrome (KS) and a total absence of motile sperm in the ejaculate. A total of three ICSI cycles was carried out. In all cycles, viable ejaculated or testicular spermatozoa were selected using the hypo-osmotic swelling (HOS) test. Case 1: In the first ICSI cycle total fertilization failure occurred after using ejaculated spermatozoa. In the following cycle testicular spermatozoa were used for ICSI, resulting in 75% fertilized oocytes and a pregnancy. Case 2: In the same ICSI cycle 50% of the oocytes were injected with ejaculated and 50% with testicular spermatozoa. The fertilization rates were 44 and 56% respectively and high quality embryos were achieved in both groups. One single embryo derived from testicular sperm was transferred with a resulting singleton pregnancy. In conclusion, testicular sperm for ICSI seem to have reliable fertilization capacity in men with KS, while ejaculated sperm, even if tested viable, seem more unpredictable. HOS test for selection of viable sperm for ICSI is recommended when ejaculated as well as testicular sperm are used for ICSI. 相似文献
5.
Multiple pregnancies obtained by testicular spermatid injection in combination with intracytoplasmic sperm injection 总被引:18,自引:16,他引:2
Kahraman S; Polat G; Samli M; Sozen E; Ozgun OD; Dirican K; Ozbicer T 《Human reproduction (Oxford, England)》1998,13(1):104-110
Recent studies have shown that the injection of spermatid cells into the
human oocyte can result in normal fertilization, embryo development and
even delivery of live, healthy offspring. In our study, 23 azoospermic
cases with severe spermatogenetic defects in their testicular biopsy are
presented. The serum follicle stimulating hormone (FSH) concentrations and
histopathological results of these males have been documented and compared
in terms of fertilization and embryo development. The mean FSH value of the
azoospermic males was 15.8 +/- 2.3 mIU/l, ranging from 1.6 to 39 mIU/l.
Elongated spermatids were used in three cases only, as these more mature
forms were mostly present in the testicular sample. In the remaining 20
cases, only round spermatids were found for use in intracytoplasmic sperm
injection (ICSI). The fertilization rate with two pronuclei was 31.3%. The
fertilization rate was found to be as high as 71% in three patients in the
elongating and elongated spermatids group and as low as 25.6% in the round
spermatid group. A few immature, non-motile spermatozoa were seen in only
two cases from the elongated spermatid group. However, in the remaining
cases, no spermatozoa were observed. The number of pronuclear (PN) arrest
was quite high when only round spermatids were used (36.1%). Total
fertilization failure was observed in two cases from the round spermatid
group with Sertoli cell only and germ cell aplasia. A total of three
pregnancies was achieved in 23 cases (13.0%), two from the elongated
spermatid group and one from the round spermatid group. One biochemical
pregnancy with a round spermatid resulted in an early spontaneous abortion
and surprisingly, the remaining pregnancies were achieved with elongated
spermatids resulting in multiple pregnancies. One twin and one triplet
pregnancy were established following four embryo transfers in each patient.
The twin pregnancy resulted in a live birth with two healthy babies;
unfortunately, the triplet pregnancy ended in an abortion at 11 weeks. The
use of testicular spermatids in the treatment of non-obstructive
azoospermia may give hope by offering a novel treatment model. In cases
with very severe spermatogenetic defect, even multiple pregnancies can be
achieved with elongated spermatid cells by yielding a high implantation
rate. However, the efficiency of round spermatids in achieving
fertilization and pregnancy was disappointing.
相似文献
6.
Payne Dianna; Flaherty Sean P.; Jeffrey Regan; Warnes Graham M.; Matthews Colin D. 《Human reproduction (Oxford, England)》1994,9(11):2051-2057
In this report, we present the results of our first 100 consecutivecycles of intracytoplasmic sperm injection (ICSI). Overall,fertilization occurred in 98% of cycles and embryos were transferredin 94% (2.6 embryos per cycle). About 50% of patients had embryosfrozen. The overall fertilization rate was 71%, of which 4%were abnormally fertilized (three pronuclei). A total of 30clinical pregnancies were established (32% per transfer), resultingin 18 singleton, six twin and one triplet ongoing pregnancies.The implantation rate per embryo was 15%. There were no significantdifferences in the fertilization or pregnancy rates betweenpatients Who had only occasional motile spermatozoa in the ejaculate,semen that was too poor for routine in-vitro fertilization (IVF),or who had failed routine IVF and/or subzonal sperm injection(SUZI). A group of 18 patients were treated with both ICSI androutine IVF on their first cycle because of the high likelihoodof failed fertilization due to poor sperm morphology (<20%normal). In this group, ICSI oocytes had a fertilization rateof 76% compared to only 15% for the routine IVF (control) oocytes,and six patients conceived after transfer of ICSI embryos (33%),indicating that ICSI can be used successfully on 50% of theoocytes if fertilization failure is expected. Similarly, patientswho had failed to become pregnant with SUZI achieved excellentresults after ICSI. There were no significant differences betweenICSI and routine IVF in the proportions of grade 1, 2 or 3 embryoson day 3 post-oocyte recovery. In conclusion, we have achievedresults comparable to those reported from Belgium and we havefound that ICSI is universally applicable to all forms of severemale factor infertility. ICSI produces fertilization, pregnancyand freezing rates comparable to routine IVF with normozoospermicsamples and has none of the drawbacks of other assisted fertilizationtechniques. 相似文献
7.
Al-Hasani S Ludwig M Palermo I Küpker W Sandmann J Johannisson R Fornara P Sturm R Bals-Pratsch M Bauer O Diedrich K 《Human reproduction (Oxford, England)》1999,14(Z1):97-107
Microinjection is established as the method of choice in the treatment of severe male factor infertility as well as in azoospermic patients. Recent studies have shown that fertilization and cleavage can be achieved by injection of ejaculated as well as testicular elongated spermatids into oocytes. Here we report on the two first pregnancies worldwide resulting from elongated spermatid injection from frozen-thawed testicular tissue. Four patients with complete Sertoli cell-only syndrome (SCOS) and two with spermatogenetic maturation arrest were included in our microinjection programme. Tissues from open testicular biopsies were cryopreserved until the time of follicle puncture. A total of 67 oocytes were harvested. In the two patients with maturation arrest, cryopreserved elongated spermatids were successfully injected, while in two of the other four SCOS patients only cryopreserved round spermatids were available to be injected into the oocytes. Out of 18 injected oocytes, 10 were fertilized in the first group, while nine out of 49 injected oocytes showed fertilization and cleavage in the second group. Two clinical pregnancies were achieved with elongated spermatids from frozen-thawed testicular tissue, while no pregnancy was established in the case of round spermatids. This study confirms that fertilization, cleavage and pregnancy can be successfully achieved in cases with spermatogenetic maturation arrest by injecting cryopreserved elongated spermatids into oocytes. The literature on pregnancies following spermatid injection, as well as the problems using this technique and possible risks, are discussed. 相似文献
8.
Kahraman S Akarsu C Cengiz G Dirican K Sözen E Can B Güven C Vanderzwalmen P 《Human reproduction (Oxford, England)》1999,14(3):726-730
In this study the fertility and outcome of intracytoplasmic sperm injection (ICSI) using megalohead spermatozoa from the ejaculates and testicles was evaluated. Seventeen males with megalohead and pinhead sperm forms in their ejaculate were studied in 22 cycles. A high number of sperm heads without tails and abundant round spermatid forms were commonly observed. Round-headed spermatozoa were seldom accompanied by these severely abnormal spermatozoa. The majority of megalohead spermatozoa were observed to have multiple tails, were predominant in the sample, and were used for ICSI. Ejaculated megalohead spermatozoa were used for ICSI in 15 cycles, while testicular spermatozoa were used in seven cycles where there were no vital spermatozoa or spermatozoa of low vitality in the ejaculate. The same abnormal morphology was observed in the testicles as in the ejaculated spermatozoa in the same males. Mean (+/- SD) low motility 4.7 +/- 5.6% and sperm count (3.8 +/- 4.19 x 10(6)) were common findings in these severely teratozoospermic patients. A low fertilization rate (43.2%) was achieved by using megalohead sperm forms (group I, n = 17) in comparison with the control group (60.2%) which had zero normal sperm morphology according to strict criteria (group II, n = 30) (P <0.01). Furthermore, a low pregnancy rate (9.1%) was obtained in the megalohead sperm group in comparison with the control group (40%) (P <0.05). Low fertilization and pregnancy rates may be due to a high incidence of chromosomal abnormalities from severely defective spermatozoa in the ejaculate. Couples should be counselled and warned about possible low fertilization and pregnancy rates with ICSI when only pinhead and megalohead forms with a high number of sperm heads without tails are present in the ejaculate. 相似文献
9.
Gianaroli L Magli MC Selman HA Colpi G Belgrano E Trombetta C Vitali G Ferraretti AP 《Human reproduction (Oxford, England)》1999,14(4):1034-1038
Between May 1996 and May 1998, 64 azoospermic patients underwent an investigative testicular biopsy combined with the cryopreservation of spermatozoa which were retrieved from a simultaneously examined fresh sample. Testicular tissue cryopreservation was carried out in 43 cases (67%) for late intracytoplasmic sperm injection (ICSI) attempts. In all, 23 couples underwent 26 assisted conception cycles; the fertilization rate was 64% with spermatozoa (139/218, 24 cycles), 40% with round spermatids (2/5, one cycle), and 69% with elongated spermatids (9/13, one cycle). The embryo cleavage rate was 84%. A mean number of 2.7 +/- 0.7 embryos were replaced in 24 patients. In two cases, embryo quality was very poor and they were not transferred. Eight clinical pregnancies resulted (35% per patient and 33% per transferred cycle) with an implantation rate of 14.1%: two patients have already delivered and six are ongoing. In conclusion, the cryopreservation of testicular tissue during the first diagnostic biopsy is an alternative to repeated surgical openings and permits patients to initiate an ovarian stimulation cycle with the certitude of having spermatozoa available. Moreover, since only one straw is routinely used for each ICSI cycle, the frozen tissue remains as a sperm source for multiple attempts. 相似文献
10.
Redgment C.J.; Yang D.; Tsirigotis M.; Yazdani N.; AI Shawaf T.; Craft I.L. 《Human reproduction (Oxford, England)》1994,9(4):680-683
We present results of in-vitro fertilization (IVF) cycles usingassisted fertilization at our centre. Assisted fertilizationwas performed in those couples who had failed to fertilize oocyteswith conventional IVF, or where this was predicted by the presenceof severe male factor infertility. In 20 consecutive assistedfertilization cycles 223 oocyted were subjected exclusivelyto subzonal insemination (SUZI). Subsequently in 32 consecutiveassisted fertilization cycles 418 oocytes were subjected tointra-cytoplasmic sperm injection (ICSI). More oocytes weredamaged by ICSI (8.9%) than by SUZI (2.3%) (p = 0.03), but normalfertilization resulted more often after ICSI (56.9%) than SUZI(35.8%) (p = 0.004). Sperm parameters, other than sufficientnumbers to perform the procedures, had no effect on fertilizationor pregnancy rates. Every cycle led to the transfer of at leastone embryo. Pregnancy resulted from eight of the SUZI cycles(40%) and nine of the ICSI cycles (28%). Implantation rateswere calculated as 25 and 12% for SUZI and ICSI respectively.The presence of living spermatozoa is the only semen parameterlimiting assisted fertilization. At present more centres areable to perform SUZI than ICSI and we feel it is premature toabandon SUZI altogether. Local conditions and success ratesshould be considered when decisions are made in assisted fertilizationcycles. 相似文献
11.
The present study aims to evaluate the injection of testicular round spermatids from patients with complete failure of spermiogenesis compared with that of mature epididymal and testicular spermatozoa. Over a period of 8 months, 188 azoospermic patients were evaluated with a view to their inclusion in our intracytoplasmic sperm injection (ICSI) programme. All patients had had a previous testicular biopsy; 38 had pure obstructive azoospermia, while 150 had non-obstructive azoospermia. Mature spermatozoa were found in 93 patients, whereas spermatozoa were entirely absent, with a predominance of round spermatids in 87. In eight patients, spermatids could not be found and therefore their cycles were cancelled. There was an early appearance of the two pronuclei stage in the round spermatid group compared with the mature spermatozoa group of patients (10.2 and 16 h respectively). The fertilization rate was also significantly lower (P = 0.00001) in the round spermatid group. The numbers of embryos developed and of embryo transfers in the round spermatid injection group were significantly lower compared with the mature spermatozoa injection group (P = 0.05 and 0.0001 respectively). No pregnancies resulted from round spermatid injection, while 18 pregnancies were achieved from the injection of mature spermatozoa. In conclusion, injection of round spermatids from patients with complete failure of spermiogenesis resulted in a significantly lower fertilization rate and a higher developmental arrest compared with injection of mature spermatozoa. With no pregnancies achieved, one may question the unusual variability of reported success rates and stress the need for further research in order to improve the outcome of this novel technique. 相似文献
12.
Limiting testicular biopsy for intracytoplasmic sperm injection (ICSI) to
those with a high chance of having testicular spermatozoa has not been
possible because of the poor predictive value of current clinical and
laboratory methods. In order to predict testicular pathology and sperm
extraction, we characterised the semen of 28 men with azoospermia due to
gonadal failure in terms of the presence of spermatids using an
immunological method. The results were compared with the assessment of
testicular biopsies by histology and the extraction of spermatozoa into
culture medium. Washed cellular elements in the ejaculate were smeared on
microscope slides and fixed in 100% methanol, before incubation with
acrosome-specific monoclonal antibody (18.6), fluorescein
isothiocyanate-labelled anti-mouse goat IgG, and examination by
epifluorescent microscopy. Semen from men with oligozoospermia and
obstructive azoospermia served as positive and negative controls,
respectively. Twelve patients who had positive immunofluorescence (one or
more spermatids present) had spermatozoa retrieved from their testes (five
hypospermatogenesis, seven focal spermatogenesis), and 16 patients with
negative immunofluorescence (spermatids absent) had apparent Sertoli
cell-only syndrome (12) or maturation arrest histological pattern (four).
However, four patients with apparent Sertoli cell-only syndrome had
testicular spermatozoa present after extraction from the biopsy. Plasma
follicle stimulating hormone concentration and testicular volume did not
predict retrieval of seminal spermatids or testicular spermatozoa. We
conclude that the immunofluorescent localization of one or more spermatids
in the ejaculate can be used to predict the likelihood of obtaining
testicular spermatozoa for ICSI. However, in some patients with Sertoli
cell-only syndrome, spermatozoa could still be recovered in the absence of
apparent seminal spermatids.
相似文献
13.
Antinori S; Versaci C; Dani G; Antinori M; Pozza D; Selman HA 《Human reproduction (Oxford, England)》1997,12(2):286-291
Between July 1995 and May 1996, 36 patients with non-obstructive
azoospermia of secretory origin underwent intracytoplasmic injection of
spermatids. A previous histological biopsy was performed on all patients:
15 had spermatogenic arrest, a further 13 had Sertoli cell- only syndrome,
and the remaining eight had post-cryptorchidism tubal atrophy. The
ejaculate was duly examined and a complete absence of spermatozoa and
spermatids was confirmed, with only bacteria and debris being found.
Testicular sperm extraction (TESE) was then performed. In 19 out of 36
cases round spermatids only were found, while elongated spermatids were
found in the remaining 17. Both round and elongated spermatids were
isolated and used for injection. A total of 135 oocytes at metaphase II
were recovered from 19 partners and injected with round spermatids, while
123 mature oocytes from 17 partners were injected with elongated
spermatids. The number of oocytes fertilized, as judged by the presence of
two pronuclei, was 75 (55.5%) and 71 (57.7%) respectively. By 34 h after
injection, the number of embryos which had cleaved to the 2-cell stage was
56 (74.6%) with round spermatids and 55 (77.4%) with elongated spermatids.
All cleaved embryos were transferred into the uterus of the partners.
Clinical pregnancies were established in two cases of round spermatid
cycles (10.5%) (both are still ongoing), and three cases of elongated
spermatid cycles (17.6%) (two are still ongoing; one was lost after 8 weeks
of gestation). Chromosomal analysis showed that all fetuses had a normal
karyotype (three male and one female) with no chromosomal abnormalities.
相似文献
14.
Sousa M Cremades N Silva J Oliveira C Ferraz L Teixeira da Silva J Viana P Barros A 《Human reproduction (Oxford, England)》2002,17(7):1800-1810
BACKGROUND: A retrospective study was carried out on 159 treatment cycles in 148 secretory azoospermic patients to determine whether histopathological secretory azoospermic subgroups were predictive for gamete retrieval, and to evaluate outcome of microinjection using fresh or frozen-thawed testicular sperm and spermatids. METHODS: Sperm and spermatids were recovered by open testicular biopsy and microinjected into oocytes. Fertilization and pregnancy rates were assessed. RESULTS: In hypoplasia, 97.7% of the 44 patients had late spermatids/sperm recovered. In maturation-arrest (MA; 47 patients), 31.9% had complete MA, and 68.1% incomplete MA due to a focus of early (36.2%) or late (31.9%) spermiogenesis. Gamete retrieval was achieved in 53.3, 41.2 and 93.3% of the cases respectively. In Sertoli cell-only syndrome (SCOS; 57 patients), 61.4% were complete SCOS, whereas incomplete SCOS cases showed one focus of MA (5.3%), or of early (29.8%) and late (3.5%) spermiogenesis. Only 29.8% of the patients had a successful gamete retrieval, 2.9% in complete and 77.3% in incomplete SCOS cases. In total, there were 87 ICSI, 39 elongated spermatid injection (ELSI) and 33 round spermatid injection (ROSI) treatment cycles, with mean values of fertilization rate of 71.4, 53.6 and 17%, and clinical pregnancy rates of 31.7, 26.3 and 0% respectively. CONCLUSIONS: Histopathological subgroups were positively correlated with successful gamete retrieval. No major outcome differences were observed between testicular sperm and elongated spermatids, either fresh or frozen-thawed. However, injection of intact round-spermatids showed very low rates of fertilization and no pregnancies. 相似文献
15.
Spermatid injection into human oocytes. II.Clinical application in the treatment of infertility due to non obstructive azoospermia 总被引:3,自引:11,他引:3
Tesarik Jan; Rolet Francois; Brami Charles; Sedbon Eric; Thorel Jean; Tibi Charles; Thebault Alain 《Human reproduction (Oxford, England)》1996,11(4):780-783
We have reported recently the first birth after intrauterinetransfer of embryos obtained by injection of round spermatidsinto oocytes in cases of unexpected azoospermia. Here we providea complete documentation of the series of 11 cases in whichthis novel method of infertility treatment was employed. Infour of these cases, elongated spermatids were identified inthe ejaculate, and it was decided to perform elongated spermatidinjection (ELSI). In the other six cases, only round spermatidswere present, and round spermatid injection (ROSI) was done.In one case, ROSI was given preference to ELSI because of avery poor viability status of elongated spermatids present inthe ejaculate. Fertilization of at least one oocyte was achievedin 10 of the 11 treatment cycles; the fertilization rate inthese 10 cycles ranged between 7 and 100% with a mean valueof 45%. All of the two-pronucleated zygotes cleaved and weretransferred to the patients uterus. A singleton pregnancywas achieved in two ROSI cycles. Both pregnancies developeduneventfully and resulted in the birth of normal infants. Thesedata show that intra-ooplasmic injection of spermatids obtainedfrom the ejaculate may become the treatment of first choicein patients with non-obstructive azoospermia. 相似文献
16.
Vanderzwalmen P; Zech H; Birkenfeld A; Yemini M; Bertin G; Lejeune B; Nijs M; Segal L; Stecher A; Vandamme B; van Roosendaal E; Schoysman R 《Human reproduction (Oxford, England)》1997,12(6):1203-1213
Spermatid microinjection into oocytes has proven to be a successful
assisted reproduction procedure in the animal model and in the human
species, since in the latter a few full-term pregnancies were actually
obtained. Patients entering our spermatid injection study included those
with a total absence of spermatozoa in the testicular tissue
notwithstanding previous positive biopsies (n = 29): an obstructive problem
(n = 3), secretory azoospermia (n = 26), and those with total arrest at the
spermatogenesis level in previous explorative biopsies (n = 15). In the
latter group, absence of spermatids was recorded in four cases. Mature,
elongated, elongating and round spermatids (ROS) were injected in
respectively 3, 2, 3, and 32 attempts. A total of 260 metaphase II oocytes
were injected with ROS, 36 oocytes with spermatids at other stages of
maturity. The rates of oocytes showing two pronuclei (2PN) and two polar
bodies reached 22% and 64% respectively after injection of round or
elongated-mature spermatids. The fertilization rate after ROS injection was
influenced by the percentage of spermatozoa observed in a previous biopsy.
Patients with a positive preliminary biopsy had significantly more 2PN
(33%) when compared to those with a severe spermatogenic dysfunction and in
whom no spermatozoa were found (only 11%) (P < 0.05). Incubation of
oocytes in calcium ionophore after ROS injection had a positive effect on
the rate of 2PN formation (36 versus 16%). Ninety per cent of all the
normally fertilized oocytes cleaved. The percentage of grade A and B
embryos depended on the type of injected cells: 12% after ROS and 30% with
the other types of haploid cells. A total of 39 transfers resulted in five
pregnancies: three full term with healthy babies delivered (one after ROS
injection, and two after injection of an elongating and a mature
spermatid), one 4 months ongoing (after elongating spermatid injection) and
one miscarriage at 4 weeks (after elongated cell injection). Compared to
our conventional intracytoplasmic sperm injection- testicular sperm
extraction (ICSI-TESE) programme, the implantation rate after ROS injection
was very low (5.5 versus 10.5%).
相似文献
17.
Zech H Vanderzwalmen P Prapas Y Lejeune B Duba E Schoysman R 《Human reproduction (Oxford, England)》2000,15(4):969-971
Spermatid microinjection into oocytes was applied in cases of intracytoplasmic sperm injection (ICSI)/testicular sperm extraction (TESE) where no spermatozoa could be found in numerous testicular samples. Although several pregnancies were obtained with this procedure, serious concerns remain regarding its safety. Although the relevance of the injection of spermatids is by no means certain, we wish to report that from four pregnancies obtained after injection of elongated spermatids, two cases of major malformation resulted. 相似文献
18.
Progression to the blastocyst stage of embryos derived from testicular round spermatids 总被引:1,自引:0,他引:1
Balaban B Urman B Isiklar A Alatas C Aksoy S Mercan R Nuhoglu A 《Human reproduction (Oxford, England)》2000,15(6):1377-1382
Progression to the blastocyst stage of embryos derived from testicular round spermatids in men with non-obstructive azoospermia was studied. A total of 56 men were studied in whom partial spermatogenesis failure had occurred where only very few spermatozoa (fewer than the number of oocytes retrieved) were extracted from multiple testicular biopsy specimens. Oocytes remaining after intracytoplasmic injection of testicular spermatozoa (group 1) were injected with round spermatids (ROSI, group 2). Only embryos derived from group 1 were transferred. Remaining embryos were observed under culture for 8 days and their progression to the blastocyst stage was recorded. Of the 546 oocytes injected with testicular spermatozoa, 404 (73.9%) showed evidence of 2-pronuclear (2PN) fertilization. Injection of testicular round spermatids resulted in 2PN fertilization rate of 50% (P < 0.05). Using a four-point grading system, 53% of the good quality embryos (grade 1 or 2) in group 1 reached the blastocyst stage compared with 25% in group 2 (P < 0.05). The rate of progression to the blastocyst stage of grade 3 and grade 4 embryos was 46 and 8.5% in the two groups respectively (P < 0.05). Using a different three-point grading system for the blastocysts, 75.3% of the blastocysts in group 1 were either grade 1 or grade 2 and 24.7% were grade 3. However, in group 2 all blastocysts were grade 3. All embryos observed in group 1 reached the blastocyst stage by day 5 or 6 compared with 25% of the embryos reaching the blastocyst stage by this time in group 2. While 31.2% of the blastocysts in group 1 showed evidence of spontaneous hatching in vitro, none of the blastocysts in group 2 hatched. In conclusion, progression to the blastocyst stage occurred at a much lower and slower rate in embryos derived from testicular round spermatids. Furthermore, all blastocysts resulting from ROSI were of poor quality and none showed spontaneous hatching. These results may explain the dismal outcome associated with ROSI. 相似文献
19.
《Human reproduction (Oxford, England)》1998,13(6):1737-1746
The second report of the ESHRE Task Force on ICSI describes the outcome of
13,666 ICSI cycles carried out in 1994 by 90 centres in 24 countries. Most
cycles used ejaculated spermatozoa (94.4%) while epididymal and testicular
spermatozoa were used in 4.1% and 1.5% of the cycles. Outcome measures in
the three types of spermatozoa included the number of: (i) intact oocytes
after ICSI; (ii) normally fertilized oocytes; (iii) transferred and frozen
embryos; (iv) embryo transfers and (v) cycles with positive serum HCG. The
evolution of the pregnancies was analysed in terms of pregnancy losses and
clinical pregnancies. The results of ICSI with spermatozoa from the
ejaculate was analysed according to the year that ICSI started in the
different centres. The survey also reports the follow-up of children born
after ICSI carried out until 31 December 1993. A total of 455 pre- and
postnatal karyotypes revealed the presence of nine abnormal karyotypes.
Twenty-four centres reported on 807 ICSI children: 763 using ejaculated
spermatozoa, 36 using epididymal spermatozoa and eight using testicular
spermatozoa. Sixteen major congenital malformations were reported.
相似文献
20.
Reubinoff BE; Abeliovich D; Werner M; Schenker JG; Safran A; Lewin A 《Human reproduction (Oxford, England)》1998,13(7):1887-1892
Non-mosaic Klinefelter patients are generally azoospermic due to primary
testicular failure. Nevertheless, in some cases, testicular spermatozoa may
be recovered and utilized to fertilize oocytes via intracytoplasmic sperm
injection (ICSI). As the risk for an increased number of gonosomes in these
spermatozoa is unclear, preimplantation genetic diagnosis (PGD) may be
attempted in the resulting embryos. In the present study, we report our
experience with the combined approach of sperm retrieval by testicular fine
needle aspiration (FNA), ICSI and PGD in seven consecutive non-mosaic
Klinefelter individuals. In four patients, between one and five spermatozoa
were retrieved in five out of nine consecutive attempts. In a fifth
patient, only 10 round spermatids could be isolated. Mature spermatozoa
were injected into a total of 16 metaphase-II oocytes, of which 11 (69%)
remained intact. Two distinct pronuclei (2PN) were observed in four oocytes
(36%) while a single pronucleus (1PN) was documented in two oocytes. Five
cleavage stage embryos developed from the oocytes of two couples. Upon the
request of one couple, their three embryos (two derived from 1PN oocytes)
were transferred without PGD but pregnancy was not achieved. PGD by
fluorescence in-situ hybridization (FISH) was performed in the two embryos
of the other couple which were derived from normal fertilization. PGD
results of one embryo were 18,18,X,X,Y, the embryo was not transferred and
FISH analysis of the remaining blastomeres identified variable chromosome
numbers in the nuclei. The second embryo was diagnosed as normal and was
transferred, resulting in a successful pregnancy and birth. In conclusion,
the results of this report indicate that a pregnancy and birth may be
attained in azoospermic non-mosaic Klinefelter individuals by testicular
FNA combined with ICSI. Due to the unknown risk of gonosomes aneuploidy in
embryos from Klinefelter patients, PGD or prenatal diagnosis should be
recommended.
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