Fertilization and early embryology: Premature chromosome condensation of the sperm nucleus after intracytoplasmic sperm injection

A cytogenetic-cytological study was performed on unfertilizedhuman oocytes (first polar body visible) after intracytoplasmicsperm injection (ICSI) with respect to the rate of prematurelycondensed sperm chromosomes (G₁-PCC). Out of 163 prepared oocytesderived from 41 ICSI cycles, 133 (-82%) could be analysed successfully.A total of 60 oocytes (45.1%) showed metaphase II chromosomesin the haploid range along with an intact sperm head and 27oocytes (20.3%) were missing the sperm head, but two of themshowed an approximately diploid set of chromosomes; 38 oocytes(28.6%) exhibited the maternal metaphase II chromosomes as wellas G₁-PCC of the sperm nucleus showing a remarkable variationin the degree of condensation. Ten ICSI cycles (each followedby an embryo transfer) were characterized each by 2–3oocytes demonstrating G₁-PCC. It is concluded that the maincause of failed fertilization after ICSI is the failure of oocyteactivation. When the sperm nucleus is able to act with the chromosomecondensing factors and the oocyte does not become activated,this will lead to the induction of PCC. Absence of the spermhead might be due to injection or ejection of the spermatozoonin the perivitelline space except for two cases in which fertilizationmight have occurred. Finally, the observation of both a singlechromatin region (n = 6) or two chromatin regions (n = 2) indicatedoocyte activation which, however, was followed by developmentalarrest.     

Intracytoplasmic sperm injection in mice: increased fertilization and development to term after induction of the acrosome reaction

A technique has been developed for intracytoplasmic sperm injection(ICSI) in the mouse with a relatively low rate of lysis of oocytes(range 5–25% across experiments) and pronuclear formationin around one-third of the intact oocytes (range 30–38%across experiments) for untreated spermatozoa. The treatmentof spermatozoa with calcium ionophore, to induce the acrosomereaction (increases acrosome-free spermatozoa from 28 to 58%)before ICSI, increased pronuclear formation to {small tilde}60%(range 59–627percnt; across experiments) in intact oocytes.The pronuclear oocytes developed to blastocysts in vitro andto term when transferred to recipient foster mothers at ratesequivalent to zygotes formed after insemination in vitro. Therewas no benefit for fertilization rates of activating oocyteswith 8% ethanol before or after ICSI, nor was there any evidenceof parthenogenetic activation by the sperm solution used forICSI. This technique adds to other in-vitro fertilization techniqueswhich can be used to explore gamete interactions and to recoverbreeding in infertile strains and reproductively unfit mice.     

Andrology: Intracytoplasmic sperm injection does not require special treatment pf the spermatozoa

In order to assess whether specific treatment of spermatozoais required prior to intracytoplasmic sperm injection (ICSI),three methods of sperm preparation were compared in this study.These three methods were (A) incubation of spermatozoa withpentoxifylline (PTX) and 2-deoxyadenosine (DOA), (B) electroporationfollowed by incubation in medium with PTX, and (C) no furthertreatment with the Percoll gradient. Controlled comparisonswere carried out between method A and method B in 21 patients,and between method A and method C in 32 patients. There wasno difference in the rates of fertilization and embryo cleavagewhen ICSI was done with spermatozoa treated by procedures A,B or C. Furthermore, the sperm selection procedure prior toICSI was done in two different media: T6 medium containing 1.78mM CaCl₂·2H₂O and a final washing step after the Percollgradient in T6 medium containing 5.0 mM CaCl₂·2H₂O, andEarle's medium containing 1.78 mM CaCl₂·2H₂O. The resultsof ICSI on sibling oocytes from 12 patients revealed no differencein the fertilization and embryo cleavage rates between the twodifferent media used during the sperm selection procedures.In conclusion, it appears that high fertilization and pregnancyrates can be obtained in couples with severe male-factor infertilityby ICSI and that no special treatment of the spermatozoa priorto ICSI is required.     

Fertilization and early embryology: Cytogenetic and fluorescent in-situ hybridization chromosomal studies on in-vitro fertilized and intracytoplasmic sperm injected 'failed-fertilized' human oocytes

This study was undertaken to establish baseline data on thechromosomal status of ‘failed-fertilized’ oocytesderived from in-vitro fertilization (IVF) or intracytoplasmicsperm injection (ICSI) procedures. A cytogenetic analysis wasundertaken on 162 IVF and 51 ICSI oocytes. In all, 82.1% (133/162)of the IVF and 78.4% (40/51) of the ICSI oocytes had metaphaseII (Mil) plates, of which 50.4% of the IVF and 47.5% of theICSI oocytes were analysed further. Chromosomes of the G-group(21–22) were identified with the majority of the anomalies.No overall significant difference in the aneuploidy rate wasfound for the IVF (37.3%) or ICSI (31.6%) oocytes, or with maternalage. However, chromosome anomalies, e.g. diploidy, fragmentedand broken chromatids, single sperm and oocyte chromatids, werefound in oocytes from IVF patients aged >36 years and inthe ICSI oocytes throughout the maternal age range (31–38years). The status of the polar body chromatin indicated thatthere was no overall significant difference in the maturationof the IVF and ICSI oocytes. Evidence of successful sperm deliverywas found in 72.5% (37/51) of the ICSI failed-fertilized oocytes.In this group there was a significant increase in the incidenceof premature chromosome condensation: 19.6% (10/51) containedsperm chromosomes, 7.8% (4/51) had swollen sperm heads, andthe remaining 45.0% had condensed sperm heads. The presenceof both sperm and Mil oocyte chromosomes was found in 19.6%(10/51) of the ICSI and 8.6% (14/162) of the IVF failed-fertilizedoocytes. Specific fluorescent in-situ hybridization DNA probeswere used to re-analyse the chromosomes of karyotyped ‘failed-fertilized’IVF oocytes and, for the first time, applied to the karyotypedchromosomes of failed-fertilized ICSI oocytes. The hybridizationefficiency was 86–95% for the centromere probe and 100%for probes 21 and 18.     

A detailed cytogenetic analysis of large numbers of fresh and frozen-thawed human sperm after ICSI into mouse oocytes

BACKGROUND: Since information about chromosome aberrations in micro-manipulated sperm is still inadequate, cytogenetic analysis was performed on large numbers of fresh and frozen-thawed (FT) human sperm after injection into mouse oocytes. The effects of the ICSI procedure on oocytes are also discussed based on analysis of the mouse chromosome complements. METHODS: After the injection of fresh and FT human sperm into mouse oocytes, chromosomes of the hybrid oocytes were analysed at first cleavage metaphase. RESULTS: Incidences of the hybrid oocytes at the first cleavage metaphase were significantly different between fresh (71.5%) and FT sperm groups (80.1%) (P < 0.05). The chromosome analysis of 477 fresh and 141 FT sperm showed no difference in the incidences of aneuploidy (1.6/0.7%), structural aberrations (8.8/7.8%) or diploidy (0.0/0.0%) between these categories. The cytogenetic result did not differ from our previous result using IVF between human sperm and hamster oocytes. In an additional cytogenetic study on 615 mouse chromosome complements, the incidence of diploidy (5.4%) was significantly higher than those (0.3-2.8%) in the previous mouse cytogenetic studies, and the hybrid oocytes with no mouse chromosomes (2.0%) existed. CONCLUSIONS: This result suggests that the ICSI procedure induces no sperm chromosome aberrations but increases numerical aberrations in oocyte chromosome complements.     

Timing of sperm and oocyte nuclear progression after intracytoplasmic sperm injection

We investigated the time course of human oocyte activation afterintracytoplasmic sperm injection (ICSI) by observing the oocytechromosome configuration at different times after injection.One day old human oocytes were injected with spermatozoa andsubjected to cytogenetic analysis at 2, 3, 4 and 5 h after injection.We found that anaphase is initiated in the vast majority ofthe oocytes between 2 and 3 h after injection, and that by 4–5h after injection most of the oocytes have reached the chromatinmass stage. Two distinguishable stages of sperm nucleus transformationwere observed. The first phase — swelling — wasreached within 2 h after the injection and was independent ofoocyte activation. The second phase — the ‘brush’-likestage or decondensed chromatin stage — was found onlyin activated oocytes. Moreover, this stage was not reached beforethe chromatin mass stage (late telophase) of the oocyte. Thesame proportion of metaphase II oocyte chromosome configurationsand unchanged sperm nuclei was found at any given time afterinjection. We conclude that: (i) ICSI allows users to obtainan almost synchronized population of activated oocytes; (ii)anaphase II is initiated in the majority of oocytes not laterthan 2–3 h after injection and telophase II is reached5 h after injection; and (iii) there are two distinguishablephases of sperm nucleus transformation after ICSI: oocyte activationindependentswelling of the sperm head and oocyte activation-dependent chromatindecondensation which is coupled to the beginning of oocyte chromosomedecondensation.     

Fertilization and early embryology: Behaviour of spermatozoa in human oocytes displaying no or one pronucleus after intracytoplasmic sperm injection

The behaviour of sperm cells after intracytoplasmic sperm injection(ICSI) was investigated by analysing 192 unfertilized and 37one-pronuclear (1PN) oocytes following ICSI. Eighty-two unfertilizedoocytes were directly fixed whereas 110 were first parthenogeneticallyactivated by puromycin. In contrast to the findings in unfertilizedoocytes after in-vitro fertilization, most unfertilized oocytesafter ICSI (n = 76) contained evidence of the presence of spermatozoain the cytoplasm. Few oocytes (n = 6) contained prematurelycondensed sperm chromosomes (PCC), whereas the majority containedeither intact sperm heads (n = 31) or swollen sperm nuclei (n= 39) along with metaphase II chromosomes of the oocyte. Followingactivation by puromycin, swollen sperm nuclei and PCC were nolonger observed, whereas unchanged sperm heads persisted in12 oocytes displaying a single pronucleus. A non-decondensedsperm nucleus along with decondensed maternal chromatin werealso discovered in 32 out of 37 oocytes displaying a singlepronucleus after ICSI. The findings in unfertilized and 1PNoocytes after ICSI indicate that successful sperm injection,even followed by oocyte activation, is not sufficient to guaranteenormal fertilization. It seems that partial sperm membrane damageprior to injection is also required to ensure normal sperm decondensation.     

Cryopreservation of human oocytes and fertilization by two techniques: in-vitro fertilization and intracytoplasmic sperm injection

Human oocyte cryopreservation results in poor survival and subsequentfertilization rates. It has been suggested that freeze-thaw-inducedchanges in the zona pellucida may impair sperm penetration orattachment. The aim of this study was to compare fertilizationand cleavage rates in cryopreserved oocytes inseminated by conventionalin-vitro fertilization (IVF) or intracytoplasmic sperm injection(ICSI). A total of 220 oocytes, obtained from volunteers whohad undergone ovarian stimulation, were cryopreserved usinga slow freeze-rapid thaw protocol with 1.5 M propanediol asthe cryoprotectant. Surviving oocytes (n= 74, 34.4%) were randomlyallocated for fertilization by conventional IVF (group 1) orICSI (group 2) using cryopreserved spermatozoa from a singledonor of proven fertility. Fertilization was achieved in five(13.5%) of the oocytes in group 1 and 17 (45.9%) in group 2(P < 0.005), with only one oocyte in group 1 exhibiting normalfertilization as opposed to 16 (43.2%) in group 2 (P < 0.001).Similarly, one oocyte fertilized by IVF cleaved, while all fertilizedwith ICSI cleaved (P < 0.001). We conclude that althoughthe survival of oocytes is poor following cryopreservation,fertilization and cleavage rates can be enhanced significantlyusing ICSI. These data also suggest that the method of cryopreservationused in this study affected the zona pellucida, such that normalsperm attachment or penetration was impaired.     

Developmental competence of oocytes showing increased cytoplasmic viscosity

BACKGROUND: The objective of the study was to investigate the developmental fate of oocytes with increased cytoplasmic viscosity as assessed by the persistence of the injection funnel after withdrawal of the ICSI pipette. METHODS: For this purpose, 1008 oocytes showing a characteristic injection funnel during ICSI were subdivided into two groups according to the oocyte's ability to restore its spherical shape within 2-3 min after ICSI. Fertilization and further development was evaluated in both groups. In addition, implantation and pregnancy rates were analysed. RESULTS: In the funnel positive cohort (group 1) significantly fewer oocytes degenerated after injection (P < 0.01) compared with oocytes without persistent funnel (group 2). However, at zygote stage, presence of a halo (P < 0.05) and a optimal pronuclear pattern 0 (P < 0.01) was increased in group 2. In addition, significantly fewer poor quality embryos were found in this group (P < 0.01). The number of good quality blastocysts but not blastocyst formation was increased in group 2 (P < 0.05). This resulted in an increased clinical pregnancy rate if embryos which derived exclusively from funnel negative oocytes were transferred (P < 0.05). CONCLUSIONS: Our data suggest that cytoplasm of higher viscosity delays development up to cleavage stage and impairs optimal development. Injection funnel persistence was found to be a negative prognostic marker of preimplantation development.     

The outcome of ICSI of immature MI oocytes and rescued in vitro matured MII oocytes

BACKGROUND: The use of immature oocytes is limited to cases where these are the only available oocytes, and they are usually only microinjected with sperm after having undergone maturation in vitro. This study compares the outcome of injection of sperm into metaphase I oocytes immediately after their denudation (MI) performed 2 h after their retrieval, with the outcome of injection of sperm into rescued in vitro matured metaphase II (IVM MII) oocytes after their short incubation in routine laboratory conditions. METHODS: ICSI was performed on MI oocytes, rescued IVM MII oocytes and on MI oocytes that were incubated but failed to extrude their first polar body (arrested IVM MI). Fertilization and cleavage rates were compared with those achieved in mature metaphase II oocytes (MII). RESULTS: ICSI of MI oocytes showed impaired performance compared with ICSI of rescued IVM MII oocytes and MII oocytes, in terms of oocyte degeneration rate (11 versus 6 versus 4%; P < 0.0001), fertilization rate (28 versus 44 versus 68%; P < 0.0001) and multipronucleated fertilization (10 versus 4 versus 4%; P < 0.01). The cleavage rate was lower in rescued IVM MII oocytes compared with MII oocytes (86 versus 95%; P < 0.01). Arrested IVM MI oocytes showed similar results to those of MI oocytes but had a lower cleavage rate (72 versus 96%; P < 0.01). CONCLUSIONS: The injection of rescued IVM MII oocytes is preferred to the injection of MI oocytes.     

Fertilization and early embryology: Intracytoplasmic single sperm injection of 1-day-old unfertilized human oocytes

Although the average fertilization rate in most in-vitro fertilization(IVF) centres is 60–70%, there are cases of complete orvirtually complete fertilization failures. The aim of our workwas to study the fertilization and the subsequent cleavage characteristicsof 1-day-old human oocytes treated by intracytoplasmic singlesperm injection (ICSI) after failing to fertilize during thestandard IVF procedure. A total of 115 metaphase II 1-day-oldunfertilized oocytes were collected from 23 patients. No additionaltreatment was applied to the oocytes or to the semen sample.A single spermatozoon from the patient's husband was injectedinto the cytoplasm of each of these oocytes 21–33 h afterovum retrieval. Injected oocytes were observed at 16–18h and again 42–44 h after the ICSI procedure. Of the injectedoocytes, 92% (n = 106) were intact after ICSI, 38% (n = 44)had two distinct pronuclei and there was no difference in thefertilization rate of oocytes when andrological and non-andrologicalpatients were compared. Similarly, there was no difference inthe fertilization rate after ICSI where patients with acceptableor good (> 15%) fertilization after standard IVF were comparedto patients who had poor (<15%) fertilization after IVF.There was no significant difference in the sperm concentrationor in the progressive forward motility (a + b motility) in thesegroups except where a + b motility of andrological and non-adrologicalpatients was compared. The majority (84%) of the normally fertilizedoocytes cleaved and most (77%) of these embryos showed <20%fragmentation 2 days after the ICSI procedure. From this studyit can be concluded that 1-day-old metaphase II oocytes whichhave failed to be fertilized after standard IVF procedure canbe fertilized and cleave when ICSI is performed on them theday after oocyte retrieval.     

A novel method for chromosome analysis of human sperm using enucleated mouse oocytes

BACKGROUND: Mouse oocytes can be used in conjunction with intracytoplasmic sperm injection (ICSI) as a technique to permit chromosomal analysis of human sperm. However, chromosomes derived both from the human sperm and the mouse oocyte appear simultaneously following ICSI. The present study focused on evaluating whether or not previously enucleated mouse oocytes are usable for the analysis of human sperm chromosomes. METHODS: The metaphase chromosome-spindle complex was removed from a mouse oocyte. Human sperm from a donor with proven fertility were injected into mouse enucleated oocytes or intact oocytes. The presence of pronuclei in the oocytes was confirmed approximately 7-11 h after ICSI, and the oocytes were then fixed so that the nuclei could be observed as chromosome samples at 15-16 h after ICSI. RESULTS: The formation rate of one pronucleus in enucleated oocytes after ICSI was 93.9% (186/198) while that of two pronuclei in intact oocytes after ICSI was 85.4% (88/103). The appearance rate of metaphase chromosomes of human sperm in the enucleated oocytes, 89.4% (160/179), was significantly higher than that in intact oocytes, 78.7% (74/94) (P = 0.017). CONCLUSIONS: An efficient ICSI method using enucleated mouse oocytes was established to allow the visualization of the human sperm chromosome complement without the risk of confusion with mouse oocyte chromosomes.     

A comparison of ICSI outcomes with fresh and cryopreserved epididymal spermatozoa from the same couples

The published experience with frozen-thawed epididymal spermatozoa and intracytoplasmic sperm injection (ICSI) suggests that fertilization and pregnancy success rates are comparable to those achieved with freshly retrieved spermatozoa. However, no study has exactly compared clinical outcomes between the two IVF/ICSI cycles in the same couples. To formally address this issue, we assessed ICSI outcomes in couples each of whom had had two IVF/ICSI cycles: one using fresh and the second using frozen-thawed epididymal spermatozoa obtained from a single aspiration procedure. From a pool of 101 consecutive patients undergoing IVF/ICSI with epididymal spermatozoa, 19 couples initially used fresh epididymal spermatozoa and subsequently underwent a second IVF/ICSI procedure with frozen-thawed spermatozoa from the same aspiration. Normal (2PN) oocyte fertilization rates, embryo quality and pregnancy rates were compared between the two IVF/ICSI cycles for each couple. In the fresh epididymal sperm group, 58.4% of the injected oocytes fertilized normally compared with 62.0% of the injected oocytes in the frozen-thawed epididymal sperm group, revealing no statistically significant difference. Graded embryo quality also did not differ significantly between the paired IVF/ICSI cycles. The clinical pregnancy rates were 31.6% (6/19) and 36.8% (7/19) in the first and second cycles respectively. All but one pregnancy were singletons. In summary, this study provides strong evidence to support the notion that motile, cryopreserved and thawed epididymal spermatozoa are equal to freshly retrieved spermatozoa for ICSI in couples with obstructive azoospermia.     

Andrology: Successful treatment of severe male factor infertility in 100 consecutive cycles using intracytoplasmic sperm injection

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.     

Human micro-insemination by injection of single or multiple sperm: ultrastructure

The process of micro-insemination by single or muhiple spermtransfer into the perivitelline space (PVS) or by direct sperminjection into oocytes was examined by transmission electronmicroscopy. Spermatozoa from normal and oligozoospermic menwere injected into oocytes, obtained from consenting IVF patients,mostly by zona-puncture using micromanipulators. Spermatozoawere washed by the Percoll or Ficoll methods and capacitatedusing Whittingham's T₆ or modified Tyrode's medium or incubatedin strontium medium before injection. The women were stimulatedby three IVF methods and oocytes were recovered by laparoscopyor ultrasonography. Sixty-one oocytes were cultured in T₆ orHam's F-10 media (3–24 h) and were subjected to micromanipulation.Four oocytes were also studied after zona-drilling. Normal 2-pronuclearova were developed after single-sperm transfer satisfying allmorphological criteria of fertilization. Both monospermic andpolyspermic fertilization resulted after multiple sperm transfer,indicating that a vitelline block to polyspermy may exist inhumans. The majority of oocytes examined were unfertilized.Spermatozoa with intact or reacted acrosomes and those undergoingthe acrosome reaction were found in the PVS and in the ooplasm.Abnormal spermatozoa were also seen in these locations. Quantitatlonof acrosomal status in 16 oocytes after multiple-sperm transfer,revealed that 24% of spermatozoa were acrosome reacted or reactingin the PVS following Ficoll entrapment, while 76% of spermatozoawere intact (33% of these abnormal). Sperm transfer seemed tobe the least invasive, while direct sperm injection was comparativelydestructive to oocytes. Drilling with acid made larger breachesin the zona when compared with mechanical perforation and spermatozoaoccasionally escaped through breaches. Three 2-pronuclear ovaobtained after multiple sperm transfer have resulted in twopregnancies, in cases of severe oligozoo spermia, during thecourse of this study.     

High rate of premature chromosome condensation in human oocytes following microinjection with round-headed sperm: case report

A young couple proceeded to three ICSI treatment cycles becauseof male infertility. The semen samples varied between 10 x 10⁶and 36 x 10⁶/ml, 38 and 51% progressive motility but 0% normalmorphology. Different types of sperm heads, mostly round-headedwith varying spherical appearance (86%) were presented besideacephalic sperm (pinheads; 12%), both one- or two-tailed andthe former also without a tail. Very few sperm (2%) exhibitedslightly oval-shaped heads. Electron microscopy revealed theabsence of the acrosome combined with disturbance of the chromatincondensation among the round-headed sperm. In all three cycles,the fertilization rate using the round-headed sperm fractionwas very low with the best result of 2/18 (11%) two-pronucleateoocytes and one one-pronucleate oocyte obtained in the secondICSI cycle. The three oocytes cleaved and were transferred inthe 3–4-cell stage without achieving a pregnancy. Of the29 unfertilized and prepared oocytes from the last two cycles,27 were informative and revealed the maternal metaphase II chromosomesin the haploid range and a high rate (85%) of premature chromosomecondensation (PCC) of the sperm nucleus with remarkable variationin the degree of condensation. Thus, it appears that nearlyall round-headed sperm from this patient were incapable of oocyteactivation after ICSI, which could be due to non-release (orabsence) of an activating factor. As a consequence, PCC wasinduced in the sperm nuclei by the chromosome condensing factorswhich were still active in the oopasm of the arrested oocytes.     

Successful fertilization and pregnancy following ICSI and electrical oocyte activation.

In a total of 1048 intracytoplasmic sperm injection (ICSI) cycles, motile spermatozoa from four out of 424 patients (0.9%) failed to fertilize oocytes, despite an apparently successful ICSI procedure. No activation was observed in these injected oocytes. The spermatozoa from three of the four patients were injected into unfertilized mouse oocytes by ICSI (mouse test) to evaluate their oocyte activating ability. The oocyte activation rate of the spermatozoa of patients A, B, and C in the mouse test was 46, 100, and 86% respectively (control: 100%). Simultaneous injection of two spermatozoa from patient A into the mouse oocytes increased the oocyte activating rate to 89% (sham control: 29%). 100% fertilization rates were obtained for patients A and B by combining ICSI and electrical stimulation, and this resulted in pregnancy and the birth of healthy twins for the partner of patient A. Thus, it is considered that the spermatozoa of these patients are not lacking sperm factors but that the activity of these factors is depressed. The combination of ICSI and electrical stimulation is effective in these cases.     

Studies of percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection

Four distinct studies were carried out using two data sets ofpercutaneous epididymal sperm aspiration (PESA) and intracytoplasmicsperm injection (ICSI) procedures performed from March 1993to January 1997. In study A, an analysis of 181 ICSI treatmentcycles following PESA revealed a successful epididymal spermretrieval rate of 83%. It confirmed that PESA is an effectivesperm retrieval method and the associated ICSI pregnancy rate(35% per embryo transfer) compared favourably with that of othersperm retrieval methods. In study B, the relevance of a priordiagnostic PESA procedure was ascertained by comparing the spermretrieval rates in two groups of patients having their firstICSI treatment cycle with spermatozoa retrieved through PESA.Group B1 (n=50) had diagnostic PESA prior to the ICSI treatmentcycle PESA procedure, unlike patients in group B2 (n=64) whodid not. The sperm retrieval rate in the treatment cycle procedurewas not different at 90 and 82.8% for groups B1 and B2 respectively.However, the discontinuation of diagnostic PESA is fraught withproblems including liability to medico-legal sanctions. In studyC, analysis of 177 treatment cycles involving PESA and ICSIrevealed a successful sperm retrieval rate by PESA of 82% inthe first cycle, 93% in the second, 96% in the third and 100%in the fourth cycle. The same trend was evident when sperm retrievalwas examined in relation to each of the epididymides. Retrievedspermatozoa were found to be motile in 67-100% of cases andthe frequency of samples containing motile spermatozoa did notdecrease with increase in the number of PESA attempts. Theseresults show that PESA does not jeopardize future epididymalsperm retrieval. In study D, the outcome of treatment with ICSIusing ejaculated spermatozoa (305 cycles) (group D1) was comparedwith that of ICSI using spermatozoa obtained through PESA (54cycles) (group D2). The median age of women in the two groupsof couples was similar (34 years). In group D1, 70% of metaphaseII oocytes were fertilized compared with 61% in group D2 (P<0.01).The cleavage rate and the median numbers of transferred andcryopreserved embryos were similar in both groups. There wasno significant difference between the clinical pregnancy rates(33 and 42% in groups D1 and D2 respectively). Our results showthat the outcome of PESA-ICSI treatment compared favourablywith that of ICSI using ejaculated spermatozoa.     

Aetiology of failed and abnormal fertilization after intracytoplasmic sperm injection1

The aim of this study was to determine why oocytes remain unfertilizedor develop three pronuclei after intracytoplasmic sperm injection(ICSI). Unfertilized and abnormally fertilized oocytes werefixed in glutaraldehyde,stained with Hoechst 33342 and examinedby fluorescence microscopy to identify oocyte, sperm and polarbody DNA.One-pronuclear oocytes were considered to be unfertilized.Atotal of 285 unfertilized oocytes were examined (104 ICSI cycles).Overall, 83% of these oocytes were not activated (still at metaphaseII) while 17% had activated and formed a single (female) pronucleus.About 66% of the unfertilized, metaphase II oocytes containeda swollen sperm head, indicating that the oocyte was correctlyinjected but had failed to activate and complete the secondmeiotic division. Premature chromosome condensation of the spermDNA was evident in 6% of these metaphase II oocytes (4% of theunfertilized oocytes). The swollen sperm head was located amongthe oocyte chromosomes in 5%of the metaphase II oocytes. Othercauses of failed fertilization in the metaphase II oocytes werethe failure of sperm head decondensation (11%) and ejectionof the spermatozoon from the oocyte (23%). A similar patternwas observed in one-pronuclear oocytes (52%, swollen sperm head;28%, intact, undecondensed sperm head; 20%, ejection of thespermatozoon), which indicates that asynchronous pronucleardevelopment does not explain the presence of one-pronuclearoocytes. A total of 41 threepronuclear oocytes were examinedand all had a single polar body, which indicates that the retentionof the second polar body leads to the formation of the thirdpronucleus.In conclusion, this study demonstrates that: (i)the major cause of fertilization failure after ICSI is failureof oocyte activation; (ii) ejection of the spermatozoon intothe perivitelline space is not a major cause of fertilizationfailure;and (iii) sperm head decondensation and oocyte activationafter ICSI can occur independently.     

The effects of the sperm motility activators 2-deoxyadenosine and pentoxifylline used for sperm micro-injection on mouse and human embryo development

The sperm motility stimulants 2-deoxyadenosine (DOA) and pentoxifylline(PTF), used to improve the success of insemination and spermmicro-injection for low motility sperm samples, were studiedfor their effects on the developmental capacity of mouse andhuman oocytes. When human oocytes were micro-injected with spermatozoain 3 mM DOA 80% of them became blocked at the 1-cell pronuclearstage. However, when spermatozoa in 3 mM PTF were used for micro-injectionor when spermatozoa were washed to remove DOA before micro-injectiononly a few oocytes (9–10%) were blocked. Pregnancies occurredin five of 14 patients into whom cleaving embryos from all threetreatments had been transferred, indicating that once cleavagewas initiated, development of embryos occurred at expected rates.Exposure of mouse oocytes to DOA for a short period during insemination(4–6 h) or a longer period during the pronuclear cellcycle (18 – 20 h) significantly reduced cleavage beyondthe 2-cell stage, resulting in a dramatic reduction in blastocystformation. PTF did not significantly reduce mouse embryo development.Similar results were obtained for oocytes inseminated in vitroor micro-injected with a spermatozoon into the perivitellinespace. Neither DOA nor PTF increased fertilization of mouseoocytes. PTF reduced fertilization, particularly in cumulus-enclosedoocytes and oocytes micro-injected with spermatozoa in PTF.We conclude that DOA is a potent inhibitor of embryo developmentand oocytes should not be exposed to DOA. Exposure of oocytesto PTF had little effect on their subsequent development buttreatment of cauda epididymal mouse spermatozoa can reduce theirfertilizing capacity.