Multiple pregnancies obtained by testicular spermatid injection in combination with intracytoplasmic sperm injection

Recent studies have shown that the injection of spermatid cells into thehuman oocyte can result in normal fertilization, embryo development andeven delivery of live, healthy offspring. In our study, 23 azoospermiccases with severe spermatogenetic defects in their testicular biopsy arepresented. The serum follicle stimulating hormone (FSH) concentrations andhistopathological results of these males have been documented and comparedin terms of fertilization and embryo development. The mean FSH value of theazoospermic 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 matureforms were mostly present in the testicular sample. In the remaining 20cases, only round spermatids were found for use in intracytoplasmic sperminjection (ICSI). The fertilization rate with two pronuclei was 31.3%. Thefertilization rate was found to be as high as 71% in three patients in theelongating and elongated spermatids group and as low as 25.6% in the roundspermatid group. A few immature, non-motile spermatozoa were seen in onlytwo cases from the elongated spermatid group. However, in the remainingcases, no spermatozoa were observed. The number of pronuclear (PN) arrestwas quite high when only round spermatids were used (36.1%). Totalfertilization failure was observed in two cases from the round spermatidgroup with Sertoli cell only and germ cell aplasia. A total of threepregnancies was achieved in 23 cases (13.0%), two from the elongatedspermatid group and one from the round spermatid group. One biochemicalpregnancy with a round spermatid resulted in an early spontaneous abortionand surprisingly, the remaining pregnancies were achieved with elongatedspermatids resulting in multiple pregnancies. One twin and one tripletpregnancy 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. Theuse of testicular spermatids in the treatment of non-obstructiveazoospermia may give hope by offering a novel treatment model. In caseswith very severe spermatogenetic defect, even multiple pregnancies can beachieved with elongated spermatid cells by yielding a high implantationrate. However, the efficiency of round spermatids in achievingfertilization and pregnancy was disappointing.