Bruno Guthauser

Can intracytoplasmic morphologically selected sperm injection be used to select normal-sized sperm heads in infertile patients with macrocephalic sperm head syndrome?

OBJECTIVE To study the chromosomal content of spermatozoa selected by intracytoplasmic morphologically selected sperm injection (IMSI) in cases of macrocephalic sperm head syndrome. DESIGN Case report. SETTING Obstetrics, gynecology, urology, and reproductive biology departments. PATIENT(S) Two infertile patients with large-headed spermatozoa. INTERVENTION(S) Fluorescence in situ hybridization on selected spermatozoa with normal-sized heads after IMSI selection. MAIN OUTCOME MEASURE(S) Percentages of polyploid, diploid, haploid aneuploid, and normal spermatozoa. RESULT(S) Of the six spermatozoa that could be selected, all were haploid but aneuploid. CONCLUSION(S) Absence of normal haploid spermatozoa among high magnification-selected spermatozoa contraindicated IMSI for these two patients.

Effects of low concentrations of inhibin B on the outcomes of testicular sperm extraction and intracytoplasmic sperm injection

OBJECTIVE To study the effects of undetectable inhibin B concentrations on the outcomes of testicular sperm extraction (TESE) and of intracytoplasmic sperm injection (ICSI). DESIGN Retrospective study. SETTING Obstetrics, gynecology, and reproductive biology departments. PATIENT(S) We carried out TESE on 75 men with nonobstructive azoospermia: 42 men had an inhibin B concentration of or = 15 pg/mL (group 2). Twenty-five ICSI cycles were carried out using sperm from men in group 1 (group A1), and 35 ISCI cycles were carried out using sperm from men in group 2 (group A2). The outcomes of ICSI in groups A1 and A2 were compared with those of 81 ICSI cycles performed for obstructive azoospermia (group B). INTERVENTION(S) Testicular sperm extraction, testicular spermatozoa cryopreservation, and ICSI. MAIN OUTCOME MEASURE(S) Testicular sperm extraction outcome, pregnancy, and delivery. RESULT(S) Sperm were significantly less likely to be successfully recovered from men in group 1 than from those in group 2 (21% vs. 48%). The inhibin B concentration was significantly lower in men in whom TESE failed, but the FSH concentration did not differ. The implantation rate per embryo transferred was twofold lower in group A1 (7.4%) than in group B (16%), but this difference is not statistically significant. CONCLUSION(S) Patients with undetectable inhibin B concentration should be informed of the low chances of positive testicular biopsy, and more embryos should be transferred to improve the success rate.

High-magnification selection of spermatozoa prior to oocyte injection: confirmed and potential indications

Intracytoplasmic morphologically selected sperm injection (IMSI) involves the use of differential interference contrast microscopy at high magnification (at least ·6300) to improve the observation of live human spermatozoa (particularly by showing sperm head vacuoles that are not necessarily seen at lower magnifications) prior to intracytoplasmic sperm injection (ICSI) into the oocyte. However, a decade after IMSI’s introduction, the technique’s indications and ability to increase pregnancy and/or birth rates (relative to conventional ICSI) are subject to debate. In an attempt to clarify this debate, this work performed a systematic literature review according to the PRISMA guidelines. The PubMed database was searched from 2001 onwards with the terms ‘IMSI’, ‘MSOME’ and ‘high-magnification, sperm’. Out of 168 search results, 22 relevant studies reporting IMSI outcomes in terms of blastocyst, pregnancy, delivery and/or birth rates were selected and reviewed. The studies’ methodologies and results are described and discussed herein. In view of the scarcity of head-to-head IMSI versus ICSI studies, the only confirmed indication for IMSI is recurrent implantation failure following ICSI. All other potential indications of IMSI require further investigation.

Successful pregnancy and delivery after testicular sperm extraction despite an undetectable concentration of serum inhibin B in a patient with nonobstructive azoospermia

OBJECTIVE To describe a successful pregnancy and delivery after testicular sperm extraction (TESE) despite an undetectable concentration of serum inhibin B in a man with nonobstructive azoospermia. DESIGN Case report. SETTING Obstetrics and gynecology and reproductive biology departments. PATIENT(S) A 31-year-old woman and a 32-year-old man with nonobstructive azoospermia and an undetectable inhibin B serum level. INTERVENTION(S) TESE, testicular spermatozoa cryopreservation, intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S) Pregnancy and delivery. RESULT(S) Successful pregnancy and delivery of a normal healthy child following a third ICSI cycle with frozen-thawed spermatozoa extracted from the testis. CONCLUSION(S) This case report shows that there is no minimal level of inhibin B below which TESE is always unsuccessful. The delivery of a normal healthy baby is strong evidence to perform TESE in these circumstances.

Inverse correlation between chromatin condensation and sperm head size in a case of enlarged sperm heads

Among sperm morphology abnormalities, macrocephalic and large-headed spermatozoa are commonly associated with a low chance of pregnancy, mainly in relation to meiotic abnormalities during spermatogenesis. Here is reported the case of a patient with 98% of spermatozoa showing abnormal morphology, many having enlarged heads (47%). Sperm-head measurement, sperm fluorescent in situ hybridization analysis, sperm chromatin decondensation and molecular biology were performed. Fifty-six percent of the sperm displayed a large head (length >4.7 μm and width >3.2 μm), and the mean sperm-head area was 15.8±3.8 μm(2) (9.7±1.5 μm(2) and 9.3±1.4 μm(2) for two controls). Normal chromosomal content was found in 97% of the cells and no aurea kinase C-gene mutation was found. Mean sperm chromatin decondensation rate was 46%, 64% for large-head forms and 10% for other forms. This is, as far as is known, one of the first cases of semen with enlarged-head spermatozoa linked to sperm chromatin condensation dysfunction with no major meiotic dysfunction. The study centre advised the couple to undergo intracytoplasmic sperm injection with the patients spermatozoa.

Chronic Excessive Alcohol Consumption and Male Fertility: A Case Report on Reversible Azoospermia and a Literature Review

AIMS The aim of this work was to report on a heavy drinker whose azoospermia was reversed after alcohol withdrawal. We also review the literature on links between alcohol consumption and azoospermia. METHOD This study is a clinical case report and a literature review. RESULTS Two years after alcohol withdrawal, a child was born following assisted reproduction technique. Excessive alcohol consumption (i.e. more than 60 g a day) is strongly associated with azoospermia and this condition may be reversible after alcohol withdrawal. CONCLUSIONS Testicular biopsies should be countra-indicated for heavy drinkers, and in order to increase the chances of obtaining a pregnancy, alcohol abstinence should be encouraged in male with low-to-moderate alcohol intakes.

Meiotic segregation of X-autosome translocation in two carriers and implications for assisted reproduction

The aim of this study was to analyse and compare the meiotic segregation of X-autosome translocation in two male carriers and to discuss couple-specific treatment modality before intracytoplasmic sperm injection (ICSI). Meiotic segregation was analysed by fluorescence in-situ hybridization (FISH) in spermatozoa of two men who were carriers of a X-autosome translocation: 46,Y,t(X;2)(p21;p25.3) (patient 1) and 46,Y,t(X;18)(qll;pl1.1) (patient 2). The results indicated a majority of unbalanced spermatozoa (62.05%) for patient 1, but normal or balanced spermatozoa (54.36%) for patient 2. Moreover, the unbalanced gametes resulted from adjacent I, adjacent II and 3:1 segregation, in decreasing frequencies, for patient 1 but from 3:1, adjacent I, adjacent II segregation for patient 2. The results of the meiotic segregation analysis had different treatment implications for assisted reproduction. Couple 1 were advised against ICSI, due to the results of the meiotic segregation in spermatozoa from patient 1 and the age of his wife. For couple 2, the clinic viewed favourably an attempt with ICSI followed by conventional prenatal diagnosis. A 46,XY child was born without malformations.

Peut-on optimiser la congélation des spermatozoïdes testiculaires? L’expérience du Centre Hospitalier de Poissy Saint-Germain

Il n’existe pas de facteur predictif fiable permettant de pronostiquer avec certitude la presence ou l’absence de spermatozoides testiculaires chez les hommes atteints d’azoospermie secretoire. La proportion de biopsies testiculaires negatives chez ces patients est elevee, et il est donc preferable de pas pratiquer de maniere synchrone la biopsie testiculaire et le cycle d’ICSI. Nous presentons ici notre experience concernant 74 biopsies testiculaires effectuees pour azoospermie secretoire, ayant donne lieu a 60 cycles d’ICSI (25 couples). Les resultats sont compares a ceux obtenus lors de 81 cycles d’ICSI effectues avec du sperme testiculaire ou epididymaire congele lors d’indications excretoires. Les spermatozoides sont congeles en petits volumes (micro-gouttes), ceci facilitant leur recherche apres decongelation, et permettant d’augmenter le nombre de paillettes congelees. II est alors possible de proceder a plusieurs cycles d’ICSI pour une meme biopsie testiculaire, y compris lorsque le tissu testiculaire est tres pauvre en spermatozoides. Les resultats obtenus sont comparable dans les deux groupes, avec un taux de grossesse clinique par transfert embryonnaire de 18% dans les indications secretoires et de 26% dans les indications excretoires. La realisation systematique de la biopsie testiculaire et du cycle d’ICSI de facon asynchrone preserve les chances de grossesse du couple quel que soit l’etiologie de l’azoospermie, et permet une meilleur gestion de la prise en charge des couples concernes.

Is intracouple assisted reproductive technology an option for men with large-headed spermatozoa? A literature review and a decision guide proposal

Although the presence of spermatozoa with an abnormally large head is rare, it is associated with low fertility or even total infertility. We reviewed the literature on assisted reproductive technology (ART) strategies and outcomes for men with large-headed spermatozoa. We also discuss additional analyses that can usefully characterize sperm defects and help with the choice between intra-couple ART and insemination with donor sperm. Lastly, we propose a classification for cases of large-headed spermatozoa.RésuméLa présence de spermatozoïdes macrocéphales est généralement associée à une hypofertilité ou une infertilité. Nous présentons une revue de la littérature concernant les stratégies de prise en charge en aide médicale à la procréation et leurs issues lorsque l’analyse du sperme met en évidence la présence de spermatozoïdes macrocéphales. Nous discutons également les examens complémentaires permettant de mieux caractériser ces anomalies spermatiques et de choisir entre l’aide médicale à la procréation avec ou sans donneur de sperme. Enfin nous proposons ici une classification pour les cas de spermatozoides macrocephales avec pour les 6 types définis une proposition de prise en charge.

Contraindication of ART following a sperm FISH analysis, even though only 12% of the spermatozoa had enlarged heads

We report on a couple with a five-year history of idiopathic primary infertility. Two early miscarriages had followed intrauterine insemination (IUI). The mans fertility was then re-evaluated, in order to establish whether or not IUI was the best treatment option. Although the semen parameters were normal (sperm concentration: 89 million/ml; progressive motility: 40%; percentage of typical forms: 20%), a computer-assisted sperm morphology analysis with strict criteria found that 12% of the spermatozoa had enlarged heads. All of the latter had a normal form and none had multiple flagella. Using fluorescence in situ hybridization (FISH) analysis, we found that the proportion of aneuploid and diploid spermatozoa was 78% for the sample as a whole and 68% for normally-shaped spermatozoa with a normal-sized head. Although treatment options are well documented for men with macrocephalic sperm head syndrom, there is no consensus on individuals with a low but non-negligible proportion of spermatozoa with enlarged heads. Here, our FISH results contraindicated the use of assisted reproductive technology with the mans sperm. The couple decided to resort to donor sperm.