Saito Masato, Tatsumi Takayuki, Nakasuji Takashi, Ibayashi Megumi, Harada Tatsuya, Mutoh Tohru, Ito Chizuru, Komiya Akira, Hiraoka Kenichiro, Kawai Kiyotaka
Department of Reproductive Medicine, Kameda IVF Clinic Makuhari, Chiba, Japan.
Department of Reproductive Medicine, Kameda Medical Center, Chiba, Japan.
Transl Androl Urol. 2020 Apr;9(2):800-806. doi: 10.21037/tau.2019.12.14.
A husband and his wife, both 34 years old, consulted our clinic because of primary infertility. Sperm analysis revealed that the sperm concentration, motility, and progressive motility were (42.8±22.8)×10/mL, 23.3%±12.2%, and 12.9%±6.1%, respectively. Based on Krugar strict morphology criteria, 100% of the sperm were teratozoospermic, with 7.9% DNA fragmentation index. Observation of the sperm under a transmission electron microscope revealed that most parts of the fibrous sheath (FS) surrounding the tails of the sperm were missing from midway through the principal piece to the end piece, although the sperm's heads, necks and midpieces were morphologically normal. To collect oocytes, the gonadotropin-releasing hormone antagonist protocol was carried out, and 7 oocytes were retrieved. Intracytoplasmic sperm injection (ICSI) was performed for all the teratozoospermic sperm. Of the 7 oocytes, 3 were fertilized, and one 8-cell embryo and 2 expanded blastocysts were vitrified. Although repeated transfers of expanded blastocysts resulted in no implantation, one 8-cell embryo transfer in a hormone replacement therapy cycle led to pregnancy. The pregnancy using an 8-cell vitrified embryo resulted in the delivery of a healthy female baby at 38 weeks of gestation. No congenital malformations were found until 28 days after birth. Our results demonstrated that healthy birth could be achieved following the transfer of an embryo derived from ICSI using teratozoospermic sperm exhibiting the dysplasia of the fibrous sheath (DFS). Furthermore, while the previous reports on DFS have not investigated male infertility, we evaluated sperms from various aspects such as Kruger sperm function test, chromatin dispersion test, electron microscopy findings, time-lapse images of the obtained embryos, and concluded that ICSI could be desirable as a treatment policy for DFS.
一对均为34岁的夫妻因原发性不孕前来我们诊所就诊。精液分析显示，精子浓度、活力和前向运动率分别为(42.8±22.8)×10⁶/mL、23.3%±12.2%和12.9%±6.1%。根据 Krugar 严格形态学标准，100%的精子为畸形精子症，DNA 碎片指数为7.9%。透射电子显微镜下观察精子发现，尽管精子的头部、颈部和中段形态正常，但围绕精子尾部的纤维鞘（FS）从主段中途到末段大部分缺失。为采集卵母细胞，采用促性腺激素释放激素拮抗剂方案，共获取7枚卵母细胞。对所有畸形精子进行了卵胞浆内单精子注射（ICSI）。7枚卵母细胞中有3枚受精，1枚8细胞胚胎和2枚扩张囊胚被玻璃化冷冻。尽管反复移植扩张囊胚均未着床，但在激素替代治疗周期中移植1枚8细胞胚胎导致妊娠。使用玻璃化冷冻的8细胞胚胎妊娠，在妊娠38周时分娩出一名健康女婴。出生后28天内未发现先天性畸形。我们的结果表明，使用表现为纤维鞘发育异常（DFS）的畸形精子进行ICSI获得的胚胎移植后可实现健康分娩。此外，虽然之前关于DFS的报道未研究男性不育，但我们从 Kruger 精子功能测试、染色质扩散测试、电子显微镜检查结果、获得胚胎的延时图像等多个方面对精子进行了评估，并得出结论，ICSI作为DFS的治疗策略是可取的。
