Gajabe Gauri, More Akash, Shrivastava Jarul, Choudhary Namrata, Dutta Shilpa, Kadu Krushnali S, Jadhav Ritesh
Clinical Embryology, Datta Meghe Institute of Higher Education & Research, Wardha, IND.
Cureus. 2024 Jan 31;16(1):e53268. doi: 10.7759/cureus.53268. eCollection 2024 Jan.
Infertility, defined as the inability to conceive after 12 months of unprotected sexual activity, affects millions globally. Approximately 80% of cases have identifiable causes, including endometriosis, tubal obstruction, ovulatory dysfunction, and male sperm abnormalities. Lifestyle factors, such as smoking and obesity, also impact fertility. Sperm morphology, a key factor in male infertility, often presents as teratozoospermia, with defects in the head, midpiece, or tail. Poor ovarian reserve, indicated by low anti-mullerine hormone (AMH) and antra-follicular count (AFC) values, contributes to female infertility, often exacerbated by age-related factors. Elevated follicle-stimulating hormone (FSH) levels further diminish oocyte quantity and quality. Intracytoplasmic Sperm Injection (ICSI), a micromanipulation technique aiding infertile couples, may face challenges in detecting subtle sperm morphology defects. Advanced methods like Motile Sperm Organelle Morphological Examination (MSOME) and Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) under high magnification enhance sperm selection accuracy. We present the case of a 36-year-old woman and her 42-year-old husband who sought assistance after seven years of infertility. Previous Intrauterine injection (IUI) and ICSI attempts failed due to the wife's low ovarian reserve and elevated FSH, compounded by the husband's teratozoospermia. Their earlier In-Vitro Fertilization (IVF) experience yielded a single poor-quality oocyte, hindering blastocyst formation. Investigations revealed the wife's poor AFC, AMH of 0.033ng/ml, and FSH at 24IU/L. Her medical history included hypertension and gallbladder removal. The husband exhibited 98% defective sperm, devoid of a substance abuse history. The wife's family had a polycystic ovarian syndrome (PCOS) history, and her low AMH and AFC yielded only three poor-quality oocytes during the current assessment. Oocytes were retrieved, and sperm were selected with the help of IMSI. After ICSI, the patient successfully conceived.
不孕症定义为在无保护性行为12个月后仍无法受孕，全球有数百万人受其影响。约80%的病例有可查明的原因，包括子宫内膜异位症、输卵管阻塞、排卵功能障碍和男性精子异常。吸烟和肥胖等生活方式因素也会影响生育能力。精子形态是男性不育的关键因素，常表现为畸形精子症，头部、中段或尾部存在缺陷。抗苗勒管激素（AMH）水平低和窦卵泡计数（AFC）值低表明卵巢储备功能差，这是导致女性不孕的原因之一，且常因年龄相关因素而加剧。促卵泡生成素（FSH）水平升高会进一步降低卵母细胞的数量和质量。卵胞浆内单精子注射（ICSI）是一种帮助不孕夫妇的显微操作技术，在检测细微的精子形态缺陷方面可能面临挑战。像高倍镜下活动精子细胞器形态学检查（MSOME）和卵胞浆内形态学选择精子注射（IMSI）等先进方法可提高精子选择的准确性。我们介绍一位36岁女性及其42岁丈夫的病例，他们在不孕七年后来寻求帮助。由于妻子卵巢储备功能差和FSH升高，加上丈夫的畸形精子症，之前的宫腔内人工授精（IUI）和ICSI尝试均失败。他们早期的体外受精（IVF）经历只获得了一个质量差的卵母细胞，阻碍了囊胚形成。检查发现妻子的AFC差，AMH为0.033ng/ml，FSH为24IU/L。她的病史包括高血压和胆囊切除。丈夫的精子有98%存在缺陷，无药物滥用史。妻子的家族有多囊卵巢综合征（PCOS）病史，在本次评估中，她低水平的AMH和AFC仅产生了三个质量差的卵母细胞。取出卵母细胞，并借助IMSI选择精子。ICSI后，患者成功受孕。
