Publication details

Live birth achieved despite the absence of ejaculated spermatozoa and mature oocytes retrieved: a case report

Authors

HOLUBCOVÁ Zuzana OTEVREL Pavel KOUDELKA Marek KLOUDOVA Sona

Year of publication 2021
Type Article in Periodical
Magazine / Source Journal of Assisted Reproduction and Genetics
MU Faculty or unit

Faculty of Medicine

Citation
Web https://link.springer.com/article/10.1007/s10815-021-02070-y
Doi http://dx.doi.org/10.1007/s10815-021-02070-y
Keywords IVF add-ons; Oocyte maturity; Polarized light microscopy; Theophylline; Testicular sperm
Description The most common reason for in vitro fertilization (IVF) cycle cancelation is a lack of quality gametes available for intracytoplasmic sperm injection (ICSI). Here we present the successful fertility treatment of the couple affected by obstructive azoospermia combined with suboptimal response to controlled ovarian stimulation. Since the conventional approach appeared ineffective to overcome both partners| specific problems, the targeted interventions, namely, (1) pharmacological enhancement of sperm motility and (2) polarized light microscopy (PLM)-guided optimization of ICSI time, were applied to rescue the cycle with only immature oocytes and immotile testicular sperm retrieved. The treatment with theophylline aided the selection of viable spermatozoa derived from cryopreserved testicular tissue. When the traditional stimulation protocol failed to produce mature eggs, non-invasive spindle imaging was employed to adjust the sperm injection time to the maturational stage of oocytes extruding a polar body in vitro. The fertilization of 12 late-maturing oocytes yielded 5 zygotes, which all developed into blastocysts. One embryo was transferred into the uterus on day 5 post-fertilization, and another 3 good quality blastocysts were vitrified for later use. The pregnancy resulted in a full-term delivery of a healthy child. This case demonstrates that the individualization beyond the standard IVF protocols should be considered to maximize the chance of poor-prognosis patients to achieve pregnancy with their own gametes.

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