Healthy twin live-birth after ionophore treatment in a case of theophylline-resistant Kartagener syndrome

Abstract

Purpose To evaluate whether it is a feasible option to target the oocyte (with Ca 2+ -ionophore) in case that sperm motility cannot be restored in Kartagener syndrome. Methods A case of a male Kartagener syndrome with exclusively immotile spermatozoa that did not react to the dimethylxanthine theophylline. Thus, half of the associated oocytes were treated for 15 min with the ready-to-use-ionophore CultActive immediately after ICSI whereas the other 50 % were injected with routine ICSI without artificial oocyte activation. Rates of fertilization, blastulation, pregnancy and live birth were evaluated. Results Fertilization check revealed that none of the conventionally injected but 4/6 (66.7 %) of the artificially activated oocytes showed two pronuclei. Three embryos were of good and one of fair quality. Corresponding blastocyst formation rate was 3 out of 4 (75 %). A double embryo transfer led to a healthy twin birth in the 34th week of gestation (two boys with a birth weight of 1724 g and 2199 g). Conclusions This case indicates that Ca 2+-ionophore treatment in cycles from theophylline-resistant Kartagener syndrome patients is a feasible option. The future will show if routine application of A23187 in Kartagener or primary cilia dyskinesis patients will be of benefit.

The combination of calcium ionophore A23187 and GM-CSF can safely salvage aged human unfertilized oocytes after ICSI

“…In PIFF cases, different methods have been applied to achieve artificial oocyte activation (AOA): activation using an electric current [12][13][14], modifications of ICSI techniques [5,15], and the use of chemical agents, such as strontium chloride [16], puromycin [17], and Ca 2+ ionophores, with calcium ionophore A23187 being the most widely used [8,[18][19][20][21][22][23].…”

“…The use of calcium ionophore A23187 has been found to salvage oocyte activation failure cases, leading to pregnancies in cycles with diminished oocyte reserves [24], although this is still a matter of discussion [25]. Delivery of healthy babies has been reported in severe male factor IVF cycles [18][19][20][26][27][28] and in normozoospermic IVF cycles [21]. Furthermore, A23187 treatment improved embryo development and IVF outcome in couples with embryos showing developmental problems in previous IVF attempts [29].…”

Gamete activation: basic knowledge and clinical applications

“…In a randomized study, electrical pulses were applied to oocytes that failed to fertilize after ICSI, showing a significant resumption of embryonic developmental events after electrical activation of the oocytes ( Manipalviratn et al ., 2006 ). Finally, the mechanical stimulus of aspirating cytoplasm during ICSI was also shown to lead to high fertilization rates ( Ebner et al ., 2004 ). In some cases, failed fertilization post-ICSI has also been associated with sperm protamine deficiency and premature chromosomal condensation (PCC).…”

Live birth after Laser Assisted Viability Assessment (LAVA) to detect pentoxifylline resistant ejaculated immotile spermatozoa during ICSI in a couple with male Kartagener’s syndrome

“…Kartagener’s syndrome results in immotile sperm production, males are incapable of achieving pregnancy through natural conception and the usage of intracytoplasmic sperm injection (ICSI) is indicated [ 2 – 4 ]. It is reported that motility of sperm in KS can be detected in some cases [ 5 – 9 ] and it can be enhanced using pentoxifylline [ 10 , 11 ], or embryos can be grown from randomly selected immotile sperms with the help of assisted oocyte activation [ 12 , 13 ]. Cases with the retrieval of testicular sperm were also reported [ 14 – 16 ].…”