Pregnancy outcome after intracytoplasmic sperm injection with strontium oocyte activation in a globozoospermic patient

Abstract

We present here a case report of a globozoospermic patient whose partner became pregnant after intracytoplasmic sperm injection (ICSI) with assisted oocyte activation (AOA). Globozoospermia is characterized by the presence of 100% roundheaded spermatozoa lacking an acrosome. The lack of the acrosome, which renders spermatozoa unable to bind to the zona pellucida or fuse with the oocyte oolemma, is considered to be the cause of infertility in these patients. 1 The introduction of ICSI provided a possible solution for patients suffering from globozoospermia. Since then, many cases of successful pregnancies after ICSI with globozoospermic sperm have been reported; 2,3 however, the fertilisation rate after ICSI in these cases has been low, and some patients failed ICSI treatment because of limited or failed fertilisation. 1 Fertilisation failure was initially attributed to the reduced ability of globozoospermic sperm to activate the oocyte.Rybouchkin et al. 4 demonstrated that the fertilisation rate was improved by the addition of a calcium ionophore. After that, ICSI combined with AOA was effectively used in many studies to improve the fertilisation rate and embryo development and to achieve live births from globozoospermic sperm from men with previously failed fertilisation attempts. Various methods of AOA, including the use of a calcium ionophore and electrical and mechanical stimuli, have been reported to be effective for fertilisation in men with globozoospermia. 3,4 Strontium treatment, which is proven to induce calcium oscillations in mice, was found to be an effective method for AOA in cases of low or absent fertilisation after ICSI. [5][6][7] Whether strontium is effective at improving fertilisation by globozoospermic sperm has not been reported. We report a successful case of a twin pregnancy resulting in live births following ICSI and strontium oocyte activation with round-headed sperm.A couple with primary infertility of 5 years' duration visited our centre. Both members of the couple were 27 years old and healthy, with no physical problems other than the husband's semen parameters. The wife had no fertility problems. Analysis of a semen sample showed normal values for volume (3.3 ml), sperm concentration (56310 6 ml 21 ) and motility (45%). The Diff-Quik staining method revealed that 100% of the spermatozoa were round-headed and lacking an acrosome 8 (Figure 1). Assessment of the acrosome with fluorescent Pisum sativum agglutinin staining of the human spermatozoa was also conducted 9 (Figure 1). Ultrastructural characteristics of the round-headed sperm were evaluated using a scanning electron microscope (JEOL Technics Ltd, Akishima-Shi, Tokyo, Japan) 3 (Figure 1). Spherical heads without acrosomes are shown. The karyotypes of the couple were obtained from peripheral lymphocytes and were 46,XX in the wife and 46,XY in the husband.A conventional long protocol was used to stimulate follicular development. Two cycle attempts were conducted. In the first cycle, the couple decided to undergo the conventiona...

Reproductive outcome in globozoospermic men: update and prospects

“…Only one case of oocyte activation using strontium chloride (10 m m , 10 min) was published in 2012. Twenty percent of the oocytes fertilized and a twin birth occurred (Yang et al ., ).…”

Association between total globozoospermia and sperm chromatin defects

“…Therefore, ICSI combined with AOA was considered as an efficient procedure for treatment of men with globozoospermia. Although, some papers reported successful fertilisation and pregnancy after ICSI‐AOA in these individuals, but there are studies that reported conflicting results (Check, Levito, Summers‐Chase, Marmar, & Barci, ; Dirican et al., ; Egashira, Murakami, Haigo, Horiuchi, & Kuramoto, ; Eldar‐Geva et al., ; Kamiyama et al., ; Karaca, Akpak, Oral, Durmus, & Yilmaz, ; Kim, Cha, Park, & Gye, ; Kyono et al., ; Rybouchkin, Van der Straeten, Quatacker, De Sutter, & Dhont, ; Tejera et al., ; Yang et al., ; Zhang et al., ).…”

Different outcomes after intracytoplasmic sperm injection without oocyte activation in two patients with different types of globozoospermia

“…However, there have not been any reports of genetic analysis in humans born following AOA treatment. The long‐term effect of the potential toxicity of AOA on humans remains unknown (Yang et al ., ).…”

“…Fertilisation and pregnancy rates in these reports have always been low, despite the application of ICSI. Therefore, activations of the oocyte by chemical (Rybouchkin et al ., ; Kim et al ., ; Tejera et al ., ; Kyono et al ., ; Taylor et al ., ; Kamiyama et al ., ; Yang et al ., ; Kuentz et al ., ), mechanical (Tesarik et al ., ) and electrical (Dirican et al ., ; Egashira et al ., ) activations have been suggested, although spontaneous activation of the oocyte after ICSI has been reported in some cases (Lundin et al ., ; Kilani et al ., ; Stone et al ., ; Nardo et al ., ; Zeyneloglu et al ., ; Banker et al ., ; Bechoua et al ., ; Sahu et al ., ). To the best of our knowledge, as the first livebirth by ICSI from globozoospermia described in 1994, there have been only 11 livebirths achieved with globozoospermia by ICSI without assisted oocyte activation (AOA) and 15 with AOA and one by intracytoplasmic morphologically selected sperm injection (Sermondade et al ., ) were reported up to 2013.…”