Pregnancy achieved by intracytoplasmic sperm injection using cryopreserved vasal-epididymal sperm from a man with spinal cord injury

From disability to fatherhood: Journey of serving soldiers with spinal cord injury

Background

Apart from neurological consequences, most distressing sequels of spinal cord injury (SCI) in men are erectile dysfunction, ejaculatory dysfunction and abnormal semen quality. Of these, ejaculatory dysfunction and poor semen parameters pose the biggest challenge to their biological fatherhood. Penile vibratory stimulation (PVS) and electroejaculation are first-line modalities for anejaculation, and surgical sperm retrieval (SSR) is adopted when other treatments fail. Sperms obtained using these techniques can be used for various fertility treatments for couples with spinal cord injured men. The aim of the study was to study the effectiveness of various modalities of sperm retrieval for assisted reproductive treatment in men with SCI.

Methods

It was a prospective observational study, wherein partners of 12 men with SCI presenting for subfertility underwent assisted reproduction after retrieving sperms via various modalities. The primary outcome was to assess efficacy of PVS in obtaining sperms and of SSR if PVS failed. The secondary outcome was to assess the pregnancy rate in their partners.

Results

PVS was successful in obtaining ejaculate in 7 of 12 men, and SSR was fruitful in 4 of 5 men. In vitro fertilization cycle for men who underwent PVS resulted in a pregnancy rate of 57.14% and 75% in couples for men who underwent SSR with an overall pregnancy rate of 58.33%.

Conclusion

With new cases of SCI occurring primarily in young men at the peak of their reproductive health, it is imperative that medical professionals involved with reproductive health should be aware of the various modalities to help them achieve biological paternity.

In vitro and in vivo fertilization potential of cryopreserved spermatozoa from bull epididymides stored for up to 30 hours at ambient temperature (18 °C-20 °C)

The aims of this study were to compare the viability and in vivo and in vitro fertilization potential post-thaw sperm collected at different times postorchiectomy from bull epididymides (EP) at 18 °C to 20 °C, with those of semen collected by electroejaculation (EJ) from the same bulls. Semen samples were collected by EJ from 10 Zebu bulls and cryopreserved. A week later 20 epididymides from these bulls were obtained by orchiectomy and randomly divided into five groups (G) to be maintained at ambient temperature for 6, 12, 18, 24, and 30 hours before sperm recovery by retrograde flow. The sperm were cryopreserved, and post-thaw parameters were determined by both computer-assisted sperm analysis and morphologic analysis. In vitro fertilization of oocytes was performed to assess the cleavage rate, blastocyst rate, total number of cells, and hatching rate of embryos. The G30 sperm samples were also used for fixed time artificial insemination (FTAI) of Zebu heifers (n = 10). The results of post-thaw sperm viability showed that total and progressive motility and plasma membrane integrity were lower in sperm in which cryopreservation was delayed for 30 hours, showing a negative correlation of these parameters with delay before cryopreservation. In all groups, it was possible to obtain viable embryos, and embryos from G6 samples had more cells than the other groups. The greatest embryo production rates were observed in G6, G12 and G18 (27.2 to 32.2%) and it was significantly lower in G24 and G30 samples. For EJ, many individual variations were observed in embryo production potential between bulls. G30 samples, with only 5.2% of post-thaw progressive motility, were able to fertilize and produced a pregnancy. To the authors' knowledge, this is the first time in vitro embryos up to 8 days of development and a pregnancy after FTAI have been produced with sperm from bull epididymides that had been stored at 18 °C to 20 °C for up to 30 hours.

Pregnancy achieved following ICSI from a man with Klinefelter's syndrome and spinal cord injury

Klinefelter's syndrome and spinal cord injury are major causes of male infertility. Intracytoplasmic sperm injection (ICSI) is a relatively new method of assisted reproduction. A testicular biopsy was obtained from a patient with the double complications of non-mosaic 47,XXY Klinefelter's syndrome and spinal cord damage, and motile spermatozoa were collected. ICSI was then performed. Of the four sperm-injected oocytes, three became fertilized and cleaved. Two embryos were implanted, resulting in a single pregnancy with visible evidence of a heartbeat appearing at 6 weeks gestation. The pregnancy is now entering its 20th week. To the best of our knowledge, this is the first case of a pregnancy resulting from the sperm of a patient with double complications.

Schedule to inject in vitro matured oocytes may increase pregnancy after intracytoplasmic sperm injection

To ascertain the value of using immature oocytes in an intracytoplasmic sperm injection (ICSI) program, the authors designed a schedule, at 5 p.m. on day 1 (the day of oocyte retrieval) and at 8 a.m. and 2 p.m. on day 2, to recognize and inject the in vitro matured (IVM) oocytes. For the 1,166 oocytes retrieved in 107 ICSI cycles, 128 (11.0%) were at the stage of metaphase I (MI) and 113 (9.7%) at germinal vesicle. Routine ICSI for metaphase 11 oocytes was performed at 2 p.m. on day 1 (initial ICSI). In culture medium of human tubal fluid with 15% maternal serum, 85.1% (205/241) immature oocytes progressed to maturation in which 16.4% (21/128) of MI oocytes matured at 5 p.m. of day 1. The rate of normal fertilization for IVM oocytes (58.5%) was not significantly different from that of initial ICSI (64.0%). One patient received a transfer of two fertilized IVM oocytes alone that were injected at 5 p.m. of day 1, maturing from the MI stage, and achieved a normal pregnancy. The fertilized IVM oocytes were replaced along with the embryos from initial ICSI for 40 cycles that led to 14 (35%) clinical pregnancies. In 43 fertilized IVM oocytes donated for research, we observed that cleavage (95.3%) to the 2- to 4-cell stage was not distinct from that of initial ICSI (94.6%); however, the percentage of embryos of grade I and II morphology was significantly smaller (24.4% vs. 62.5%). Only five (11.6%) developed to blastocysts in vitro. Twenty-one fertilized IVM oocytes were frozen for future transfer. A schedule to inject IVM oocytes in ICSI cycles may generate more accessible embryos for fresh transfer or cryopreservation to increase the chance of pregnancy, although the embryo quality was relatively poor.