A LIVE BIRTH FROM INTRACYTOPLASMIC INJECTION OF A SPERMATOZOON RETRIEVED FROM TESTICULAR PARENCHYMA

The field of gamete micromanipulation has taken enormous strides in th e last 6 years. Before the development of micromanipulation convention al in vitro fertilization was used for couples with poor seminal param eters, nonreconstructible obstructive azoospermia or severe fallopian tube abnormalities. With the development of micromanipulative techniqu es the hope was that minimal sperm density requirements would be reduc ed, and fertilization and pregnancy rates would improve. The technique s initially developed were partial zona dissection and subzonal insert ion. The micro-instrumentation created to perform partial zona dissect ion and subzonal insertion enabled the development of single sperm inj ection into the cytoplasm of an oocyte or intracytoplasmic sperm injec tion. Van Steirteghem et al performed the first large series using int racytoplasmic sperm injection and reported a pregnancy rate of 35%.(1) Micromanipulative technology became beneficial in the patient populat ion with nonreconstructible azoospermia. Temple-Smith et al successful ly achieved fertilization and pregnancy using conventional in vitro fe rtilization and microscopic epididymal sperm aspiration in patients wi th nonreconstructible vasal obstruction.(2) We previously combined mic roscopic epididymal sperm aspiration with intracytoplasmic sperm injec tion and achieved an overall pregnancy rate of 40% per cycle.(3) Becau se intracytoplasmic sperm injection requires the injection of only I s permatozoon into the cytoplasm of the egg, we wondered if sperm from t esticular parenchyma could be successfully retrieved and then used to initiate fertilization and pregnancy with intracytoplasmic sperm injec tion. Our case demonstrates that the use of testicular sperm can resul t in a Live birth.