MULTIPLE PREGNANCIES OBTAINED BY TESTICULAR SPERMATID INJECTION IN COMBINATION WITH INTRACYTOPLASMIC SPERM INJECTION

Recent studies have shown that the injection of spermatid cells into t he human oocyte can result in normal fertilization, embryo development and even delivery of live, healthy offspring, In our study, 23 azoosp ermic cases with severe spermatogenetic defects in their testicular bi opsy are presented, The serum follicle stimulating hormone (FSH) conce ntrations and histopathological results of these males have been docum ented and compared in terms of fertilization and embryo development, T he mean FSH value of the azoospermic males was 15.8 +/- 2.3 mIU/l, ran ging from 1.6 to 39 mIU/l, Elongated spermatids were used in three cas es only, as these more mature forms were mostly present in the testicu lar sample, In the remaining 20 cases, only round spermatids were foun d for use in intracytoplasmic sperm injection (ICSI), The fertilizatio n rate with two pronuclei was 31.3%, The fertilization rate was found to be as high as 71% in three patients in the elongating and elongated spermatids group and as low as 25.6% in the round spermatid group, A few immature, non-motile spermatozoa were seen in only two cases from the elongated spermatid group, However, in the remaining cases, no spe rmatozoa were observed, The number of pronuclear (PIV) arrest was quit e high when only round spermatids were used (36.1%), Total fertilizati on failure was observed in two cases from the round spermatid group wi th Sertoli cell only and germ cell aplasia, A total of three pregnanci es was achieved in 23 cases (13.0%), two from the elongated spermatid group and one from the round spermatid group, One biochemical pregnanc y with a round spermatid resulted in an early spontaneous abortion and surprisingly, the remaining pregnancies were achieved with elongated spermatids resulting in multiple pregnancies, One twin and one triplet pregnancy were established following four embryo transfers in each pa tient. The twin pregnancy resulted in a live birth with two healthy ba bies; unfortunately, the triplet pregnancy ended in an abortion at 11 weeks;, The use of testicular spermatids in the treatment of non-obstr uctive azoospermia may give hope by offering a novel treatment model, In cases with very severe spermatogenetic defect, even multiple pregna ncies can be achieved with elongated spermatid cells by yielding a hig h implantation rate, However, the efficiency of round spermatids in ac hieving fertilization and pregnancy was disappointing.