Intracytoplasmatic injection of round and elongated spermatids in patientswith spermatogenetic maturation arrest

Purpose: The ICSI procedure is established as the method of choice in the t reatment of severe male factor infertility. Recent studies have shown that fertilisation and cleavage can be achieved by injection of ejaculated round spermatids as well as testicular round and elongated spermatids into oocyt es. Methods: In this study, attempt was made to establish this procedure in our laboratory to include patients with spermatogenetic maturation arrest in o ur ICSI programme. Six patients were diagnosed to have complete Sertoli-Cel l-Only syndrome after a first testis biopsy. After an additional second bio psy in all cases focal functional spermatogenesis either at the stage of ro und or elongated spermatids was found. The tissues were cryopreserved until the time of follicle puncture. Women were stimulated using the long protoc ol by gonadotropine injections after downregulation with GnRH-agonist. ICSI procedure was the same using an injection pipette of 8 - 10 mu m diameter. Results: 66 metaphase-ll oocytes were harvested. In two patients cryopreser ved elongated spermatides were successfully injected while in the other fou r cases cryopreserved round spermatids were possible to be injected into th e oocytes. 10 out of 18 oocytes were fertilised in the first group while on ly 9 out of 48 injected oocytes showed fertilisation and cleavage in the se cond group. Two clinical pregnancies were achieved with elongated spermatid s, while in case of round spermatids, no pregnancy could be established. Conclusions: This study confirms that fertilisation and cleavage could be s uccessfully achieved in cases with spermatogenetic maturation arrest by inj ecting cryopreserved elongated as well as round spermatides into oocytes. H owever, pregnancies occurred only after injection of elongated spermatids.