RESUMEN
Genetic aspects of male infertility and the possible risks of new assisted reproduction and their influence on the development of zygotes and children born after intracytoplasmic sperm injection (ICSI) need further research. These patients have an increased risk of diploidy, and disomies are frequent in their spermatozoa. Meiotic disorders are more common in testicular biopsies of patients with severe oligoasthenozoospermia. For these reasons, a detailed andrological study is absolutely mandatory before accepting a couple with these characteristics into an IVF-ICSI programme. When an andrological patient has plasma FSH values >10 IU/l and/or very low total motile sperm count <1 x 10(6), despite a normal karyotype, they clearly need a testicular biopsy and a meiotic study in order to rule out meiotic arrest or synaptic anomalies. Another important aspect to be considered is the possible benefit of applying preimplantation genetic diagnosis in these cases because they normally have a high percentage of chromosomally abnormal embryos, although in the present study this was not evident. All studies agree on the necessity of conducting follow-up studies in the population of children born after IVF-ICSI. In this way, it will be possible to find out if these infertile patients and their offspring have a higher risk of suffering epigenetic errors and imprinting disorders.
Asunto(s)
Infertilidad Masculina/patología , Meiosis , Inyecciones de Esperma Intracitoplasmáticas/métodos , Espermatozoides/patología , Estudios de Casos y Controles , Fase de Segmentación del Huevo , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Infertilidad Masculina/genética , Infertilidad Masculina/terapia , Masculino , Embarazo , Índice de Embarazo , Estudios Retrospectivos , Motilidad Espermática , Espermatozoides/fisiología , Resultado del TratamientoRESUMEN
PURPOSE: Evaluate the influence of different baseline spermatogenic patterns [meiotic pattern (normal or abnormal), sperm concentration (> 1 x 10(6)/mL or < or = 1 x 10(6)/mL), and the combined meiosis-sperm concentration pattern] on early embryo development in severe oligoasthenozoospermia. METHODS: Embryo outcomes (fertilization rate, cleavage rate, and 4-cell stage embryo division rate on day 2) after IVF-ICSI in 75 oligoasthenozoospermia and 79 normozoospermic males. RESULTS: The embryo division rate was significantly lower in oligoasthenozoospermia compared to normozoospermia (50.43% vs. 58.72%, p < 0.01) and in the oligoasthenozoospermia group for meiotic anomalies (43.40%), sperm concentration < or = 1 x 10(6)/mL (44.35%), and the combined pattern < or = 1 x 10(6)/mL with meiotic anomalies (37.17%). Logistic regression analysis showed a synergic effect (OR = 2.00; 95% CI = 1.28-3.12) when the two spermatogenic patterns predictive of slow embryo development [meiotic anomalies (OR = 1.49; 95% CI = 1.03-2.15) and sperm concentration < or = 1 x 10(6)/mL (OR = 1.53; 95% CI = 1.09-2.13)] were present. CONCLUSIONS: The data suggest that the early embryonic developmental capacity is inversely related to the severity of spermatogenic impairment (meiotic anomalies and/or sperm concentration < or = 1 x 10(6)/mL).