RESUMO
OBJECTIVE: To treat couples with intracytoplasmic sperm injection (ICSI) after annexin V sperm sorting. DESIGN: Two case reports. SETTING: Department of Reproductive Medicine at a private medical institute. PATIENT(S): Couples on infertility treatment, donor oocytes. INTERVENTION(S): Sperm sorted with annexin V magnetic microbeads before ICSI, day 3 embryo transfer; case 1: ovum donation; case 2: patient oocytes. MAIN OUTCOME MEASURE(S): 1) Sperm DNA fragmentation (terminal deoxynucleotide transferase-mediated dUTP nick-end labeling [TUNEL]) and active caspase-3 (immunocytochemistry); 2) fertilization rate, embryonic quality, blastocyst development of nontransferred embryos, and pregnancy outcome after ICSI of sorted sperm. RESULT(S): Case 1: Premature ovarian failure patient with previous fertilization failures: asthenoteratozoospermia, abnormal DNA fragmentation (TUNEL 30%; normal <20%). ICSI with annexin V-treated sperm done on six donated metaphase II (MII) oocytes; four fertilized, and a 5-cell/grade-2 and a 6-cell/grade-2-3 embryo were transfered. A day 5 blastocyst was cryopreserved. The patient was in the last trimester of gestation. Case 2: Couple with >4 years of primary infertility and recent ICSI failure. Semen with teratozoospermia (5% normal forms [Kruger]) and abnormal active caspase-3 (16%; normal <11%). ICSI with annexin V-treated sperm done on 9 MII oocytes. All fertilized; a 7-cell/grade-1 and an 8-cell/grade-1-2 embryo were transferred. A day 5 expanded blastocyst was cryopreserved. The patient was in the second trimester of a twin normal pregnancy. CONCLUSION(S): Sperm sorting with annexin V columns was effective in the treatment of two cases of ICSI failure, resulting in a single and a twin pregnancy after transfer of two embryos in each case.
Assuntos
Anexina A5/administração & dosagem , Microesferas , Resultado da Gravidez , Injeções de Esperma Intracitoplásmicas/métodos , Espermatozoides/citologia , Adulto , Separação Celular/métodos , Fragmentação do DNA , Feminino , Humanos , Masculino , Gravidez , Espermatozoides/efeitos dos fármacos , Falha de Tratamento , GêmeosRESUMO
OBJECTIVE: To report on the development of human parthenogenetic blastocysts and an in vitro attachment that was generated from noninseminated cryopreserved human oocytes for the first time. DESIGN: Prospective study. SETTING: Department of reproductive medicine in a medical institute in Buenos Aires, Argentina. PATIENT(S): Five healthy fertile donors. INTERVENTION(S): Artificial activation of noninseminated cryopreserved human oocytes after thawing, parthenote culture, and their in vitro attachment. MAIN OUTCOME MEASURE(S): Survival rate, activation rate, cleavage rate, and blastocyst formation. RESULT(S): Thirty-six of 38 cryopreserved noninseminated oocytes survived after thawing (survival rate, 94.7%). Thirty-one of 36 oocytes showed one pronucleus (activation rate, 86.1%). Thirty of 31 cleaved (cleavage rate, 96.8%). Five of 30 showed cavitation (blastocyst rate, 16.7%). CONCLUSION(S): Noninseminated cryopreserved human oocytes showed a high survival rate after thawing. They responded very satisfactorily to artificial activation, which was followed by a high rate of parthenogenetic embryos, which can develop into blastocysts. In the future, these could be a new source for development of human parthenogenetic stem cells.