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Case Studies

Dr. Chandana Lakkireddi, NIF, Hyderabad helps a couple with Asthenozoospermia have their baby

Treatment profile

Absolute Asthenozoospermia and ICSI – what are the options

  • Complete asthenozoospermia, i.e. 100% immotile spermatozoa in the ejaculate, is reported at a frequency of 1 of 5000 men.
  • Absence of motile spermatozoa is also observed in epididymal sperm aspirations and in testicular biopsy specimens.
  • Complete asthenozoospermia is caused by two different events. The first event is a genetically caused defect in the composition of spermatozoa; the outcome is immotility because of the structural inability of these spermatozoa to move, as, for example, seen in Karthageners syndrome.
  • The other one is based on very heterogeneous events and immotility is a consequence of oxidative stress, infection or numerous other influences

Viable /Non-Viable sperm

  • In cases of complete asthenozoospermia, the fertilization rate after ICSI with randomly selected immotile spermatozoa is usually very low, especially when using ejaculated spermatozoa
  • Impaired results have been obtained with ejaculated spermatozoa due to the difficulty of distinguishing viable from non-viable immotile spermatozoa.
  • Differentiation between the two categories is very important as sperm vitality is one of the main conditions in order to achieve pregnancy.

The four main techniques for immotile sperm selection

  1. HOS test
  2. Activating substances
  3. Mechanical technique
  4. Laser activation

Hypo‐osmotic swelling test

The osmotic challenge of exposure of spermatozoa to a hypo‐osmotic medium   causes the tails with intact membranes and hence viable, to curve or swell.  Once identified these spermatozoa can be retrieved and placed in a normo‐osmotic fluid where they regain normal shape prior to injection

Activating substances

The clinical use of sperm selection with chemical substances has gained more and more attention recently

They induce sperm motility by inhibiting phosphodiesterase activity and thus increasing intracellular cAMP levels.

Pentoxyfylline has also been used to induce tail movements in immotile testicular spermatozoa and in ejaculated spermatozoa with very low motility

Further to the utility of pentoxifylline in ART, the compound has been shown to also be effective in the selection of spermatozoa with structural defects such as axonemal, enzymatic or functional tail defects

Brief

A couple visited Dr Chandana with primary infertility of 4years. Both husband and wife were initially advised to undergo the routine fertility tests. The wife’s cycle and hormonal analysis were normal, but the husband’s semen analysis revealed complete immotile sperm, which has been confirmed in 2 samples  and have a normal genetic screening.Husband has been refered to Androlist for further evaluation and after detailed tests, they have been advised to go for ICSI treatment.

Therapeutic approach and results

After an ovarian stimulation by a short protocol using GnRH antagonist

in association with recombinant FSH, 11 oocytes were recovered. Semen analysis

confirmed total asthenozoospermia and pentoxyfylline

was used to identify motile/viable sperm for ICSI. Post ICSI 8 oocytes were fertilized.four blastocyst formed with two embryos transfered in that cycle and the other two were frozen

A pregnancy test performed 15 days after embryo transfer was

positive and a pregnancy scan in the 6th week of gestation revealed a

viable twin pregnancy, both children were uneventfully delivered .

Nova IVF Fertility helps a couple with Asthenozoospermia have their baby

A couple visited Dr Chandana Lakkireddi at our Nova IVF Fertility, Banjara Hills, Hyderabad.

Upon collecting details, we found out that this was a case of primary infertility of 4 years. Primary infertility means that the couple had never so far conceived.

Pre-Pregnancy Tests at Nova IVI Fertility 

Both husband and wife were initially advised to undergo routine fertility tests.

The wife’s cycle and hormonal analysis were found to be normal. The husband’s semen analysis, however, revealed completely immotile sperm, confirming that he had Asthenozoospermia and hence this was a case of male infertility.

Diagnosis of Asthenozoospermia was subsequently reconfirmed in 2 samples. Genetic screening was also performed, and the outcome for this was normal.

Understanding Asthenozoospermia

Asthenozoospermia is a condition with very low sperm motility, thus impacting the ability of the sperm to move on their own. 100% immotile sperms are found in 1 in 5000 men. Absence of motile spermatozoa is also observed in epididymal sperm aspirations and in testicular biopsy specimens.

Complete Asthenozoospermia could be a result of either of the following.

  • Based on heterogeneous events and because of oxidative stress, infection or numerous other influences
  • The genetic defect in the composition of spermatozoa. This results in immotility due to the structural inability to move. For example, seen in Karthageners syndrome.

Poor motility decreases sperm quality and is one of the major impacts on male fertility.

There is no specific cure for Asthenozoospermia.

Some lifestyle changes may help increase sperm motility for some men by exercising regularly, maintaining a healthy weight, reducing cell phone exposure, reduce alcohol and quitting smoking.

Since in this condition, sperm motility (ability to travel) is impacted, male fertility gets impacted. IUI (or Intra Uterine Insemination) or IVF/ ICSI (or In Vitro Fertilization with Intracytoplasmic Injection) is an effective procedure for achieving pregnancy for the impacted.

The advice given at Nova IVI Fertility

Since this was a case asthenozoospermia, the husband was referred to Andrologist for further evaluation. Andrologist, as we know, is the doctor for helping with men’s sexual health issues, and advises on sexual health fertility as gynaecologists do for females. After detailed tests, the Andrologist advised going for ICSI IVF.

IVF ICSI (or In Vitro Fertilization with Intracytoplasmic Injection)

IVF underwent by a patient post an ICSI cycle is called an IVF ICSI cycle.

Intracytoplasmic Sperm Injection or ICSI is a superior fertility micromanipulation technique that increases the chances of pregnancy in IVF treatments. Instead of allowing the sperm to fertilise the egg in a petri dish naturally, the embryologist injects a healthy sperm, into the cytoplasm of an egg, using a fine glass needle, in a laboratory. This results in fertilisation, and subsequently, IVF is carried out.

Such ICSI procedure is used in assisted reproductive techniques, mostly where sperm may have lower motility. Since the sperm do not need to travel into the ova, their poor motility can be bypassed and does not have any impact on the IVF treatment outcomes. However, there is a need to be able to select the best quality sperms, called viable sperms, for carrying out the ICSI.

In complete Asthenozoospermia, the fertilisation rate after ICSI with randomly selected immotile ejaculated spermatozoa is usually very low. If the spermatozoa used is non-viable, impaired results have been obtained.

Hence, differentiation between the viable and inviable categories of sperm is very important as sperm vitality is one of the main conditions for pregnancy.

Techniques used for identifying immotile sperm and aiding in sperm selection

  • Hypo‐osmotic swelling test – The osmotic challenge of exposure of spermatozoa to a hypo‐osmotic medium causes the viable sperms with tails and intact membranes, to curve or swell. Once identified, viable spermatozoa are retrieved and placed in a normo‐osmotic fluid to help regain normal shape before use for ICSI.
  • Activating substances – Clinical use of sperm selection using chemical substances has gained much attention recently. Sperm motility is induced by inhibiting phosphodiesterase activity and thus increasing intracellular cAMP levels.

Pentoxifylline is used to induce tail movements in immotile testicular or ejaculated spermatozoa with very low motility. Further to the utility of pentoxifylline in ART, the compound has been shown to also be effective in the selection of spermatozoa with structural defects such as axonemal, enzymatic or functional tail defects.

Fertility Treatment at Nova IVF Fertility – Therapeutic approach and successful outcome

After an ovarian stimulation of the lady, using a short protocol using GnRH antagonist in association with recombinant FSH, 11 oocytes were recovered.

Pentoxifylline was used to identify motile/viable sperm for ICSI. ICSI was carried out, and eight oocytes were fertilised. This resulted in four blastocysts being formed. Two embryos were transplanted into the uterus of the lady in that same cycle, and the other two were frozen, in case required in future.

A pregnancy test was performed after 15 days, and the couple’s joy knew no bounds to know that the same was positive. A subsequent pregnancy scan in the 6th week of gestation revealed a viable twin pregnancy. Finally, upon completion of 9 months, the twins were uneventfully delivered.

The joy of successful outcomes – helping couple beat the odds and become parents

Nova IVF Fertility Hyderabad team had helped the couple with the right guidance and helped them navigate through their fertility journey. Our team, as well as the couple, were super happy to see the twins and the couple were very grateful that the fertility team had made their dream of parenting true, despite all the odds.

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