PDF(Pubmed)
Abstract：
The most common reason for in vitro fertilization (IVF) cycle cancelation is a lack of quality gametes available for intracytoplasmic sperm injection (ICSI). Here we present the successful fertility treatment of the couple affected by obstructive azoospermia combined with suboptimal response to controlled ovarian stimulation. Since the conventional approach appeared ineffective to overcome both partners\' specific problems, the targeted interventions, namely, (1) pharmacological enhancement of sperm motility and (2) polarized light microscopy (PLM)-guided optimization of ICSI time, were applied to rescue the cycle with only immature oocytes and immotile testicular sperm retrieved. The treatment with theophylline aided the selection of viable spermatozoa derived from cryopreserved testicular tissue. When the traditional stimulation protocol failed to produce mature eggs, non-invasive spindle imaging was employed to adjust the sperm injection time to the maturational stage of oocytes extruding a polar body in vitro. The fertilization of 12 late-maturing oocytes yielded 5 zygotes, which all developed into blastocysts. One embryo was transferred into the uterus on day 5 post-fertilization, and another 3 good quality blastocysts were vitrified for later use. The pregnancy resulted in a full-term delivery of a healthy child. This case demonstrates that the individualization beyond the standard IVF protocols should be considered to maximize the chance of poor-prognosis patients to achieve pregnancy with their own gametes.
摘要：
体外受精（IVF）周期取消的最常见原因是缺乏可用于胞浆内精子注射（ICSI）的优质配子。在这里，我们介绍了受阻塞性无精子症影响的夫妇的成功生育治疗以及对控制性卵巢刺激的次优反应。由于传统方法似乎无法有效克服双方的具体问题，有针对性的干预措施，即,(1)精子活力的药理增强和(2)偏振光显微镜(PLM)引导下ICSI时间的优化,用于挽救周期，仅回收未成熟的卵母细胞和不运动的睾丸精子。茶碱治疗有助于从冷冻保存的睾丸组织中选择可行的精子。当传统的刺激方案无法产生成熟的卵子时，采用非侵入性纺锤体成像将精子注射时间调整到体外挤出极体卵母细胞的成熟阶段。12个晚熟卵母细胞受精产生5个受精卵，都发育成胚泡。受精后第5天，将一个胚胎转移到子宫中，另外3个质量好的胚泡被玻璃化以备后用。怀孕导致足月分娩健康的孩子。该病例表明，应考虑超出标准IVF方案的个体化，以最大程度地提高预后不良患者用自己的配子实现妊娠的机会。
