Male fertility relies on both the quantity and quality of sperm. If the number of sperm cells released in a single ejaculation is low, or if the sperm is of poor quality, conception may be difficult and in some cases, even impossible. In most male subfertility and infertility cases, there are no obvious physical symptoms. Intercourse, erection and ejaculation usually occur without difficulty, and the quantity and appearance of ejaculated semen appears normal to the naked eye. However, a detailed semen analysis in a fertility lab can reveal abnormalities in sperm count, motility and morphology.
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Treatment for male infertility should be tailored in line with the underlying problem at hand, or should follow an evidence-based approach in case of an unidentified problem. Treatment approaches include surgery to correct or repair anatomic abnormalities, and use of assistive reproductive procedures like intrauterine insemination (IUI), in vitro fertilisation (IVF) and third-party donor programmes. Male infertility stemming from hormonal imbalances and erectile dysfunction can usually be treated with medication, while surgery is effective for tubal blockages and varicocele. For men with defective sperm, poor motility or low sperm count, intracytoplasmic sperm injection (ICSI) is a preferred option. ICSI is an advanced technology that involves the injection of a sperm cell directly into an egg, to maximise the chances of fertilisation.
This case is about a 35-year-old man and his 30-year-old spouse, whom we shall call Mr. and Mrs. Y, who experienced over 3 years of primary infertility. Our initial investigation showed that Mr. Y's semen contained 100% defective sperm, with sperm cells that were completely immotile thanks to an absent tail. I walked the couple through a detailed diagnosis, and explained to them that even with an ICSI cycle, the chances of fertilisation failure and miscarriage were high due to the nature of abnormalities in the sperm. In addition to the problem of male infertility, Mrs. Y was diagnosed with endometriotic cysts and a low ovarian reserve.
For the ICSI cycle, I used pentoxifylline to select viable sperm cells from the ejaculated sample. However, given that the function of pentoxifylline is to elicit the instantaneous coiling of sperm tails, this step remained redundant and hence, it was a challenge to identify a viable sperm cell.
Ultimately, I retrieved 7 oocytes and injected them each with an individual sperm cell (albeit with a compromised mid-piece and tail). 6 oocytes fertilised normally, and we ended up with 3 blastocysts on day 5. The same day, I transferred one grade B embryo; the rest were frozen. Unfortunately, that cycle did not result in a pregnancy. However, on the next cycle, we chose to transfer two frozen embryos, which did result in a pregnancy. After the pregnancy confirmation via blood test, the early pregnancy ultrasound reports confirmed a single intrauterine gestational sac with a fetal heartbeat. The antenatal period was smooth and Mrs. Y delivered a healthy baby girl naturally, at full term.
According to studies on the subject, the centrosome present in the mid-piece of the human sperm cell serves as a microtubule organising centre responsible for fertilisation and even distribution of chromosomes during cell division. The identification of a live viable sperm is most important in such cases, for successful fertilisation and pregnancy.
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