Birth of healthy twins after fertilization with in vitro cultured spermatids from a patient with massive in vivo apoptosis of postmeiotic germ cells.
OBJECTIVE
To examine whether the results of assisted reproduction with the use of elongated spermatids from a man with incomplete arrest of spermiogenesis and a high frequency of apoptosis among postmeiotic germ cells can be improved by germ cell in vitro culture.


METHODS
Case report.


METHODS
Private assisted reproduction centers and a university department.


METHODS
Man with incomplete spermiogenesis failure.


METHODS
Testicular spermatid extraction, in vitro culture of testicular biopsy samples, intraoocyte injection of elongated spermatids, embryo culture, and transfer.


METHODS
Fertilization rate, embryo morphology, and pregnancy.


RESULTS
An assisted reproduction attempt with viability-selected elongated spermatids from a fresh testicular biopsy sample resulted in a poor fertilization result and embryo quality. Further analysis of the sample used in this attempt showed a high incidence of apoptosis among postmeiotic germ cells. A second attempt was then performed with in vitro culture of testicular cells for 24 hours before spermatid injection. This procedure led to a significant decrease in the frequency of apoptosis among viability-selected spermatids, to improvement of the fertilization rate and embryo quality, and to the birth of healthy twins.


CONCLUSIONS
In vitro culture of testicular biopsy samples before assisted reproduction with elongated spermatids may improve the efficacy of treatment in cases of massive in vivo apoptosis of postmeiotic germ cells.
Tesarik
J
J
Molecular Assisted Reproduction and Genetics, Granada, Spain. cmendoza@goliat.ugr.es
Cruz-Navarro
N
N
Moreno
E
E
Cañete
M T
MT
Mendoza
C
C
D000328:Adult; D017209:Apoptosis; D001706:Biopsy; D002478:Cells, Cultured; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007743:Labor, Obstetric; D008297:Male; D008540:Meiosis / Q000502:physiology*; D008875:Middle Aged; D011247:Pregnancy; D019233:Retreatment; D013087:Spermatids / Q000166:cytology* / Q000502:physiology*; D013737:Testis / Q000473:pathology; D014427:Twins