Androlog Mail
Regarding Andy Meacham's question of how to proceed with a case exhibiting
100% non-motile sperm, I would like to suggest some lines of investigation
in addition to the proposed use of hypoosmotic swelling to choose sperm for
ICSI.
First, a viability test is essential. Alternatives to HOS are Eosin Y or
Trypan blue staining, or use of a fluorescent DNA-binding probe such as
Hoechst 33258.
If all the sperm in semen are 'dead', we would not suggest ICSI using them.
In our practice (Dr. Richard Berger), we determine whether there is an
immediate possible cause of cell death such as high reactive oxygen species
generation by leukocytes, which might be addressed. If not, a vas or
testicular aspiration is considered. We have seen normal (for the site)
motility from either vas or testis when semen sperm motility is poor.
Second, if some of the sperm are apparently live, we would attempt to
stimulate motility using pentoxifylline. Surprisingly, this has worked in
some cases of 0% motility. The induced motility may or may not be of
sufficient quality and quantity to consider IUI or IVF. But, even if there
is only twitching motility, this may be sufficient to choose sperm for ICSI.
The pentoxifylline is washed out of the sperm preparation before any of the
insemination procedures. This also avoids having to use HOS to choose
non-motile sperm.
Third, if no sperm respond to pentoxifylline, medical, genetic, or electron
microscopic evidence could be gathered to rule out an immotile cilia
syndrome, followed by genetic counseling.
Good luck with this case!
-- Charles H. Muller, Ph.D., HCLD Director, Male Fertility Laboratory Department of Urology, Box 356510 University of Washington School of Medicine Seattle, WA 98195-6510 USA206-543-9504 (office) 206-543-4671 (lab) cmuller@u.washington.edu
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