Aggressive Sperm Immobilization Prior to Intracytoplasmic Sperm Injection with Immature Spermatozoa Improves Fertilization and Pregnancy Rates

This study was conducted to determine whether the mode of sperm immobilization prior to intracytoplasmic sperm injection (ICSI) influences fertilization by immature spermatozoa. Of the 837 ICSI cycles evaluated, 81 were performed with epididymal or testicular spermatozoa; 35 cycles with epididymal spermatozoa immobilized in the standard fashion resulted in fertilization and pregnancy rates of 48.3 and 51.4% respectively. When a more aggressive sperm immobilization technique (i.e. permanently crimping the sperm flagellum between the midpiece and the rest of the tail) was applied in 17 cycles, the resultant fertilization and pregnancy rates were significantly (P < 0.05) higher: 82.0 and 82.4% respectively. Similar increases in fertilization and ensuing pregnancy rates were also observed in ICSI cycles with the aggressive immobilization of frozen-thawed epididymal spermatozoa (eight cycles) versus standard immobilization (16 cycles). However, the fertilization rates for ICSI using testicular spermatozoa (five cycles) were basically the same, regardless of the immobilization technique. Furthermore, for ejaculated spermatozoa (756 cycles), the fertilization rates following aggressive sperm immobilization were also positively affected (73.4%), although no statistical differences in the clinical pregnancy rates were found. Because aggressive immobilization appears to affect sperm membrane permeabilization, the enhanced fertilization patterns observed in immature spermatozoa following aggressive immobilization may suggest a different membrane constitution in these spermatozoa. These findings indicate that immature gametes may require additional manipulation to enhance the post-ICSI events essential for adequate nuclear decondensation.