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n Obstetrics and Gynaecology Forum - The management of a patient with Globozoospermia : case report

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Abstract

Globozoospermia is a severe form of teratozoospermia associated with the absence of the acrosome. In about 1% of round-headed spermatozoa an acrosome may persist as a rudimentary structure. It is the absence of the acrosome that renders rounded headed spermatozoa incapable of initiating oocyte activation with consequent failure to achieve fertilisation due to deficiency of phospholipase C-zeta (PLC ), the oocyte activating factor. Persistence of the acrosomal bud in globozoospermia is associated with spontaneous oocyte activation using intra-cytoplasmic sperm injection (ICSI). Assisted oocyte activation using calcium ionophore-A23187 has been the main method by which couples with globozoospermia have hope for achieving a pregnancy. The technique has a reported 60% chance of successful oocyte activation. We describe a couple with total globozoospermia who achieved fertilisation using sequential combination of motile sperm organelle morphological examination (MSOME) and intra-cytoplasmic morphologically selected sperm injection (IMSI). Fertilisation was achieved followed by transfer of four embryos as dictated by the patient's age, but all embryos failed to implant. Concerns over the possible transmission of defective genes to the offspring of couples with globozoospermia treated with ICSI/IMSI or assisted oocyte activation remains unabated. Our case demonstrates the efficacy of MSOME/IMSI as a good alternative to calcium ionophore for assisted oocyte activation in globozoospermic couples.

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/content/medog/25/1/EJC166284
2015-01-01
2016-12-09
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