The aim of this communication is to present the various forms of abnormality noted in testicular sperm (TS).
The testicular tissue was macerated using two 1ml syringes fitted with 27g needles in FM. The macerated suspension was placed in 15x60mm culture dishes and was observed under inverted microscope at 20x and 40x objectives..
Morphological features of abnormal sperm encountered were oftentimes abnormal with a grossly bizarre range of abnormalities. These were photographed and presented. Grossly abnormal spermatozoa exhibit fertilization potential. We present one case in which 50% fertilization (2 of 4 eggs) was noted after injection with grossly abnormal spermatozoa. One oocyte appeared to have fertilised but the pronucleus fragmented and subsequently did not cleave. Another egg also appeared to have fertilised and undergone syngamy but the video showed one pronucleus fragment and subsequently no cleavage was noted. Two other oocytes did not fertilise.
We perform one of the largest diagnostic testicular biopsies for detection of spermiogenesis / spermatogenesis in the Kingdom of Saudi Arabia with well over 750 cases per year. We have noted fertilizations and oftentimes cleavages in a number of patients but quality of embryos generated do not appear viable. Grossly morphologically abnormal sperm are frequently encountered in testicular tissue. The use of surgically retrieved sperm in ICSI invariably will have to be performed with grossly abnormal sperm for lack of normal sperm, although this is less productive than ICSI with normal sperm, but still allows the generation of transferable embryos for a small proportion of patients and the possibility of treatment cycle completion. PGT must precede ET. In conclusion, in spite of the less than optimal fertilization rates, embryo development potential and pregnancy, there is often no alternative besides the use of such grossly abnormal sperm. The patient must be well counselled to anticipate failure.