First successful pregnancy outcome after intracytoplasmic sperm injection with short-tailed sperm from an infertile Han Chinese man

Dear Editor, Short-tailed sperms are rarely encountered in clinical practice, but they make achieving fertilization difficult. We encountered a very rare case of an infertile man having short-tailed sperm. A 32-year-old Chinese farmer and his 27-year-old wife were referred to Xiamen Maternity and Child Care Hospital for a fertility evaluation. They were married in March 2008, and after 3 years, his wife became pregnant. However, spontaneous abortion occurred 40 days later. Afterward, pregnancy was not achieved despite 4 years of unprotected coitus. The man reported that he had been smoking 10 cigarettes per day for the past 10 years. A semen sample was collected by masturbation after 4 days of sexual abstinence. The ejaculate was fully liquefied in 20 min, and a semen analysis was performed in our laboratory according to the standard World Health Organization (WHO) criteria. Through light microscopic evaluation, we found that the sperm concentration was 15.5 × 106 per ml, and the percentages of progressive (PR), nonprogressive (NP), and immotility (IM) were 14.5%, 11.7%, and 73.7%, respectively. Morphology analysis revealed that 99.5% of the spermatozoa showing a short-tail phenotype (Figure 1a) compared with normal sperm morphology (Figure 1b). Based on the results of the semen analyses, the patient was diagnosed with asthenoteratozoospermia. Because of the patient’s asthenoteratozoospermia, we chose to perform intracytoplasmic sperm injection (ICSI) to fertilize oocytes. Twelve oocytes were obtained from his wife on day 0, and all oocytes were mature (MII). For the ICSI procedure, we prefer ejaculated spermatozoa that were fast-moving and had long tails. Eighteen hours after ICSI, a fertilization check was performed. Eight of the embryos had two pronuclei (2PN) (Figure 2a), one had 0 pronuclei (0PN) (Figure 2b), and the remaining three each had one pronucleus (1PN) (Figure 2c). On the second day after ICSI, cleavage was observed in nine embryos; one was grade 2.5 and the others were grade 3 or 3.5. Two embryos (Figure 2d and 2e) were transferred on day 2. The other embryos were frozen. Pregnancy did not occur, as evidenced by the low levels of βhCG 15 days after transfer. Five months later, we thawed three embryos (Figure 2f–2h) (10C3.5; 9C3; 7C3) and transferred them to his wife’s uterus. Fortunately, pregnancy was successful and the wife delivered a live baby. To our LETTER TO THE EDITOR