Pregnancy from intracytoplasmic sperm injection of a sperm head and detached tail

Objective: To evaluate sperm ultrastructure and the efficacy of intracytoplasmic sperm injection (ICSI) with careful positioning of the sperm midpiece next to the sperm head in a patient with easily decapitated sperm syndrome. Design: In vitro fertilization case report with retrospective sperm ultrastructure analysis. Setting: In vitro fertilization clinic and andrology laboratory. Patient(s): A couple seeking treatment for diminished ovarian reserve and male factor infertility using donor oocyte IVF. Intervention(s): Motile sperm inadvertently decapitated during micromanipulation were used for a modified C ICSI procedure in which the midpiece was carefully positioned proximal to the sperm head. Sperm were also analyzed by transmission electron microscopy (TEM). Main Outcome Measure(s): Fertilization rate, embryo development, pregnancy, and the incidence of normal sperm ultrastructure. Result(s): The ICSI resulted in a fertilization rate of 63% and embryo development of good to moderate quality of 36% of the embryos. Transfer of two embryos resulted in a pregnancy and birth of a healthy child. Normal sperm centrosonnes were identified retrospectively. Conclusion(s): Pregnancy can result in patients where the sperm are decapitated during immobilization before ICSI if normal centrosomes are present and the head and midpiece are positioned closely together.