Intracytoplasmic sperm injection outcomes in Chinese men with multiple morphological abnormalities of sperm flagella

Dear Editor, Asthenozoospermia is a common cause of decreased male fertility, and several factors can inhibit or prevent sperm motility, including ultrastructural defects of the sperm flagellum.1 An ultrastructural defect leading to severe asthenozoospermia is a syndrome called dysplasia of the fibrous sheath (DFS),1 which results in short, thick, and irregular sperm tails; this feature is caused by severe disturbances in the fibrous sheath (FS) and other cytoskeletal components and(or) the dynein arms. DFS is also known as tail stump syndrome2 or short‐tailed spermatozoa and is a likely variant of primary ciliary dyskinesia (PCD).3 However, multiple morphological abnormalities of the sperm flagella (MMAF) is a more accurate description for this syndrome.4 No empirical medicinal treatment has been reported to improve the semen parameters of MMAF men, and intracytoplasmic sperm injection (ICSI) is the only way to conceive with a female partner.1 Chemes and Alvarez1 reviewed the ICSI outcomes of 12 cases, the total fertilization rate was 63 ± 16%; 10 pregnancies followed, and 14 babies were delivered. Six Chinese men (age, 31–34 years) with MMAF were diagnosed between March 2012 and October 2014. All of the participants had suffered from primary infertility for 1–7 years. All patients were subjected to a complete physical examination, and no significant respiratory symptoms were observed. All of the men showed a normal lymphocyte karyotype, and reproductive hormones were within normal ranges. The female partner of case 1 was diagnosed with mosaic Turner syndrome, and the fluorescence in situ hybridization analysis revealed nuc ish (DXZ1 ×1)[1024]//(DXZ1 ×2)[50]//(DXZ1 ×3)[65]. The other female partners had no special reproductive system problems. Case 2 was diagnosed with varicocele and underwent varicocelectomy at another hospital, but his semen parameters failed to improve. All couples signed informed consent for the ICSI procedure, and our hospital Ethics Committee approved this study. LETTER TO THE EDITOR