Dados do Trabalho

Title

Case report: use of pentoxifylline in frozen samples of patients with asthenozoospermia, who had undergone Microdissection Testicular Sperm Extraction (MicroTESE), resulting in clinic pregnancy.

Objective

The objective of this case report is evidencing the effect of pentoxifylline in spermatic parameters of frozen MicroTESE samples and report the final results of In vitro fertilization (IVF) cycles treatment.

Methods

It is known that semen cryopreservation and thawing can cause decrease in motility and reduce potential of sperm fertilization. Thus, various substances had been tested to increase sperm resistance to cryopreservation process, for example, pentoxifylline. This substance is a methylxanthine derivate and a phosphodiesterase inhibitor, use to promote sperm motility.

For this case report, two IVF cycles treatment were selected, and were performed on different days in LabForLife laboratory; frozen samples from MicroTESE were used. The patients were 34 and 45 years old and their partners were 33 and 28 years old, respectively. The samples were frozen after the urological procedure and microscopic evaluation. Freezing Medium TYB (Irvine) was used, following the manufacturer's protocol, and thawing was performed on the day of oocyte retrieval. After thawing the sample, an evaluation of sperm concentration and motility was performed.

After the initial evaluation, the entire thawed volume was washed, and a new analysis were performed. In both samples, the absence of motility was verified, therefore, pentoxifylline reagent (Vitromed) was used following the manufacturer's protocol. After a period of 10 minutes of incubation, the analysis was performed in an inverted microscope and progressive motile spermatozoa were found in the samples. After selecting the best sperm, intracytoplasmic sperm injection (ICSI) was performed in the patient's oocytes.

Results

In the first case analyzed, 20 oocytes were injected with progressive motile spermatozoa, resulting in 8 blastocysts (6AA, 6AA, 5AA, 5AA, 4BA, 3AA, 3AA, 3BB), 5 of which were euploid. Transfers of a single embryo were performed on two separate dates. The 4BA blastocyst transfer resulted in a negative beta HCG; and the second transfer, a positive beta HCG and 1 gestational sac were obtained from a 5AA blastocyst. In the second case, 12 oocytes were injected, also with progressive spermatozoa, which resulted in 3 blastocysts (5AA, 4CB,

3BC), 2 of which were euploid. A transfer of a 5AA blastocyst resulted in a positive HCG beta and 1 gestational sac. There is still no information on live births for both cases so far.

Conclusion

Regardless of the impacts of cryopreservation on sperm parameters, the use of pentoxifylline increased the rate of progressive motility, enabling the selection of better quality sperm in samples where initially only immobile sperm had been observed. In this case report, an improvement in the parameter of sperm motility was observed after the use of pentoxifylline, no other effect that it could cause on sperm was studied.

Keywords

Pentoxifylline; asthenozoospermic; cryopreservation, MicroTESE; sperm motility