Dados do Trabalho

Title

Impact of Paternal Age on Embryo Development: A Case Report of Thawed Oocytes Inseminated with PESA-Derived Sperm in a 73-Year-Old Male.

Objective

This case report describes a fertility intervention utilizing percutaneous epididymal sperm aspiration (PESA) in a male patient aged 73 years, aiming to present the treatment cycle and its outcomes.

Methods

In this study, a 73-year-old male patient with a history of vasectomy 26 years ago underwent a procedure known as Percutaneous Epididymal Sperm Aspiration (PESA). PESA involved making two punctures on the right epididymis to retrieve motile sperm for use in Intracytoplasmic Sperm Injection (ICSI). Thirteen donated oocytes (egg cells) were thawed for this particular case, and all of them survived the thawing process. Out of these oocytes, seven were subjected to ICSI using sperm obtained through PESA, while the remaining six oocytes were injected with sperm from a previously frozen semen sample acquired from a sperm bank. Fertilization assessment was conducted 19 hours after the ICSI procedure to determine the success of sperm-egg fertilization. On the fifth and sixth days of embryonic development, Preimplantation Genetic Testing for Aneuploidy (PGT-A) was performed on the resulting embryos.

Results

All injected oocytes exhibited fertilization, with six fertilized by the semen bank sample displaying two pronuclei (2PN). Among the seven oocytes fertilized with PESA sperm, four showed 2PN, one displayed 1PN, and two exhibited 2 polar bodies. During embryo development, ten blastocysts were biopsied and cryopreserved—five from oocytes fertilized with the semen bank sample and five from PESA-fertilized oocytes. The PESA group achieved a 71% blastocyst formation rate relative to injected oocytes, while the semen bank group achieved 83% blastocyst formation. On the fifth day of embryo development from PESA-originated embryos, we observed the classifications 5AB, 5BB, and 3BB, based on Gardner's grading system. On the sixth day, two blastocysts were classified as 5BB. Genetic analysis was only performed on PESA-derived embryos, revealing two euploid blastocysts, 5AB and 3BB on D5, and three aneuploid blastocysts. The 5AB PESA blastocyst was thawed and transferred. Nine days after the transfer, the beta-HCG level was measured at 373.7. The beta-HCG values demonstrated expected growth, doubling every two days during monitoring. The patient's pregnancy is progressing without complications.

Conclusion

In conclusion, this case report underscores the feasibility of attaining optimal-quality embryos with euploid genetics using PESA-derived sperm from patients aged above 70 years.

Keywords

PESA, ICSI, euploid embryo, PGT-A