Case Study 1
World’s first frozen egg and frozen testicular sperm twins

Mr X underwent a testicular biopsy prior to commencement of the IVF cycle. Twitching sperm were obtained from the right testicular biopsy but none from the right epididymes. Sufficient sperm were frozen for at least 2 IVF-ICSI cycles. The survival of thawed sperm is poor (about 11%).

Mrs X started treatment for IVF-ICSI 3 months later using buserelin for down regulation and Metrodin HP for ovarian stimulation. Thirty eight eggs were retrieved transvaginally. Two straws of sperm were thawed but due to the extremely poor motility, very few motile sperm could be located and only eight eggs were injected by ICSI in 4 hours. In order not to compromise the rest of the eggs, they were frozen and stored as eggs cannot survive after 24 hrs. The following day only one of the eight injected eggs were normally fertilized. As Mrs X developed moderately severe ovarian hyperstimulation symptoms within the next 2 days, the scheduled embryo transfer had to be cancelled. Therefore the single 4-cell embryo was frozen.

Two months later, the patient returned for a thaw cycle and she was placed on a hormone replacement therapy regime. Twelve eggs were thawed and ten survived. ICSI was performed with the frozen testicular sperm and seven normally fertilized. This time the sperm motility markedly improved after incubation with recombinant FSH. The transfer of three embryos resulted in a pregnancy. However, it did not continue and ended in a missed abortion at 9 weeks.

The patient returned for a second thaw cycle 6 months later. Twelve eggs were thawed and ten survived. ICSI was performed with the thawed testicular sperm and only two normally fertilized. Motile sperm were used throughout. Two eggs fertilized and two embryos at 4 cell stage were transferred. This resulted in a twin pregnancy which became the world’s first pregnancy from frozen eggs and frozen testicular sperm.