Microinjection of spermatids or immature sperm cells (ROSI or ELSI), in the oocyte, will be only done when there is not possibility of obtaining sperm in the ejaculate or testicular biopsy. In the latter case, they will try to grow in-vitro and in an appropriate way, the testicular biopsies in order to develop the most advanced possible sperm or sperm forms.
All these details will be carried out with the knowledge and necessary consent of the couple. Aninformation leaflet about each technique as well consent forms are available for those couples that require them.
Previous performed tests indicate that the secretory azoospermia is caused by the absence of spermatozoa production in the testis. However, the sperm contains immature alive germ cells and with no apparent anomalies. These observations suggest that it might be possible to developthese cells to the spermatids state using cell culture. The spermatids originated in this crop could be injected directly into the egg in order to fertilize it.
To facilitate the maturation of germ cells during in vitro culture, it is essential to haveother types of testicular cells that are absent in the ejaculate but present in the testicular tissue. Therefore it is necessary to obtain a testicular biopsy for the success of this technique.
The proposed technique has allowed the birth of many genetically normal children. The analysis and treatments that apply to patients will be the same as those needed for an ICSI with sperm in the ejaculate.
Since the number of children born after the injection of spermatids and, in particular, matured spermatids in vitro, is still very small, we recommend that once pregnancy is established a prenatal diagnosis should be undertaken . It would be necessary to perform an amniocentesis to analyze chromosomes and an ultrasound study to analyzefetal morphology.