Introduction
In recent years,the terms of “MMAF” was more and more popular in the reserches about asthenozoospermia in male infertility, with a typical phenotype characterized by the presence of immotile sperm with cureled, short, bent, coiled, absent flflagellum or flflagellum with an irregular width[6,8,10-13,21,23,26,28,30,31]. Previous studies reported as dysplasia of the fifibrous sheath(DFS) or stump tails or non-specifific flflagellar anomalies[2,4,9,25,27]. Ben Khelifa M firstly described it as MMAF in 2014, a name that seems more accurate[3] . Electron microscopy examination of spermatozoa showed that MMAF are often accompanied by ultrastructural/functional defects of the axoneme, which contains 9 outer microtubules doublets and 2 central singlets (9+2 structure), several axonemal dyneins, radial spokes, nexin links and many other components[3,24]. Any defects in these structures would lead to abnormal sperm morphology of the flagella and further results in severe asthenozoospermia or 100% sperm immotility.
Another MMAF-like phenotype is observed in men with primary ciliary dyskinesia (PCD), which is determined by the presence of classical PCD Phenotypes such as recurrent respiratory tract infections, bronchitis, rhinosinusitis, bronchiectasis, and infertility[16].
At present,intracytoplasmic sperm injection (ICSI) is the best possible tool for MMAF patients to obtain healthy offspring.In previous MMAF cases,normaI fants delivered following ICSI were reported by other authors[7,21,19]. Here, we report pregnancy with the delivery of a girl after frozen embryo transfer from vitrified oocyte injected by immotile testicular spermatozo from a MMAF patient with no clinical features of PCD. This observation suggests that vitrified oocytes also could be fertilized by 100% immotility testicular spermatozoa with multiple morphological abnormalities of the sperm flagella,even with mostly curled end piece of the flagella.