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.