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Novel Spermatid Injection Technique (ROSI) for those with failed mTESE

What is new generation ROSI technique?

This technique was first described by Dr. Tanaka and colleagues from Japan in 2014 with succesfull 14 live births. To date, there have been many ROSI IVF studies with limited pregnancy success. However, this novel hybrid technique is quite different from old school ROSI tech:

  1. Spermatids are selected after several enzymatic procedures
  2. Nucleus and cytoplasm are seperately collected by disrupting the membrane of the spermatid.
  3. Oocyte activation is performed by electro-fusion device before injection

These important steps as described by Tanaka et al. Contributed to promising results.

By utilizing equipment and getting adequate training in Japan, Centrum Clinic IVF Center staff announced their first ROSI pregnancy achievement in Februray 2019. That was actually just the visible part of the iceberg. Because, Prof. Dr. Recai Pabuçcu and his team had already gone to Japan where foundations of the ROSI technique had been laid and also the largest ROSI series is owned to get a training with Dr. Tanaka. After completing the training process, the team returned to Turkey and achieved their first successful pregnancy by using ROSI technique in a contemporary sense.

‘In summary, the ROSI technique in a comtemporary sense will be a beacon of hope for thousands of families !!…!!

The situation we call azoospermia means that there is semen in men, however there are no live sperm cells in the semen. It is seen in 1% of the society and in 30% of men who have infertility complaints.

What is the ROSI technique? Why is it different than traditional IVF treatment?

Before mentioning the ROSI technique, we must understand sperm production phases first. Sperm production is a complicated process which lasts around 90 days. In this process;

  • Spermatogonium(the most precursor cell)
  • Spermatocyte (precursor cell)
  • Spermatids (Round shaped, elongating and elongated form precursors)
  • Spermatozoa (mature) cells enter into the maturation process respectively.

Among these cells, the best with the capacity to fertilize the egg is mature cells. However, since azoospermic males do not have these cells, mature sperm cells are searched in tissues taken from testicles. The testicular biopsy is called TESE. In the TESE procedure, mature sperms can be found in 30-40% of males, however if nothing can be found the process could be challenging for men. In this case, if there are no mature cells precursors are searched and round or elonge sperm cells are found in especially spermatid precursors. Under normal conditions these precursor cells do not have the capacity to fertilize eggs. However, with the new generation ROSI technique, it is possible for these precursor round and elonge sperm cells to fertilize eggs. Special technologies and techniques are used for this procedure.

In traditional IVF treatment, mature sperm cells are collected from ejaculated semen samples, the best one is selected and injected inside the egg. In the ROSI technique, the procedure can not be applied since there are no mature sperm cells in the semen. Round cells shelled from the tissue obtained through TESE are injected inside the oocyte, namely the egg.

What is the chance of finding round-precursor cells in a new ROSI cycle for patients who have had TESE before, however cells were non-existent?

In a ROSI cycle, a new TESE procedure is definitiley applied hence, there might be a treatment process beforehand. At a rate of approximately 30% precursor-round cells can be found in TESE which is applied to patients who will go through the ROSI technique.

Who can benefit from the ROSI technique?

Those who do not have mature sperm cells in their semen, namely patients diagnosed with azoospermia. However, we may be able to obtain mature sperm cells in almost half of them after TESE procedure. Hence, patients who have had TESE procedure previously but no mature sperm cells were found can benefit from the ROSI technique.

Will the embryo obtained by the ROSI technique be healthy?

Yes. We know that to date, embryos which have been obtained by the ROSI technique do not cause any serious problems both fertilizationwise and genetically. However, it is still quite early to make a firm decision on the matter

Which equipment are used for the ROSI technique? Can every center perform ROSI?

ROSI technique is a technique which requires both craftsmanship and equipments. Hence, every center may not be able to perform the ROSI technique thoroughly. Especially shelling precursor round cells and placing them inside the egg requires fine craftsmanship. Moreover, you definitely need to have specific machines for the ROSI procedure. So, it is essential to perform ROSI in highly qualified and experienced centers.

What is the chance of pregnancy using the ROSI technique? Is it more or less when compared to traditional IVF treatment?

We predict about 10-20% success in pregnancies and around 10% of live birth success per application with the ROSI technique. So, chances of getting pregnant is lower when compared to traditional IVF treatment. Hence, the rate of miscarriages is slightly higher around 30-40% in the ROSI technique.

What are the other options for couples who have had TESE but no sperm cells were found and who reject the ROSI procedure?

One of the main options is stem cell therapies, however we haven’t been able to achieve healthy live birth success in humans from stem cells with today’s technology. We still need time to develop this procedure. Another option is sperm donation, unfortunately legal legislation in our country does not allow it. The last option is adoption.

Are the children who were born with the ROSI technique healthy?

We have observed more than 90 live births to date. We may assume this number has risen up to around 300 today. The data we have was acquired in 2017 with large ROSI series. 90 children were born to date and except three of them, all are healthy. Moreover, their conscience-intelligence development is compatible with their peers.

Does Centrum Clinic perform ROSI procedure?

We have been applying this procedure since February 2019. We use equipment which we have brought from Japan. We have applied the novel ROSI technique more than a thousand  cycles and have been able to achieve 42 live births and more than 50 ongoing pregnancies.

We are also proud of contributing to ESHRE 2020 meeting with our ROSI pregnancy series.

New Generation ROSI- Summary in 7 steps:

  1. Evaluating both the male and female
  2. Requesting hormone tests from males and 6-8 weeks of hormone therapy according to the results
  3. After completing treatment of males, beginning follicle enlargement for spouses on the 2nd or 3rd day of menstruation.
  4. Collection of mature eggs and concurrently searching sperm cells through biopsy from testicles which is called TESE.
  5. Fertilization of eggs with mature cells if there are mature sperm cells, if there isn’t, with precursor that is round or long sperm cells.
  6. Stimulation of eggs which will be fertilized through special electrical activation.
  7. PGT-A (genetic screening of available embryos if possible)
  8. Transfer of (euploid)ROSI embryos.