Until 1992, couples with male infertility could not be helped by the then in vitro fertilization, as the fertilization rate was very low. In 1992, the first pregnancies were announced after microfertilization (ICSI) with sperm that had very poor characteristics. Low sperm count or low or non-existent motility have ceased to be a problem in ICSI, since fertilization does not depend on the ability of sperm to enter the egg, but a single sperm is injected directly into the cytoplasm of the egg. With the ICSI method the fertilization rates are very high (over 80% of the mature eggs are fertilized). As a result, the ICSI method is used worldwide with great success to treat severe oligo-patient-teratozoospermia.
Azoospermia (complete absence of sperm in the seminal fluid) can also be successfully treated. In these cases, the sperm are obtained by biopsy of the testicle or epididymis with a slightly lower (or equal, according to other researchers) success rate.
Key Indications for Microfertilization (ICSI)
1. Sperm quality problems. Oligospermia (number less than <15 million / ml), asthenospermia, teratozoospermia and a combination of all these problems which is Oligo-asthenotterozoospermia (OAT). Fertilization failure after in vitro fertilization (IVF).
2. Ejaculation dysfunctions. Sperm from the epididymis. Congenital aplasia of the seminal vesicle. Failed resection of the seminal vesicle. Occlusion of ejaculatory pores.
3. Sperm from the testicle. Azoospermia due to inhibition of sperm maturation, testicular dysfunction or genetic factors, necrospermia.
For each ICSI attempt only a few sperm are needed and a single biopsy can give enough for cryopreservation, in multiple tubes, to avoid repeated operations for future microfertilization efforts.
Azoospermia, testicular biopsy and in vitro fertilization
About 1% of men in the general population and 10% of men who undergo a fertility test do not have sperm in the seminal fluid (azoospermia). Today, men with azoospermia can now have their own biological offspring with the help of testicular biopsy and in vitro fertilization with ICSI.
Testicular biopsy
Once azoospermia is detected and confirmed, a careful examination by a specialist urologist and / or endocrinologist follows, in order to determine the possible causes and its treatment. In most cases of azoospermia, a testicular biopsy remains the only test that will show whether or not there are sperm in the testicles. Since sperm are present in the biopsy they can only be used for IVF (in vitro fertilization) with microfertilization (ICSI) and not for insemination or simple IVF due to the low motility of the sperm coming from the testicular tissue and the absence of processes and occurring in the epididymis.
The testicular biopsy technique is applied only by a specialist urologist who selects the appropriate method. It can be done the same or the day before the egg collection or before, in order to freeze the sperm and use it in the future. In the past, testicular biopsy had only diagnostic value to rule out the possibility of male fertility or to find the cause of azoospermia. As soon as it is possible to use the sperm taken from the testicle in in vitro fertilization, microfertilization (ICSI), the biopsy becomes therapeutic.
Based on current data, the testicular biopsy is performed by taking multiple tissue samples from different areas of both testicles, as well as the possibility of direct microscopic observation by a specialized embryologist and cryopreservation of the tissue in case of presence of sperm.
Writes:
Eleni Kontogianni Clinical Embryologist
Scientific Associate of the HYGEIA IVF Embryogenesis Unit
Follow Skai.gr on Google News
and be the first to know all the news
.
