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What to do if the spermogram has rather disappointing indicators, and the spermatozoa are simply not able to fertilize the oocytes on their own?
We must not despair, but resort to an alternative and effective method – the introduction of spermatozoa into the oocyte (intracytoplasmic injection of spermatozoa into the oocyte).
The introduction of spermatozoa into the oocyte is a procedure that involves the artificial introduction of a spermatozoon into the cytoplasm of an already mature egg for its fertilization. This technique has been successfully used since the 90s and allows to solve most of the couple’s infertility problems due to the male factor. According to statistics, the success of fertilization is 70-80 percent.
Who is recommended for the procedure?
The procedure for introducing a spermatozoon into the oocyte is recommended for couples who, as a result of IVF, did not have the desired pregnancy, for men who have a pathological change in sperm, as a result, there is a decrease in the likelihood of successful fertilization during IVF.
The procedure should also be used by men with a complete absence of spermatozoa in the ejaculate (azoospermia), as well as in the case when cryopreserved sperm with an unsatisfactory number of “live” spermatozoa is used. The method is also used by patients with severe endometriosis or infertility of unknown origin.
Advantages and disadvantages
The introduction of spermatozoa into the oocyte provides a couple with a chance to consider their own genetic child when other fertility treatments have failed. If the partner is unable to ejaculate on the day of collection for standard IVF, sperm can be retrieved for ICSI instead, which is also an undeniable advantage of the procedure.
Oocyte sperm injection can also be used to help some couples with unexplained infertility without ICSI affecting the mental or physical development of the unborn child.
Unfortunately, the introduction of spermatozoa into the oocyte is a more expensive procedure than IVF. In addition, ICSI is considered a young procedure, truly unexplored by doctors. It has the risk of developing an ectopic or multiple pregnancy, and the risk of developing neonatal infections (eg, hypospadias in boys) is also increased.
The fertilization rate for injecting sperm into the oocyte may be higher than with conventional IVF methods, but the pregnancy rate with ICSI is the same as the pregnancy rate with IVF:
- 44% for a couple from 18 to 34 years old;
- 39% for a couple from 35 to 37 years old;
- 30% for a couple from 38 to 39 years old;
- 21% for a couple from 40 to 42 years old;
- 11% for a couple from 43 to 44 years old;
- 2% for a couple over 45 years old.
How is the procedure carried out
As with standard IVF treatment, fertility drugs will be needed to stimulate the ovaries in order to develop multiple mature eggs for further fertilization. The doctor usually uses an ultrasound and sometimes blood tests to monitor this stage of treatment.
A man will need to masturbate to collect the ejaculant in a special bowl. This procedure is carried out when the woman’s egg is as mature as possible. In the event that there are no spermatozoa in the semen sample obtained or the man has failed to ejaculate, the doctor may collect eggs using a thin needle: the epididymis, in a procedure known as percutaneous epididymo sperm aspiration (PESA), or the testis, in a procedure known as aspiration testicular testis (TESA). This is usually done under local anesthesia so the man will not feel any pain.
If these methods also do not allow you to collect sperm, the doctor may prescribe a biopsy of testicular tissue, which sometimes has attached sperm. The method is called testicular extract (TESE) or micro-TESE if the operation is performed under a microscope. The procedure is usually performed under general anesthesia.
For practical reasons, surgical retrieval of sperm from the epididymis or testis is often performed prior to the start of the treatment cycle. The retrieved sperm is frozen.
From a woman, the egg is taken using a thin, hollow needle attached to an ultrasound probe. In order to prepare the uterus for replanting an already fertilized egg, a woman is prescribed progesterone. After egg retrieval, a woman may feel depressed, exhausted, and there may also be light bleeding.
Meanwhile, the embryologist isolates the individual sperm in the lab and injects it into the egg. A day later, the fertilized eggs will become embryos. Further, the procedure is the same as in IVF. The doctor will transfer one or two embryos into the uterus through the cervix using a thin catheter (tube), usually under the supervision of an ultrasound.
Embryos can stay in the lab for up to six days, but can be transferred two to three days or five days after fertilization. If transferred after five days, the embryo will be at the blastocyst stage.
If there is only one embryo transferred, transferring the blastocyst transplant may improve the chances of the procedure being successful and getting pregnant. The maximum number of embryos that can be transferred into the uterus is two.
If all goes well, the embryo will be attached to the uterine wall and continue to grow. After about two weeks, it will be necessary to conduct a pregnancy test and visit a doctor to ascertain the presence of pregnancy and the normal development of the fetus. One ICSI cycle takes four to six weeks. A couple can spend half a day at the clinic for egg and sperm retrieval procedures.
Risks of introducing spermatozoa into the oocyte
Many experts express their concerns about the ICSI procedure. One of the fears is the possibility of fertilization of a defective egg (during IVF, the use of a defective egg is minimized). The second concern is the development in children of genetic diseases associated with a violation of the X and Y chromosomes. According to preliminary statistics, Shereshevsky-Turner syndrome is observed in one percent of children. Usually, all genetic changes in a child are associated either with a defect in the egg or with low sperm quality in men. Male infertility can cause the development of the following pathologies: cystic fibrosis, Y chromosome defect (Rett syndrome), Klinefelter syndrome, etc.