Choosing a Method of Fertilization
Classic Method of Fertilization
If the results of the semen analysis, post coital test (PCT) and function tests (TW and IBT) are in order, and the couple does not manage to conceive naturally, the physician often recommends the classic IVF (joint co-incubation of gametes in a small space in a special medium).
ICSI (Intracytoplasmic Sperm Injection)
If the man was diagnosed with a low sperm count, low motility or morphology, the classic IVF may not be effective. In these cases it is suitable to use the ICSI method (Intracytoplasmic Sperm Injection), in which the embryologist selects one suitable sperm and inserts it into an egg. An alternative to this method is the PICSI method, which can be recommended to you if there is a lot of sperm with fragmented DNA in the ejaculate. In this method, the embroylogist selects the sperm according to the visual assessment and their functional quality.
The advantage of the PISCI method is an objective selection of sperm according to its functional quality. It is important to realize, the selected sperm is essentially the same as one that would be successful in the natural reproductive process in the woman’s body. When an embryologist selects the sperm only by visual observation, defects such as immature sperm, chromosomal aneuploidies or DNA damage cannot be detected. So, if we suspect that there may be sperm with such defects in the spermatoza, it is recommended to fertilize eggs by using the PICSI method.
Sanatorium Helios has had several years experience with the PICSI method and therefore a doctor may recommend to you this method, especially when a man has been diagnosed with a higher rate of damaged DNA sperm, a woman undergoing the IVF treatment is over 38, the ICSI method has failed in some of the previous cycles (concerning the egg fertilization or further development of embryos) or the couple have had a history of repeated miscarriages.
Selection of sperm using MACS (Magnetic Activated Cell Sorting)
The MACS method allows us to adjust the sperm sample to increase the chances of successful fertilization with any assisted reproduction method. MACS catches sperm with damaged DNA, they are removed. The sperms that pass through this selection have better properties than the original sample.
In the IMSI (Intracytoplasmic Morphologically selected Sperm Injection) method, high magnification (>6000 ×) is used for a thorough morphological selection of the sperm to be injected into the egg (ICSI). (read more)
If there is no sperm in the ejaculate (azoospermia), it is possible to try to obtain the sperm by surgical retrieval. If the transport of sperm between the urethra and the epididymis fails, sperm can be obtained with the MESA technique (micro epididymal sperm aspiration), in which sperm is aspirated from the epididymis.
If the transport of sperm to the epididymis fails, we opt for the TESE technique (testicular sperm extraction) in which a small piece of germinal epithelium is removed. The removed tissue is then processed in the laboratory, and if live sperm are obtained, they can be used for fertilization by the ICSI technique.