Last week we discussed artificial insemination.  This week we will discuss intracytoplasmic sperm injection (ICSI) for the treatment of severe male factor infertility.  ICSI has been a tremendous benefit to assisted reproductive technologies for over a decade and has revolutionized the treatment for couples who have severe male infertility.

One severe male factor that requires the use of  ICSI is severe oligospermia (total sperm count < 5 million).  When there is a severely low amount of sperm available, the chance of fertilization of the egg becomes extremely low.  As a result, an assisted fertilization technique called intracytoplasmic sperm injection (ICSI) must be employed.

With ‘conventional’ IVF, processed sperm is combined with the eggs, and the sperm naturally swim up to and penetrate the egg.  In the ICSI procedure, the embryologist sifts through the sperm specimen to identify a single healthy appearing sperm.  This single healthy sperm is gently drawn into a pipette.  The egg is stabilized.  The embryologist then skillfully pierces the shell of the egg with the pipette and the sperm is injected directly into the interior of the egg.  This effectively leads to fertilization of the egg.

Here are some photos of Intracytoplasmic Sperm Injection (ICSI):

Prior to the development and advancement of ICSI, it would not be unusual for a couple with severe male factor to have very poor or absent fertilization with conventional IVF.  Now couples with severe male factor often have equivalent pregnancy rates to couples without a male factor.

Some other severe male factor conditions requiring ICSI include:

1.  Men with a very poor semen analysis,  which may include a low concentration, poor motility, or poor morphology (shapes of the sperm).

2.  Men who produce sperm in low quantity and have absence of sperm in the ejaculate. They require a testicular biopsy to obtain sperm that can be used for the IVF/ICSI cycle. Some men who have had certain types of chemotherapy may have compromised sperm production and are in this category.

3.  Men who have had vasectomies. If a man has had a vasectomy and does not wish to have a reversal, a testicular or epididymal biopsy can be done to obtain sperm that can then be used for IVF/ICSI.

4.  Couples who have had poor fertilization with ‘conventional’ IVF on a previous cycle.

5.  Men who produce sperm, but are born without a vas deferens (part of the outflow tract). These men will require either a testicular or epididymal biopsy to retrieve their sperm and then use ICSI to ensure fertilization.

For more information about ICSI, is available on our Dallas IVF website.

Next week we will discuss the IVF process.

Lowell T. Ku, M.D. is a Reproductive Endocrinology and Infertility specialist at Dallas IVF and clarifies the many confusing terms used in the world of Infertility therapy using straightforward explanations.

Source:  Speroff L, Fritz MA, Clinical Gynecologic Endocrinology and Infertility , 7th ed. Philadelphia: Lippincott Williams & Wilkins, 2005: 1236-37.

Hello to all, it’s Thursday’s with Sharon. Summer is here and the Attain® IVF Call Center is busy, busy, busy!

Today I want to talk about callers we frequently speak with who are hesitating to take the next step and make their first appointment with a fertility specialist. Some have been trying for 6 months and others much longer. Just how long one is willing to wait is a personal choice. There are many factors we hear, including the concerns, questions, fear of the unknown and how much is this going to cost. Sometimes people even self-diagnosis themselves with checklists found on the Internet. (yikes!)

Admitting there’s an issue isn’t easy and takes courage no matter how long you have been trying. This first step is probably one of the most difficult to take. It’s never too early to seek help and address your concerns with a professional and will bring you one step closer to realizing your dream of having a child.

So let’s take that leap and schedule an appointment to get some answers. Please call us at the Attain IVF Call Center at 1-866-968-7483 and we will assist you with scheduling your first appointment. Remember, we are as committed to building your family as you are.

Until next time, all my best.

Last week we discussed the parameters for a normal and abnormal sperm count.  This week we will discuss the main option of therapy when oligospermia (sperm count < 20 million sperm / mL) is discovered.

Artificial insemination (also known as IUI) is an accepted form of treatment for oligospermia.  According to the textbook Clinical Gynecologic Endocrinology and Infertility, IUI has been used to treat infertile couples for almost 200 years.¹ IUI is the placement of sperm past the cervix and into the uterine cavity via a small catheter.  In general, an insemination is quick, painless, and is performed in the office.

The uterus can only accommodate a small amount of fluid.  Thus, prior to an IUI, the husband’s sperm is concentrated into a smaller volume by removing seminal plasma.  The resultant concentrated sperm is also known as “washed” sperm.  IUI with sperm concentrate delivers most of the sperm ejaculate to the upper female genital tract.

The sperm count and morphology play important roles in the success rate of an IUI.  The probability of successful IUI increases when the total motile sperm count exceeds 10 million and the normal morphology exceeds 14%.^{2, 3}

A large study in the New England Journal of Medicine suggested that the conception rate is as high as 10% when IUI is performed using infertile partner sperm.⁴ This study further proved that the success rate of an IUI can be increased when more eggs are developed through the administration of medications prior to the IUI.⁴

If the sperm count reveals severe oligospermia (less than 5 million sperm / mL), IUI may not prove to be a successful option for therapy.  In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an accepted form of treatment for severe oligospermia.

In next week’s installment of Terminology Tuesdays, we will discuss ICSI for severe male factor infertility.

1. Speroff L, Fritz MA, Clinical Gynecologic Endocrinology and Infertility , 7th ed. Philadelphia: Lippincott Williams & Wilkins, 1156, 2005.
2. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J, Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization, Fertil Steril 75:661, 2001.
3. Lee RK, Hou JW, Ho HY, Hwu YM, Lin HM, Tsai YC, Su JT, Sperm morphology analysis using strict criteria as a prognostic factor in intrauterine insemination Int J Andrology 25:277, 2002.
4. Guzic DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, Hill JA, Mastroianni L, Jr., Buster JE, Nakajima ST, Vogel DL, Canfield RE, for the National Cooperative Reproductive Medicine Network, Efficacy of superovulation and intrauterine insemination in the treatment of infertility, New Engl J Med 340;177, 1999.

Today Paula Dwan, RNC, MS, NP, Clinical Services Manager at Reproductive Science Center of New England is guest blogging on what you should know about gardening safety and treating seasonal allergies while preparing for pregnancy.

Gardening: A variety of bacteria and parasites can be found in soil and they can be harmful to a pregnancy. If you want to participate in gardening or plan to consume vegetables fresh from the garden or a farmers’ market, follow these guidelines

• Wearing gloves while gardening should protect you from contracting these bacteria and/or parasites.
• Vigorously wash your hands with soap and water after any exposure to soil or unwashed vegetables.
• Thoroughly wash and/or peel all fruits and vegetables before eating them.

Over-the-counter medications for seasonal allergies

It’s that time of year and allergies are prevalent. It is a good idea to minimize taking any medications during pregnancy or while you are attempting pregnancy. However, the following medications are considered relatively safe when taken according to package instructions:

• Benadryl
• Claritin
• Zyrtec

Products that have a ‘D’ after the product name should be avoided (for example, Claritin-D, Zyrtec-D). These may contain ingredients that are not considered safe during pregnancy. (The ‘D’ stands for decongestant, meaning the medication contains pseudoephedrine, which influences the human central nervous system. It is commonly recommended that pseudoephedrine should be avoided during the first trimester of pregnancy).

Sources: The National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention