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.

Last week many of our physicians, lab directors and scientists met for the annual C.O.P.S. leaders conference. We sent out a press release about the event that I’ve included here. I thought you’d find it interesting reading. Enjoy!

The Council of Physicians and Scientists (C.O.P.S.), an invitation-only event sponsored by IntegraMed (integramed.com), concluded their annual conference on Saturday, May 1 following three full days of discussion about the emerging technologies and trends in fertility care. More than 100 reproductive endocrinologists, lab directors and scientists attended the 16^th annual conference which was held in Dallas, Texas.

“We are proud to be in our sixteenth year with C.O.P.S.” said Joe Travia, C.O.P.S. Vice Chairman and Senior Vice President, Eastern Region for IntegraMed Fertility. “By bringing together the nation’s thought-leaders in reproductive endocrinology, we remain on the forefront of advancements that support our commitment to provide patients the best possible fertility care and treatment options at our IntegraMed Fertility centers.”

C.O.P.S. is co-chaired by Dr. John A. Schnorr, of the Southeastern Fertility Center, located near Charleston, SC. “This year we focused on three transformational technologies and topics that we are confident will positively impact the future of fertility,” said Dr. Schnorr.

The three trends in fertility treatment are:

• Improved pregnancy rates with decreased multiple rates through metabolomics. With metabolomics, embryo quality can now be evaluated non-invasively to more accurately measure their quality. In doing so, only the most viable embryo needs to be transplanted rather than multiple embryos, thus improving pregnancy rates while significantly reducing the instances of multiples through in vitro fertilization (IVF).

• Use of vitrification technology to successfully freeze eggs. One of the most exciting and long-awaited advances in fertility preservation is the ability to successfully freeze eggs via a technology called vitrification. Through vitrification, eggs are plunged in liquid nitrogen and instantly frozen, ensuring that this largely water-based cell does not form crystals that would expand and disrupt the egg’s membrane.

Dr. Schnorr predicts that within the next three to four years about 25 percent of all fertility preservation will utilize vitrification.

• Improvement in the evaluation and treatment of severe male-factor infertility.

Today 40 percent of infertility problems are attributed to the man. Procedures to improve the evaluation, risk assessment and treatment of severe male-factor infertility were discussed.

“C.O.P.S. embraces the spirit of collaboration and the exchange of ideas. Collectively we can accomplish more than we would ever be able to achieve individually,” concluded Dr. Schnorr. “That’s what C.O.P.S. is all about.”

We have a not-so-little project we’ve been working on these last few months – called the Free Fertility Check^TM – and are very excited (and proud) to launch it during National Infertility Awareness Week. Free Fertility Check is an interactive infertility assessment tool that helps women determine whether they meet the clinical definition of being infertile and should see a fertility specialist.

Click on the “Start” button below to see what your results are.

According to the American Society for Reproductive Medicine (ASRM) approximately 7.3 million women and their partners are facing fertility issues. Residing on its own website, www.freefertilitycheck.com, and featured on www.Attainfertilty.com, Free Fertility Check was designed and reviewed by fertility experts as an educational tool to assist these people.

We understand there are many questions and unknowns on the path to conception, the sooner issues are identified and addressed, the sooner women can be on track towards having a baby.  While nothing is as important as seeking professional care from a fertility specialist, we hope that Free Fertility Check will support women in seeking that care.

With a few clicks of the mouse, women can answer a brief assessment and receive recommendations. Should an issue be identified, information and referrals to Attain Network Fertility centers are available.

For those who are not by definition infertile, Free Fertility Check provides helpful lifestyle information about how woman can improve their chance for success and identify when they may need to see a specialist later on. Among the issues the assessment addresses are:

• Weight/BMI and fertility
• Smoking
• The connection between age and fertility
• Pre-existing medical conditions that may indicate the need to consult a fertility specialist

After taking the assessment, you’ll receive a personalized email with specific information and recommendations based on your responses.

Our hope is that this information is useful and actionable and helps you along the path to parenthood. We’re committed to your success!

NIAW is an acronyn for National Infertility Awareness Week.  NIAW is a movement to raise awareness about the disease of infertility which affects 7.3 million Americans.  Join the movement! NIAW runs from April 24 – May 1 this year.

Infertility is the inability to conceive;  a woman’s fertility declines naturally with age.  It is recommended that you consult a fertility specialist if

• You’re 35 years old and have been actively trying to conceive for more than a year, or
• You’re over 35 years old and have been actively trying to conceive for more than 6 months.

Infertility may be defined as primary or secondary.

• Primary infertility – couples who have never been able to become pregnant after at least one year of unprotected intercourse.
• Secondary infertility – couples who have been pregnant at least once but have not been able to become pregnant again.

We recently had the opportunity to catch up with Barbara Collura; Executive Director of RESOLVE as plans for National Infertility Awareness Week were underway. Barbara took a few minutes to tell us about their important works.

What is RESOLVE?

We are the largest non-profit dedicated to improving the lives of women and men diagnosed with infertility during their family building journey. Since 1974, RESOLVE has provided compassionate support and educational programs while being the voice that represents people with infertility.

What is National Infertility Awareness Week?

Part of RESOLVE’s public education efforts includes a week dedicated to working with RESOLVE volunteers, professional members,  corporate partners, and the media to share important facts and personal stories so that the public understands that people with the disease of infertility matter.  National Infertility Awareness Week® (NIAW) started in 1989 and has turned into the largest movement dedicated to the disease of infertility.

Why NIAW?

NIAW is a chance for the entire infertility community and those that support us, to come together to provide others with information on how to take charge of their family building and shed the isolation they feel when they are wishing for a baby and it’s not happening as quickly has they had planned.

If there’s one thing you would like men and women to get out of NIAW, what would that be?

Our message: Take Charge. It translates no matter where you are in your family building journey. We invite you to take this message, make it your own, and help us spread the word. National Infertility Awareness Week is a movement that needs every one of us.

Resolve, along with some of our clinics, have some great programs going on this week to support NIAW. Check out the Attain Fertility Facebook page and go to the Events tab to see which ones might be right for you!