New Hope For Male Infertility
There was a time when infertility was "the woman's fault," and men were erroneously left out of the equation. Thankfully, in recent times, things have changed and with the aid of advanced testing techniques, it is now possible for formerly infertile men to father children. With the use of such techniques as TESE (testicular sperm extraction), men who were faced with infertility as a result of primary testicular failure, congenital absence of the vas deferens, or non-reconstructed vasectomy or damage from chemo-therapy, now have hope of conceiving their own biological child.
IVF, TESE, And ICSI
Intracytoplasmic sperm injection (ICSI-pronounced "eeksee or "icksy") is a type of in vitro fertilization procedure that is done under a microscope using a variety of micromanipulation tools to accomplish fertilization of the egg by a single sperm. Similar to conventional IVF in that the sperm and eggs are collected from each other, the actual method of fertilization is very different. With conventional IVF, the eggs and sperm are mixed together in a dish and the sperm fertilizes the egg in a natural way, by penetrating the egg. However, in order for this to happen, there has to be a large number of actively motile sperm. When the sperm count in the man is very low or the motility of the sperm is poor, TESE may be necessary to retrieve sperm for IVF. ICSI is also used if there are high levels of antibodies in the semen or when there has been a previous failure of fertilization using conventional IVF.
ICSI does not require a large number of sperm nor does it require the sperm to penetrate the egg by itself. Experienced embryologists using special equipment carry out ICSI, a laboratory procedure wherein a single sperm is picked up with a fine glass needle and injected directly into a mature egg. The egg is held steady using a holding pipette with gentle suction and, from the opposite side of the egg a thin, hollow glass micropipette is used to collect a single sperm. The micropipette is used to pierce through the egg into the cytoplasm and the sperm is then released into the egg. After this procedure, the egg is placed in a cell culture and monitored through the next day for signs of fertilization.
Natural or Artificial Selection?
In natural fertilization, the sperm compete for placement and the first one to get to the egg and penetrate it is the one that will fertilize the egg. After there is penetration by the sperm into the egg, the outside of the egg hardens to prevent the entry of other sperm. There has been some concern raised that the natural selection of strong sperm arriving and penetrating the egg has been bypassed, having been replaced with the selection of a sperm by an embryologist without any type of specific testing of the sperm. This concern has been assuaged with the use of a test where the sperm is placed on a microdot of hyaluronan hydrogel, the main constituent of the gel layer of the egg. If the sperm binds to the hyaluronan, it is indicative of mature sperm with fewer DNA strand breaks and low levels of aneuploidy.
Success varies between patients and also according to the age of the woman. However, about 25 percent of patients will have a baby after one attempt of ICSI.