Intracytoplasmic Sperm Injection (ICSI)
Male factor infertility results when the sperm count is extremely low or the sperm quality is very poor. It is a common reason couples present for treatment; around 40% of infertility cases are attributed to male factor. When there is no reason for poor semen parameters identified, which is usually the case, there is no treatment that can be recommended to normalize semen parameters when male factor infertility is unexplained. Lifestyle changes may help to improve sperm quality, such as increasing exercise, improving one's diet, eliminating obesity and quitting smoking and/or use of recreational drugs. No vitamins or supplements have been shown to reverse male factor infertility, though some may offer general health benefits.
Conventional IVF without ICSI, it turns out, often ends in disappointing results for patients experiencing male factor infertility, such as no fertilization of eggs or a low percentage of eggs fertilized in vitro, with no or few embryos available for transfer. Until the 1990s, the only available treatment was the use of donor sperm. With the development of ICSI in Belgium, a powerful tool became available for what had been an intractable problem. IVF with ICSI is the best treatment for male factor infertility and has been employed at FIRST for almost two decades, so we've had vast experience with this technique! And IVF/ICSI is always necessary when sperm is obtained by surgical means (see below).
The steps leading to ICSI are identical to IVF until just after the eggs are retrieved. Instead of mixing the sperm and eggs in a dish and waiting for fertilization to occur naturally, individual eggs are isolated and, with the use of sophisticated micromanipulation techniques, a single sperm is injected into each normally formed, mature egg. The fertilized eggs resulting from the ICSI procedure, identified 24 hours later, are then incubated as in IVF until they are ready for transfer. Note that not all eggs subjected to ICSI will necessarily fertilize.
Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration/Extraction (TESA/E)
Some men have no sperm in their semen because of vasectomy, previous infection or trauma, or a congenital defect. In such instances, sperm may be obtained by extracting it through a needle placed in the testicle or epididymis under local anesthesia. Sometimes, the scrotum is opened surgically, and a small piece of testicular tissue is excised in an attempt to obtain sperm. Sperm obtained by these means must be used in conjunction with ICSI because such sperm cells are too immature to fertilize eggs on their own.
We do not perform these procedures at FIRST, but we do collaborate closely with specialists who have extensive experience with surgical sperm extraction.