The wonders of intracytoplasmic sperm injection
Intracytoplasmic sperm injection (ICSI) has revolutionized the treatment of male-factor infertility. It allows men who were previously incapable of producing adequate sperm to father genetically related children.
ICSI involves the placement of a single sperm directly into the egg using a microscopic pipette. Men normally produce millions of sperm in each ejaculate. These sperm “swim” through the cervical opening and into the tubes to the site of fertilization. Some men have sperm defects such as a reduced sperm count, deformed sperm or sperm that cannot swim effectively. When any one of these abnormalities is present it can prevent normal fertilization.
ICSI bypasses sperm defects because our team selects a single sperm and places it inside the egg. ICSI is a part of the IVF cycle. During IVF, a doctor retrieves the eggs from the ovaries and takes them to the embryology laboratory. In ICSI, experts use a stereomicroscope to manipulate the egg(s). They hold the egg in place while puncturing it by the micropipette and then insert the sperm.
IVF/ICSI is for cases of severe male factor infertility and failed fertilization in previous cycles.
You can conceive with intracystoplasmic sperm injection after a vasectomy
Couples have the option of a vasectomy reversal or IVF-ICSI with epididymal or testicular sperm extraction. Age of the female partner and length of time since prior vasectomy are important factors in decision-making. It can sometimes take 6-9 months to recover adequate sperm counts following vasectomy reversal. Also, the greater the length of time between the vasectomy and the reversal, the greater the chances are that the surgery will be unsuccessful or that anti-sperm antibodies will form, preventing the recovered sperm from penetrating the eggs without IVF-ICSI.
Testicular sperm extraction (TESE)
A TESE is a procedure that involves directly aspirating the sperm from the testes or obtaining sperm from a testicular biopsy. We perform this procedure while the patient receives a local anesthesia block. Our team can do it as an in-office surgical procedure. The disadvantage is that in many cases, testicular sperm is much more scarce and therefore difficult to freeze. Usually, there is only enough sperm for one IVF procedure. If we need further IVF attempts, we will need to repeat the TESE procedure.
Microsurgical epididymal sperm aspiration (MESA)
With a MESA procedure, we make an incision is made in the scrotum, exposing the epididymis, the tubules immediately adjacent to the testicles that collect the sperm. Using an operating microscope, we make an incision into these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique.
The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if his partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures. Contact us to learn more.