Sperm can be retrieved directly from the testis rather than from the ejaculate. These procedures are often called TESA (testicular sperm aspiration), TESE (testicular sperm extraction) or PESA (percutaneous epididymal sperm aspiration) or Micro-TESE.
Why would surgical sperm recovery be performed?
The most common reason is because sperm are not present in the ejaculate. This can be because the vas deferens (the tube which carries sperm from the testis) can be blocked due to a vasectomy or if the man is a carrier of the genes for cystic fibrosis. Sometimes the sperm are present in the testis in very low quantities and are not seen in the ejaculate.
How is the sperm extracted?
There are two ways in which sperm can be extracted. If the sperm is blocked, there are generally abundant in the testis and can be extracted by passing a fine needle into part of the testis (the epididymis at the top of the testis) or the testis itself. These procedures are performed under local anaesthetic.
Sometimes sperm are produced in very low amounts in the testis and cannot be ejaculated. In these cases a technique called micro-TESE can be performed. This is performed under general anaesthetic by a surgeon (usually a urologist) using an operating microscope. A scientist takes samples and seeks live sperm in the samples removed from the testis. This is highly skilled work which takes a long time.
How are the sperm used?
Sperm obtained through TESE and micro-TESE can be used directly if there’re fresh or frozen oocytes (eggs) available or sperm can be frozen. Fertilization of the eggs is by injecting the sperm directly in the eggs in a procedure called intracytoplasmic sperm injection (ICSI).
Are there any risks?
These procedures can be painful. Rarely bleeding may occur and long-term damage to the testis causing hormone deficiency may occur. Men who have reduced testicular production of sperm are at risk of developing hormonal deficiency.
Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) is a sperm injection (ICSI) of a specially selected single sperm directly into the mature egg. IMSI is a new and relatively unstudied technique. Sperm often have have abnormally shaped heads and often have vacuoles (cavities) and it is believed that these abnormal sperm are less likely to carry normal genetic material. IMSI use high power magnification to identify these abnormalities of sperm, therefore select the most normal looking sperm. Because sperm are so tiny compared to the egg, special high power magnification is required.
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| Standard ICSI (approximately 200x magnification | IMSI (approximately 6000x magnification |
Who is IMSI for?
This is a treatment option if the male has
- poor sperm motility
- poor sperm morphology
- a low sperm count
- surgically recovered sperm.
What are the steps involved in the IMSI procedure?
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A fresh or frozen semen sample is prepared on the day of the procedure by an embryologist
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Under a microscope, an embryologist specially trained in the IMSI and ICSI technique, selects a single sperm for injection.
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As with routine ICSI after the egg collection, the eggs are washed and examined to determine which eggs are mature enough for injection.
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Using a fine glass needle the sperm is aspirated and then injected into the selected egg.
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The injected eggs are cultured in labelled sterile culture dishes in an incubator overnight.
What are the risks of IMSI?
It is not known if there are risks of IMSI over and above those known from ICSI.
What are the risks of ICSI?
The first live birth following ICSI was reported in 1992 and therefore it is a relatively new technology.
The procedure is associated with irreparable damage to the eggs in approximately 5%‐ 10% of eggs injected and these eggs do not fertilise.
Children resulting from the ICSI procedure have an increased risk of a sex chromosomal abnormality of 1:100 compared to a risk of 1:400 of children who are spontaneously conceived. The manifestations of sex chromosomal abnormalities are variable but may include infertility and reduced intelligence.
Some but not all studies have shown higher birth defects in ICSI children particularly genital abnormalities. Up to 6% of ICSI children may have a defect at birth compared to 3% in naturally conceived children. It is not certain if these abnormalities are genetically determined as fathers with these conditions are more likely to need ICSI or whether the procedure of ICSI contributes to the birth defects. 93% of children born after ICSI are healthy at birth.
ICSI is a more expensive procedure than IVF and should only be performed instead of IVF when necessary. However very many children are conceived using ICSI in Australia and around the world.
GM-CSF (granulocyte macrophage colony stimulating factor), also known as Embryo Gen, is an additive to embryo culture media. Embryos are cultured in a nutrient solution made by Origio which contains a genetically engineered form of GM-CSF made from yeast culture system from fertilisation until day 3 of development.
What is the success rate of using GM-CSF?
GM-CSF has been used in over a thousand couple cycles and has shown an increase in live birth rate compared to couples who used standard culture media. Birth abnormalities were not significantly higher in the babies which resulted from the use of culture media containing GM-CSF. Benefit beyond day 3 of culture has not yet been demonstrated.
What are the potential risks?
The risks of this procedure relate to the fact that it has only been studied recently and less than 500 babies have resulted from its use. None of these children have been followed in early childhood, later childhood and adult life. There have been no long-term adverse effects on the mother sought or reported.
What are the costs?
To use Origio GM-CSF incurs extra cost. Contact us for the current price.
The EmbryoScope is designed to capture more information about your embryos, so that we can identify those that have the most potential for success. Our scientists use a type of special incubator, a high resolution time-lapse camera and a computer with software to monitor embryo development. This technology takes an image approximately every 7 minutes, allowing scientists to carefully monitor an embryo’s development whilst in the incubator.
What’s the difference between standard culture and Embryoscope?
When embryos are developed in our laboratory in a standard culture incubator, they are typically removed from the incubator around four or five times, so we can assess how they are growing and changing. This involves removing them from the incubator.
The EmbryoScope and its time-lapse video enables our scientists to carry out these crucial assessments without removing the embryos from the incubator.
Who is Embryoscope suited for?
Embryoscope is suitable for every patient , however it’s morevaluable for patients who have had previous failed cycles of IVF or ICSI.
What are the benefits to Embryoscope?
- The Embryoscope allows more frequent imaging therefore more information about the crucial early developments
- Anomalies can be shown in Embryoscope that may not be visible during standard embryo culture
- The images allow our scientists to collate and build up data relating to the precise timing of specific developmental milestones that we expect to see in good embryos, helping us to identify the embryos with the highest potential for pregnancy. You’ll receive a document of the key stages of development once we have identified which of your embryos is most suitable for transfer
What are the risks involved?
There are no extra risks involved in using Time-lapse imaging to monitor your embryos. However, it is important to realise that because the EmbryoScope gives our scientists such highly-detailed information, it may mean that the information gathered may suggest that there are fewer or no embryos suitable for transfer or freezing.
What are the number of embryos that can be developed in the EmbryoScope?
Your EmbryoScope slot has the capacity to culture up to 12 eggs or embryos.
When do Care Fertility collect the eggs for EmbyroScope?
If you have ICSI, your eggs are placed in the EmbryoScope after the ICSI procedure so actual fertilisation can be observed. If you have IVF, your embryos are placed in the EmbryoScope after they have been checked for fertilization the day after egg collection. This is because the cells surrounding your embryo have to be removed for the camera to have a clear view of its development.
Preimplantation genetic testing (PGT) is a technique in which a sample of the cells of the embryo are removed and the genetic composition of the embryo determined by complex gene analysis called next generation sequencing.
Who gets PGT?
PGT is often performed in couples who are at risk of having embryos with a chromosomal imbalance or genetic abnormality which may lead to disease. This may be because of their individual genetic makeup, their age or their past history.
What are the risks?
PGT is a new technology and data on the long term health of the children is not known. Preliminary data of the children is however reassuring. There is a small risk that the embryo may not survive the biopsy.
As with any diagnostic test, errors can occur but these are uncommon. Sometimes the genetic code cannot reliably be analysed and the biopsy is indeterminate.
What is the process?
- Biopsy is often performed on Day 5 and both embryos and biopsy are then frozen. Sometimes embryos do not develop until Day 5 and this particularly occurs when only a few eggs can be collected from the female.
- Biopsies are kept until they can be analysed as a group as this keeps the costs of the analysis as low as possible.
- When we get the biopsy results the uterus of the woman is prepared for embryo transfer and the normal embryo is transferred to the uterus. Not all normal embryos will result in the establishment of a pregnancy. This could be because the process of warming the embryo, the uterine environment and other factors which are as yet unknown. Pregnancy rates from embryos that have been screened genetically is generally higher than embryos which have not been screened.
Sometimes it is difficult to determine the best embryo to transfer and this is discussed with your doctor when the results are available.
Using PGT to select for gender except when serious medical conditions may be transmitted is not allowed in Australia.
