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IUI

ICSI

TESE


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Sperm and Infertility - IUI and ICSI

All therapies that try to compensate for a sperm problems, do so by getting more sperm to the egg. The more technology you use, the more control you have over the process. Almost any male factor problem can be effectively treated today.

IUI

IUI or intrauterine insemination is a procedure that involves preparing the sperm for placement directly in the uterus. (An older term is artificial insemination.) Sperm is a small drop of the material in an ejaculate. Since semen contains large quantities of prostaglandins, the sperm must be removed from the semen before placement in the uterus. Prostaglandins can cause violent contractions, nausea and vomiting, and diarrhea if placed directly in the uterus. Most separation techniques utilize sperm motility in part for separation from the semen. The separated sperm are both more motile and more normally shaped than those found in the semen. All separation techniques loose some motile sperm. Between 10 and 30% of the motile sperm in the ejaculate are likely to be captured after separation. Older separation techniques (simple wash) damaged the sperm and are hopefully abandoned.

From a sperm viewpoint, getting pregnant either naturally or with IUI is a probabilistic event. Pregnancy is likely to occur more quickly when many sperm are available. We recommend IUI only when we expect to be able to harvest at least 10 million motile sperm from the ejaculate for use in IUI. IUI can clearly be done with fewer sperm, but pregnancies are then quite rare and IVF is usually a better use of your resources. When we reviewed our IUI results after our first five years in practice, we found that virtually all of our pregnancies had occurred in patients who had an IUI containing at least 20 million motile sperm. Some of these patients had much lower IUI yields in the cycles before they got pregnant. The variation in sperm counts from time to time can be helpful.

Although IUI is a simple procedure for a practice providing procedures as complex as IVF and ICSI, the thought of any procedure can be intimidating to the patient who is facing it for the first time. Like most infertility treatments, the scariest part about IUIs is whether or not it will work to help make a baby. For some patients, it helps to http://www.fertilityplus.org/faq/iui.html. For other patients, it helps to understand that IUI is just one part or one step in a larger approach to help you achieve pregnancy.

ICSI

If a couple fails to get pregnant with IUI or if the sperm presents a very poor prognosis with IUI, then we generally recommend IVF. Since sperm is an issue, ICSI would be utilized. ICSI or intra-cytoplasmic sperm injection involves injecting a single sperm into an egg in order to achieve fertilization. This compensates for multiple sperm problems. The principle burden of sperm is to bind to the shell around the egg and penetrate it in order to fertilize it. Most sperm are not able to do this. (See science of infertility) In men with a low sperm count, functional sperm are likely to be even more rare.

For ICSI, relatively few sperm are required. We have helped a couple get pregnant with ICSI when we could locate only six sperm in the husband's ejaculate. Sperm shape is only weakly related to a sperm containing normal DNA. About 10% of the sperm of all men contain abnormal DNA. Some men with severe sperm problems will have decreased fertilization with ICSI, compared to other patients, but usually there are some sperm that will produce normal appearing embryos.

The performance of ICSI requires IVF like procedures, but does not require traditional IVF.  Mini-stim IVF or IVM may be used which require minimal or no stimulation of the ovaries.  Such procedures may be better choices than IVF for younger patients.

TESE

In men with obstructive azoospermia (e.g., vasectomy, absent vas deferens), sperm can be easily harvested surgically from the testicles or the vas deferens in our office. This sperm can then be used with ICSI to achieve pregnancy. The procedure is referred to as TESE.

Life often poses the question of whether the cup is half empty or half full. Many couples despair after they learn that they have to deal with poor sperm and that there are usually not good procedures to correct the situation. We now have the technology to compensate for almost any sperm problem. These techniques did not exist just a few years ago.