Fertility Treatment

The ICSI Technique for Male Infertility

If the male sperm quality is poor, treatments such as microinjection of sperm cells (ICSI) can be used to assist in such cases. In a normal semen sample there would be 40 million sperm cells per ml, 50% motile and at least 10 % with a normal shape. When these conditions are not met we attempt to obtain a sample of sperm cells (5 million motile per ml, through laboratory techniques capacitation), they are injected directly into the uterine cavity. This is called intra-uterine insemination. If there are less sperm cells (500.000 per ml), then we bring these together with the oocytes under the best conditions. With this method, known as in vitro fertilisation , it is possible to fertilise up to 80% of all oocytes.

ICSI Technique

Where the quality of the sperm is poor and there is less chance of fertilisation. The ICSI (intra-cytoplasmatic sperm-injection) technique can be used. A single sperm cell, that does not need to be motile, is injected, with a little pipette, straight into the cytoplasm of the oocyte.

There are other additional methods of sperm-retreval. Sperm cells can be surgically obtained through MESA (Microsurgical Epididymal Sperm Aspiration) with a biopsy of the epididymis, or a biopsy of the testis.

After these retreval methods are applied the ICSI technique is undertaken and the fertilised embryos are then implanted into the uterus.

Oocyte Donation

For some couples it is impossible to have children such as when:

• Surgical treatment where both ovaries have been removed
  
  
• Malfunctioning ovaries
  
  
• Radiation of the abdomen or chemotherapy
  
  
• Premature menopause
  
  
• Women with a serious genetic disease

It is possible to donate oocytes to help partners in such cases.

Where Do Donated Oocytes Come From?

We try to maintain our anonymity policy. Ocytes cannot be frozen for later use, surplus oocytes can be donated. There is a severe deficiency of oocytes.

Blastocyst Culture Technique

During this fertility treatment technique, the fertilised oocytes are cultured for two days in an artificial fluid before implantion. Recent figures indicate that there is a 30,4 % chance of pregnancy and a 21,9 % chance of a living child after an embryo-transfer during fertility treatment.

Several reasons are suggested to explain the lower figures of successful implantation in the endometrium of the uterus. The main cause is the difficulty in predicting the development of the embryo in the early stages after re-implanting. In nature the embryo comes into contact with and implants in the uterus 5 days after fertilisation.

It is possible to wait up to 5 days before the embryos are re-implanted into the uterus. This technique is the blastocyst culture therapy. Fertilised oocytes are cultured in a several different media that nurture the embryo until it has developed into a 5-day-old embryo called a blastocyst.

Indications To Apply Blastocyst Culture Therapy

This technique is used to improve chances of implantation in the uterus where:

• There have been 3 successive failures after embryo-transfer, despite a normal uterine cavity, progesterone concentration and luteal phase. Progesterone is the hormone that supports the endometrium for implantation of the embryo. The luteal phase is a period after the ovulation, which is characterised by the formation of a yellow body in the ovaries, capable of producing progesterone
  
  
• One wishes to avoid a multiple pregnancy, due to a malformed uterus
  
  
• After the fertility treatment it appears that the quality of the embryo is poor
  
  
• There is a risk of hyper stimulation

An advantage of blastocyst culture method is a better evaluation the embryo. 10 perfect embryo's at the outset may reduce to just 1 or 2 developing well by day 5.

Frozen Blastocysts

Spare embryo's are frozen in liquid nitrogen at -196°C for 5 years. They can be transferred in another cycle months or years later. Results of frozen embryo transfer (FRET) fertility treatment are 10% pregnancy rate; the results of embryo's frozen on day 2 are better than that of frozen blastocysts. This is because of the complexity of the blastocyst, which can sustain damage while freezing or thawing.

Outcomes

IVF and ICSI fertility treatment lead to a pregnancy in 30 % of cases. In Blastocyst culture the pregnancy rate might be slightly higher. Almost 40% of the embryos reach the blastocyst stage. The chances of a successful implantation are 25 %. (10 % with regular IVF treatment) Our policy limits the number of embryo transfers to one in order to reduce the risk of complication and in other cases to a maximum of 2 embryos.

IVF, GIFT and ICSI really are worthwhile

We have tried to give an insight into the various methods applied with IVF fertility treatment and some of its variants. If you plan to undergo this treatment let your GP or gynaecologist know. Take your time to come to the right decision and listen to the advice of your GP or gynaecologist.

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