In vitro fertilization or IVF is the most effective method of dealing with infertility. During this procedure, fertilization of the egg does not occur in the woman’s body, but in the test tube. IVF involves several steps:
- stimulation of ovulation with hormones and follicles monitoring;
- puncture follicles in order to obtain eggs;
- fertilization of eggs with partner spermatozoa;
- embryo cultivation;
- transfer of the obtained embryos into the uterine cavity;
- hormonal support for the body of a woman.
Modern assisted reproductive technologies help to overcome infertility due to both female and male factors. At the same time one of the main problems solved with the help of IVF is the poor quality of sperm. Developed several techniques aimed at obtaining a sufficient number of full-fledged sperm:
- microsurgical epididymal spermatozoon aspiration (MESA);
- sperm extraction from the testicle (TESE).
Microsurgical epididymal aspiration of spermatozoa is a microsurgical procedure aimed at obtaining a large number of sperm from the epididymis. Only a few cubic milliliters of epididymal fluid make it possible to isolate millions of sperm suitable for fertilizing an egg. That is why often a certain part of the material obtained is subjected to cryopreservation or freezing , which allows to preserve spermatozoa for subsequent IVF attempts.
The MESA procedure can be performed in two ways:
- using a micro toner and an obtuse micropipette - during the operation, the epididymis is dissected, followed by the collection of spermatozoa;
- using micro-pipette - does not require dissection of the epididymal sheath. The microfunction pipette, the diameter of the tip of which does not exceed 0.25-0.35 mm, the doctor performs several punctures of the spermatic cord.
Extraction or extraction of sperm from the testicles is an open technique for testicular biopsy. When performing the manipulation, the surgeon selects an avascular area on the surface of the testicle, makes an incision, and then excludes about 500-700 mg of the testicular parenchyma. The operation can be performed under both local and general anesthesia.
The improved technique for obtaining sufficient sperm is Micro-TESE. During such an operation, only 3-5 mg of testicular tissue is removed. Despite the small amount of material extracted, a large number of spermatozoa can be obtained by selecting the most suitable seminiferous tubule. In addition, accurate identification of the testicular circulatory network is carried out, which minimizes the risk of damage to the blood vessels and testicular tissue.
IVF features in male infertility
Intracytoplasmic sperm injection is the very technique that allows fertilization of the egg by spermatozoa. The use of ICSI in the IVF procedure significantly increases the chance of obtaining a viable germ. As with conventional in vitro fertilization, the preparation of the partner’s body is carried out using hormonal preparations. After receiving the eggs and sperm using microsurgical manipulations, experts begin to perform IVF directly.
When using the ICSI method, the sperm cell does not fertilize the egg independently, but under the supervision of a physician. In preparation for the procedure, a specialist makes the selection of the most complete sperm under a four-hundred-fold increase in the special micromanipulation system. Selected sperm is placed in a special viscous solution that prevents cell damage. Then the embryologist deprives the sperm cell of its ability to move, destroying the membrane of its tail. After that, the sperm is absorbed into the cavity of the microneedle, which is introduced into the egg cell.
The likelihood of achieving a positive result in the treatment of male infertility depends largely on the causes of infertility in the married couple. Undoubtedly, the more spermatozoa of satisfactory quality can be obtained when performing TESE and MESA procedures, the higher the chance of success. Not the last role is played by the age of the woman. So, if the partner is younger than 35 years old, the percentage of conception using IVF reaches 35%. For women aged 40-42 years, this figure is only 14%.