Male factor infertility and IVF treatment: procedures which help dealing with it
Procedures which help dealing with male factor infertility can be divided into two groups: those helpful during the diagnosis and other used during the treatment. What procedures are these and how they can help?
Watch 3on1 #IVFANSWERS where we asked our experts about it:
- Dr Àlex García-Faura Scientific Director of Institut Marquès
- Dr Diana Obidnyak– Head of International Cooperation Department AVA Peter Clinic
- Dr. Miguel Ángel Checa – Specialist in Obstetrics/ Gynecology and Reproductive Medicine at Fertty International
Answer from Dr García-Faura Scientific Director
There are many procedures that help us to deal with a male factor during fertility treatments. Some of them will help us during the diagnosis, others will help us during the treatment. To avoid the risk of failure during the fertility treatment, we need to do specific semen analysis. The most important is sperm fragmentation which is used to determine the degree of DNA damage. The other one is FISH test that will help us to determine if there is any chromosomal abnormality in the semen. These studies will help us especially in case of patients who have had many failed fertility treatments previously. DNA fragmentation is usually studied in those patients who’ve had repeated miscarriages. If there is a high degree of DNA fragmentation, there are some medical procedures that the andrologist can offer to a patient in order to reduce this problem and increase pregnancy rates. FISH study on sperm samples is used to determine if there is any chromosomal abnormality in spermatozoa that might give us abnormal embryos, implantation failure or repeated miscarriages. In some cases we need to undergo testicle biopsy and check testicular tissue to see if there is any chromosomal abnormality as well.
Once we have the diagnosis and we know which male problem we are dealing with, there are some procedures during the fertility treatment that may help us to increase the chances of pregnancy and reduce the chances of miscarriage. They’re based on sperm selection. Some of them are based on the morphological study of spermatozoa, like IMSI or PICSI. They will help us in magnifying the image of the spermatozoa head and choosing the normal forms. It refers especially to those patients who have a high degree of abnormal spermatozoa according to their semen analysis. We can use this technique when there’s less than 4% of normal form in the semen analysis. This will help us to reduce miscarriage rates.
We use other techniques like Fertile Chip to help us in sperm selection, especially in patients with high fragmentation or in cases where we’ve detected chromosomal abnormalities in the semen analysis. This technique will help us to select the best spermatozoa to get higher pregnancy rates and lower miscarriage rates at the same time.
Answer from Dr Obidnyak- Head of International Cooperation Department
Infertility has come to be defined as inability to conceive after 12 months of regular unprotected sexual intercourse. Generally, infertility can be caused by woman’s or man’s health problems.
Sometimes it’s caused by both partners’ disorders when both a man and a woman have some abnormalities which make a natural conception impossible. Correct understanding of sterility provides a quick and effective individualised treatment plan.
The probable causes of male infertility are the following: abnormal sperm production or function, problems with delivery of sperm associated with sexual disorders, genetic diseases or some structural problems. They also relate to exposure to certain environmental factors, chemicals or taking certain medications. Moreover, they may be associated with cancer and its treatment. No doubt, each infertility case is unique and requires individual approach.
The treatment plan is to be identified only after the entire examination of the couple and diagnosis verification. Actually, we have several treatment tools for male factor infertility. The first one is intracytoplasmic sperm injection. Through this procedure, a single sperm is injected directly into the oocyte. Nowadays just a small amount of spermatozoa is needed to achieve good results after ICSI.
There is now an alternative to a conventional ICSI procedure called the PICSI procedure. This procedure is rather simple. The only difference between the standard ICSI and PICSI is the actual dish with hyaluronic acid. This enzyme works like a magnet which attracts the strongest and the healthiest spermatozoa. The hyaluronic acid as an enzyme makes the normal spermatozoa bind to its layer. Thus, we obtain a reliable criteria for spermatozoa selection that is more than just visualisation. Sperm that bind to the hyaluronic acid show more DNA integrity and fewer DNA mistakes compared to those that do not bind.
Moreover, we have one more method, the so-called intracytoplasmic morphologically selected sperm injection. It’s an actual method which allows to assess morphological features of native spermatozoa. The semen image is enlarged 6000 times using a new electro-optical microscope.
However, this procedure is still under discussion so we never use it routinely.
Answer from Dr Ángel Checa - Specialist in Obstetrics/ Gynecology
The first step to do an IVF is normally to perform an efficient study of the sperm sample. It means that we try to find genetic abnormalities in the sperm. The second tool that we have in the lab is ICSI, meaning intracytoplasmic sperm injection. We pick up one single sperm cell and we inject this cell inside the oocyte. This technique allows a man with poor sperm quality to have babies.
The third tool we use in our lab is Fertile Chip. It’s a new technique to prepare and select sperm to do the injection. This allows us to reduce the fragmentation of DNA in the sperm samples.