|There are many steps involved in the
process of conceiving a child and any one of a variety of problems
can prevent the sperm from making its journey to fertilize the egg.
Sometimes the man does not produce enough sperm, the sperm can't swim
properly, or the sperm can't penetrate the egg. Other factors which
could limit a man's fertility include infection, hormonal imbalance,
injury, varicoceles, and psychological stress.
A couple diagnosed today, with male factor infertility, has available
many advanced diagnostic and reproductive technologies which can
help to achieve their goal of becoming parents.
In any field of medical research, success is often measured in minute
degrees, the impact of which may only be known to those whose careers
are spent in a laboratory. Occasionally, there comes a discovery
so outstanding that it revolutionizes medical treatment. Such is
the case with Intracytoplasmic Sperm Injection (ICSI), a new infertility
treatment utilizing micro manipulation technology that specifically
addresses severe male factor infertility issues. In fact, ICSI is
so remarkable that most treatments previously used have been abandoned
in its favor.
In 1991 a Belgian physician pioneered the ICSI process and first
reported the remarkable successes to the American Fertility Society
(now known as the American Society for Reproductive Medicine) annual
scientific conference. When a single sperm was injected directly
into the egg, it virtually eliminated the problems and limitations
found with previous male factor infertility treatments. Palermo and
others studying ICSI found that not only did it address the issues
of poor sperm motility and low count, but it was also successful
with sperm that were considered less than ideal for a conventional
IVF procedure. Today, ICSI has been successfully used to treat men
with fresh sperm collected directly from the testis, epididymis and
those with sperm previously cryopreserved.
The actual process of injecting a single sperm into an egg is carried
out by the embryologist in the ART laboratory. A sterile glass holding
pipette is used to secure the egg; an injection needle is used to
pierce the egg membrane and to inject the sperm cell. Once the holding
pipette secures the egg and the sperm cell has been drawn into the
injection needle it takes less than 45 seconds for the sperm to be
injected directly into the center of the egg. Remarkably, once the
micro injection pipette is withdrawn, the egg will close and assume
its original shape within 60 seconds. If all has gone according to
plan, the transfer of the resulting embryo(s) into the female patient
can occur within 3 to 5 days of ICSI.
Based on the results of this procedure, SFIRM has incorporated ICSI
as a successful treatment option for couples facing male factor infertility.
The future for the ICSI process is even more promising. Researchers
expect that the current fertilization rates of 85% will continue
to improve. As stated previously, sperm selection for the ICSI process
focuses on available motile sperm, but it is only a matter of time
until the ability to select living, but non-motile sperm will help
up the odds even more for couples seeking to have a baby. Currently,
results are poor with sperm that don't move, as it is not known whether
they are alive or dead. The staining method currently used for determining
whether non-motile sperm are dead or alive actually kills living
sperm. In the near future, techniques will be developed which will
help determine which sperm are alive and viable for the ICSI process
without killing them with the stain.