When do we recommend IVF for male infertility?

If a semen analysis reveals a very low concentration of normal sperm, Dr. Tas often will recommend IVF for male infertility. This is because the chances of success are much better than with timed intercourse or IUI.

IVF is also a good option when there are multiple fertility factors, such as a low sperm count in combination with a blocked tube, difficulty in ovulation or advanced age of the woman. IVF can be the most effective treatment for couples in these situations by increasing the chance for fertilization of the egg.

The reason why is as follows:

• Sperm with poor motility can still be used to fertilize eggs through IVF. By placing sperm and egg in close proximity in a petri dish, the poorly motile sperm do not have to travel far to reach the egg and fertilization is controlled in the lab.

• Low sperm counts can still achieve fertilization through IVF

Because the egg and sperm meet in the lab, the sperm have no chance of “getting lost” in the female reproductive tract. Normally, sperm travel along the specific path to reach the egg, but many fall off during the trip. If there isn’t enough sperm that can make the trek to the egg, fertilization never happens.

• For severe male factor, IVF with intracytoplasmic sperm injection (ICSI) will be performed.

• ICSI involves carefully choosing a single sperm and injecting this sperm directly into the egg, which improves the chance for fertilization. ICSI is also performed when sperm is retrieved by performing a biopsy of the testicle, also known as TESE (testicular sperm extraction), or when a frozen sperm specimen is used.  

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Semen collection for IVF

A sperm sample is collected onsite at our center through masturbation on the day of egg retrieval. In some cases, men with extremely low sperm counts may need to freeze a sample in advance as a backup for IVF, to ensure that the lab has enough healthy sperm on the day of the egg retrieval to fertilize the eggs.

In an IVF cycle, our embryologist prepares the sperm specimen by washing it to sort for the strongest, most motile sperm. This process increases the amount of motile sperm that will be exposed to the egg. IVF also allows for the sperm to be placed directly in contact with the egg. Both of these steps help to improve the chance for fertilization to occur.

In vitro fertilisation (IVF)

IVF is an Assisted Reproductive Technology (ART) procedure used to treat a range of fertility problems. In IVF treatment, the process of fertilisation occurs outside the female body. A woman’s eggs are retrieved from her ovaries via the egg collection procedure, and fertilised with sperm in a laboratory petri dish. Once fertilised, the embryo is implanted into the woman’s womb.

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What is Abdominal Egg Collection?

CRGH is able to offer transabdominal egg retrieval in addition to the more common transvaginal method.

The abdominal route is used where the patient’s ovaries are difficult to access. It can also be performed where there are cultural or religious factors, which make the transvaginal route inappropriate or undesirable.

Transabdominal egg retrieval is performed under deep sedation. The doctor reaches the ovary using a needle through the abdomen, guided by continuous ultrasound.

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How does IVF treatment work?

In IVF treatment, fertility drugs are given to the female partner to stimulate the production of multiple eggs which are contained in follicles on the ovaries. Progress is monitored using ultrasound and blood tests.

When the leading follicle reaches 17-22mm, the final preparation for the egg collection is done. This involves a hormone injection of human chorionic gonadotrophin (hCG) or gonadotrophin releasing hormone agonist (GnRHa) or dual trigger (hCG and GnRHa), which is given approximately 37 hours before the egg collection. The hCG and/or GnRHa injection stimulates the eggs to mature.

 

 

What is the Egg Collection procedure?

The egg collection procedure is usually carried out under sedation. An ultrasound guided vaginal probe is used to locate the follicles and aspirate (empty) its contents. The eggs are then placed in culture in our embryology laboratory. It is difficult to determine the number of eggs that will be collected until the procedure. In rare cases, no eggs are collected.

Eggs are placed into a petri dish with sperm, left to fertilise and develop under close observation by the embryology team.

 

Embryo transfer

Once the embryos have developed, the embryologist will select one to be transferred back to the womb during an embryo transfer procedure. It is a painless and quick procedure. The embryo(s) are loaded into a fine catheter and this is placed into the womb and the embryo(s) are expelled. After the embryo transfer, the patient can resume her usual activities.

Two weeks after the embryo transfer, a pregnancy test should be performed and CRGH should be informed of the result.

 

How long do embryos take to develop?

The day after the sperm is mixed with the egg, embryologists will look for signs of fertilisation. The following day they will check to see if the embryo has divided (cleaved). Embryos are then allowed to develop and monitored in the laboratory until day 5 or 6. By day 5 or 6, approximately 40-50%  of the embryos should reach the blastocyst stage. At CRGH, we carry out blastocyst embryo transfer. There is a risk that none of the embryos reach the blastocyst stage.

The embryologists monitor and grade the embryos very carefully. In the majority of cases, if the embryos have developed well we would recommend a single embryo to be transferred to reduce the risk of twins. If a blastocyst transfer is going to take place, we will only normally transfer one embryo in patients under 38 years.

 

What happens to embryos that are not transferred?

All good quality embryos that are not transferred will be frozen. CRGH has a very high pregnancy rate for frozen embryo transfers. This gives a very high chance of getting pregnant in a subsequent cycle without having to go through the whole IVF procedure again.

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MALE FACTOR

What are the medical treatments for azoospermia?

Obstructive azoospermia may be treated by either reconnecting or reconstructing the tubes or ducts that aren’t allowing the sperm to flow. This may mean surgery or other procedures. Hormonal treatments and medications may also help if the underlying cause is low hormone production.

Non-obstructive azoospermia may or may not respond to medical treatment. But there’s some good news: You may still be able to achieve pregnancy with a biological child through in vitro fertilization or intracytoplasmic sperm injection.

How? Your doctor can extract sperm from the testes using a tiny needle. This retrieval may be done during a biopsy as well. This procedure may work even if you only have a few sperm present in your testicles.

If you choose to go this route, it’s important to receive genetic counseling to understand the root cause and how it may impact any biological children.

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How is azoospermia treated?

Treatment of azoospermia depends on the cause. Genetic testing and counseling are often an important part of understanding and treating azoospermia. Treatment approaches include:

• If a blockage is the cause of your azoospermia, surgery can unblock tubes or reconstruct and connect abnormal or never developed tubes.

• If low hormone production is the main cause, you may be given hormone treatments. Hormones include follicle-stimulating hormone (FSH), human chorionic gonadotropin (HCG), clomiphene, anastrazole and letrozole.

• If a varicocele is the cause of poor sperm production, the problem veins can be tied off in a surgical procedure, keeping surrounding structures preserved.

• Sperm can be retrieved directly from the testicle with an extensive biopsy in some men

If living sperm are present, they can be retrieved from the testes, epididymis or vas deferens for assisted pregnancy procedures such as in vitro fertilization or intracytoplasmic sperm injection (the injection of one sperm into one egg). If the cause of azoospermia is thought to be something that could be passed on to children, your healthcare provider may recommend genetic analysis of your sperm before assisted fertilization procedures are considered.

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Our consultants are experienced microsurgeons with special interest in male infertility. Their skill and advanced techniques offer males with azoospermia the best chances of fathering their own child.