Routine sperm analysis
Semen obtained from the patient is put into one or two tubes (split ejaculate) and kept at 37 OC for 15-30 minutes to permit liquefaction. Then, sperm number, motility and morphology are evaluated. After this initial evaluation, swim-up is performed. Swim-up lasts around 35-40 minutes. The procedure aims to separate sperms from other contents of semen.
Semen Analizi
Insemination
After swim-up, sperms are kept at 37 OC and at 6% CO2 for 30 minutes to obtain increased motility. Then, these sperms with increased motility are inseminated to the uterus via a thin catheter. Success rate of insemination depends on the etiology of infertility, patient age, stimulation protocol, follicle number and quality and on sperm parameters and varies around 15-25%.
Azospermi nasıl sperm elde edilir?
IVF/Microinjection
Etiology of infertility, number of oocytes picked up and sperm parameters determine whether IVF or ICSI should be preferred. Although similar protocols are applied to the patients for both IVF and ICSI, their laboratory procedures differ. During IVF, oocytes and sperms are put together into culture medium and kept in incubators for 14-16 hours and at the end of this time period, sperms are expected to fertilize oocytes. Differently, during ICSI, a single sperm is put into the oocyte via a manipulator. Several studies pointed to similar pregnancy rates with both IVF and ICSI.
Blastocyst transfer
Recent advancements in IVF cultures made embryo development for a longer time in vitro possible. This created the advantage of day 5 or 6 transfers, which is associated with higher pregnancy rates. Last form of the embryo before it adheres to the endometrium is called as the blastocyst.
Advantages of the blastocyst transfer:
- Embryos with beter development can be differentiated
- Transfer of less embryos with beter development can decrease high order pregnancies
- Better inspection of embryo development
- If PGD is going to be performed, cells of trophoectoderm may be obtained which will solve ethical issues.
Embryo freezing
Cryopreservation of human gametes and embryos has an important place in IVF practice. Transfer of a maximum of 3 embryos is a general practice to reduce higher order pregnancies. In this case, the fate of the excess embryos is a question. Cryopreservation of the excess embryos provides the patient both psychological and economical relief. Furthermore, the patient does not require any more treatment fort he transfer of the cryopreserved embryos.
Embryo cryopreservation provides several embryos ready for transfer and relieves the patient from physical burden, the price of ovulation induction and oocyte pick-up. As a consequence, cryopreservation of the excess embryos provides the patient both an economical and psychological advantage.
Besides standard IVF procedures, embryo cryopreservation may be applied for embryos obtained after either oocyte or sperm donation in cases of IVF failure or demand of the parents for another child.
Surgical sperm collection (PESA, PTSA, TESE)
Sperm should be surgically obtained for microinjection in azospermic patients. Surgical sperm collection is an important point in male infertility treatment. In obstructive azospermia, a fine needle is inserted to the blocked ducts and sperm is aspirated (PESA). PESA obtains sperms in 99.6% of cases. Nonobstructive cases present a more difficult problem. A very limited production of sperm in some foci of testes is possible in these cases. So, multiple biopsies of the testes is required in these cases. Biopsies can be obtained either by a fine needle (PTSA) or by an open surgical procedure (TESE). These procedures reveal sperm in 60% of cases.
Assisted hatching
Half of patients undergoing IVF treatment do not achieve a pregnancy despite good quality embryos. Rate limiting step at this stage is probably implantation. Once the embryo is placed within the uterine cavity, embryo grows, divides, gets rid of the zona pellucida and adheres to the endometrium. Failure in removal of zona pellucida is thought to be a rate limiting step in implantation. So, before embryo transfer, a hole in the zona pellucida can be created using chemical or mechanical forces. Researches proved an increase in clinical pregnancy rates by this way. The procedure is performed as follows: the embryo is held stable via a pipette. Two holes a created on the zona pellucida via a micro-needle.
Blastokist Aşaması
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