|
Sperm motility appears to be one of the most
important factors in determining the
fertilizing capability of sperm. Even with a
low sperm count, many men with highly motile
sperm may still be fertile. A semen analysis
is the study of a freshly ejaculated semen
sample. This analysis
measures the number of sperm present in the
ejaculate (sperm count) and checks the shape
and size (morphology) of sperm and their
motility. The
semen analysis is not an absolute test for
fertility because it does not test certain
important aspects of sperm function, such as
whether sperm can actually penetrate the egg;
however, it is very useful in initially
determining if the cause of infertility is an
obvious male factor.
Semen
testing is performed using a fresh semen
specimen within 2 hours of collection. The
specimen is obtained through masturbation and
is collected in a container provided by the
physician. Semen for this analysis should not
be obtained by interrupted intercourse or by
use of an ordinary condom. Ordinary condoms
contain substances that are toxic to sperm. If
religious or personal practices prohibit
masturbation or if the patient feels
uncomfortable, the physician may suggest using
a special condom designed for specimen
collection that does not damage sperm. Feeling
anxious about producing a specimen is common.
Any questions or concerns should be discussed
with a physician.
The
information gathered during the semen analysis
depends on proper collection of the specimen,
as well as the skill of the technician or
physician performing the test. Before testing,
a standard period of sexual abstinence is
recommended. Often, this is 2 to 3 days or the
"usual" number of days between
intercourse for the couple. This helps the
physician obtain an idea of what the normal
seminal fluid exposure is for the female
partner. Because sperm counts and quality can
vary, at least two or three samples will
usually be obtained to establish a baseline.
Evaluation of semen is based on standards
established for fertile males. When a patient
has values below these limits, a male factor
does not necessarily exist, but the
probability is significantly increased. It is
important to remember that, despite an overall
low sperm count, men with high-quality sperm
may still be fertile. High quality sperm is
defined as having a high percentage of motile
sperm with good forward movement. Sperm
motility appears to be one of the most
important factors in determining the
fertilizing capability of sperm.
This
test assesses several factors: the quality and
quantity of cervical mucus and the number and
motility of sperm in the mucus. A sample of
the cervical mucus is taken 4 to 12 hours
after sexual intercourse and just before
expected ovulation. The sample is examined
under a microscope and sperm number and
movement are assessed. Improper timing may
cause a poor result because only preovulatory
mucus will nourish sperm and allow them to
remain active. Consequently, this test may
have to be repeated. Because the couple is
required to perform sexually on demand for
this test, it is also a frequently rescheduled
test. Some impotence and sexual dysfunction
are common at this time. Usually, two abnormal
postcoital test results suggest that a more
thorough evaluation of sperm and mucus quality
is needed.
|
|
Ovulation
Induction and
IUI |
Intrauterine
insemination (IUI)
is a process by
which a
husband’s or a
donor’s semen
sample is
processed and a
concentrated
preparation of
sperms is
directly
injected into
the uterus with
the help of very
thin flexible
tubing. Is a
treatment option
for pts with
minor semen
abnormalities
& in women
whom post coital
test is
negative, have
cervical
hostility to
sperms, &
those couples
having sexual
dysfunction.
This is mainly done for
blocked tubes,
unexplained
infertility, PCO,
Endometriosis
grade 3-4, mild
oligospermia in
males. Hormonal
injections given
to woman to
induce
super ovulation,
serial
Transvaginal
sonographies
done to monitor
follicles, HCG
injections given
to induce
release of eggs,
Ovum pick up
done with trans
vaginal
sonography, eggs
are inseminated
with processed
sperms of her
husband.
Fertilization of
eggs takes place
within a day
followed by
cleavage & then
embryos thus
formed are
replaced into
uterus on day 2,
3 or 5 (Blastocyst).
Patient is given
Luteal phase
support with
injectable
vaginal
progesterone
pessaries.
IVF
is a four-stage
procedure:
Stage
One –
Hormonal
injections are
given to
stimulate the
development of
multiple
follicles.
Stage
Two-Once
mature, the eggs
are removed (or
retrieved) from
the woman's
ovaries using a
fine needle.
Stage
Three-The
eggs are
transferred to a
laboratory dish
where they are
fertilized by
sperm collected
from the male
partner.
Stage
Four-Several
days later, the
fertilized
embryo is
inserted back
into the uterus.
|
|
|
|
Fertilized
Embryos
|
Embryo
Transfer
Under
Sonographic
Guidance
|
|
ICSI
(
Intracytoplasmic
Sperm
injection
) |
|
|
|
|
ICSI
Procedure
|
PN-stage
|
|
|
|
Human
embryo
at
8-cell
stage
|
This is the
treatment of
choice for male
factor
infertility in
which the sperm
count is less
than 5
millions/ml,
sperm defects,
dead, immotile,
abnormal sperms,
unexplained
infertility and
failed IVF. ICSI
is a
micromanipulation
procedure
whereby a single
sperm is
injected into
the single egg
with the help of
small micro
needle with the
help of robotic
machine called
micromanipulator.
Super ovulation,
follicular
monitoring, ovum
pick up is done
like that in IVF. This
technique may
provide men who
have very small
amounts of weak
sperm (too small
for routine IVF)
a chance to
fertilize
individual eggs.
If the egg is
fertilized, the
embryo is
inserted into
the uterus.
Embryos
which are not
used in a
particular ART
cycle are
preserved for
future use. Once
embryos are
frozen and
stored, they
remain viable
for long periods
of time. About
half of frozen
embryos will
survive thawing
and can be
transferred.
Cryopreservation
enables some
embryos to be
used in the ART
cycle and some
to be stored for
future use in a
natural cycle (a
cycle without
hormonal
stimulation).
Cryopreservation
may also lower
the cost of
subsequent ART
procedures
because the
first few stages
(ovarian
stimulation, egg
retrieval) do
not have to be
repeated when
the frozen
embryos are
used.
When
sperm cannot
move through the
male genital
tract due to an
uncorrectable
blockage, sperm
can be extracted
directly from
the epididymis
or the testicle
by microsurgical
techniques.
Congenital
absence of the
vas deferens or
seminal
vesicles, failed
vasovasostomy or
epididymovasostomy
are all
conditions where
MESA might be
used. Usually
performed as an
outpatient
procedure, MESA
can provide
sperm for in
vitro
fertilization
cycles.
Epididymal sperm
are usually not
fully motile
and, therefore,
cannot be
inseminated into
the uterus or
cervix
successfully
without
sophisticated
techniques that
place the egg
and sperm in
direct contact
so fertilization
can occur. If
MESA is done in
conjunction with
an IVF cycle, it
will be
performed around
the same time as
egg retrieval
from the female
partner. Sperm
obtained from
the epididymis
are usually
placed directly
into the egg.
Gamete
Intrafallopian
Transfer (GIFT),
developed in
1984.
This is a
treatment of
choice in
unexplained
infertility and
patients having
cervical factors
and
immunological
factors. In this
procedure
mixture of sperm
and eggs is
placed directly
into one of the
woman's
fallopian tubes
during a laparoscopy.
Conception
occurs in the
fallopian tube.
Once fertilized,
the embryo then
travels into the
uterus, just as
in a natural
cycle.
As with other
ART procedures,
GIFT requires
that the woman's
ovaries first be
stimulated with
hormonal
medication to
encourage the
development of
multiple oocytes.
This enhances
the possibility
of
fertilization.
With GIFT,
fertilization
takes place
inside the
woman's body.
However, GIFT
can only be used
in patients with
healthy
fallopian tubes
( atleast one).
Zygote
Intrafallopian
Transfer (ZIFT)
combines aspects
of both IVF and
GIFT. Protocols
for ovarian
stimulation are
similar to those
used for IVF and
GIFT. Eggs are
collected and
fertilized by
the partner’s
sperm in the
laboratory. What
makes ZIFT
different from
IVF is that the
embryo is placed
into the woman's
fallopian tube
via laparoscopy
instead of the
uterus.
This
is a form of
embryo
micromanipulation
whereby a hole
is artificially
produced in the
embryo's
covering, which
may increase the
chance of embryo
development.
Selective
assisted
hatching may
increase the
chance of
pregnancy in
women age 39 or
older, women
with elevated
basal FSH
levels, women
with a history
of implantation
failure or in
women with
embryos having a
thick zona
pellucida (a
layer or
envelope that
surrounds the
oocyte).
Thermal
Balloon Therapy-Endometrial
ablation
(EA) involves
removing the
lining of a
woman's uterus.
EA is an
alternative to
hysterectomy for
women who have
excessive
menstrual or
uterine
bleeding.
Ablation
procedures can
prevent the need
for 80%-90% of
currently
performed
hysterectomies
based on
extensive review
of the published
literature. In
contrast to a
hysterectomy
(removal of the
uterus), an
ablation
procedure is
performed either
in your
gynecologist's
office or as an
outpatient
surgery, with
patient's
returning home
the same day,
and without the
need for an
abdominal or
vaginal
incision.
-
First,
a
soft,
flexible
balloon
attached
to a
thin
catheter
(tube)
is
inserted
into
the
vagina,
through
the
cervix
and
placed
gently
into
the
uterus.
-
Then
the
balloon
is
inflated
with a
sterile
fluid
that
expands
to fit
the
size
and
shape
of the
uterus.
The
fluid
in the
balloon
is
heated
to 87°C,
or 188°F,
and
the
temperature
is
maintained
for
8minutes
while
the
uterine
lining
is
treated.
When
the treatment
cycle is
completed, all
the fluid is
withdrawn from
the balloon and
the catheter is
removed. Nothing
stays in the
uterus.
|
Advanced
Laparoscopic
Surgeries |
|
|
|
|
Ultrasonography/
Colour Doppler |
This
painless test is by applying a probe to the
outside of the abdomen, or by inserting a
diagnostic instrument into the vagina.
High-frequency sound waves produce pictures
that reveal information. The pelvic organs
(uterus and ovaries) can be examined in detail
and both normal and or problem pregnancies can
be monitored. Abnormalities including cysts,
tumors and infections seen, cyclical
development of the ovarian follicles and
uterine lining can be monitored.
|
HSG-
Hysterosalpingography |
Structural
problems, blockages and other disorders of the
uterus, the fallopian tubes and the pelvis may
be diagnosed through a sophisticated x-ray
study (or film). A small tube is inserted into
the cervix and a dye is injected slowly. The
flow of the dye into the uterus, out through
the fallopian tubes and into the pelvis can
then be viewed on a screen.
This test is performed after a menstrual
period but before ovulation. During the
injection of the dye, the woman may feel
uterine cramping that may last several hours.
After the test, there may be a sticky
discharge for several hours as the dye is
expelled from the uterus. A sanitary napkin is
worn instead of a tampon to allow the fluid to
escape. Whatever fluid remains in the pelvic
cavity is absorbed by the body without harmful
effects. One positive potential side effect of
HSG testing is that the chance of conception
appears to increase for several cycles after
an oil dye is used. Because of this, some
physicians may prefer to wait several cycles
before proceeding to the next test, a
diagnostic laparoscopy.
Its
visualization of the interior of the uterus to
look for tumors, scars and/or abnormalities
may also be done at the time of the
laparoscopy. This is done under general
anesthesia where in a fiber optic scope is
inserted through the cervix and into the
uterus.
Performed
under general anesthesia, this test enables
direct visualization of outside of the uterus,
the fallopian tubes, the ovaries and the
pelvic cavity. An instrument is passed into
the abdomen through a tiny incision below the
navel. A second instrument is inserted through
an incision at the pubic hairline. This
procedure enables more detailed information to
be obtained about these organs and detection
of scar tissue that might be located on the
fallopian tubes. It also helps to identify
endometriosis, the presence of normal uterine
tissue in abnormal places outside the uterus.
Sometimes even minimal endometriosis can cause
infertility. Laparoscopy is performed if
endometriosis, tubal disorders or adhesions
(scar tissue) are suspected, and it is
generally reserved for the end of the work-up.
The incision is closed with several stitches
that absorb within weeks. The procedure is
scheduled before ovulation and is usually done
as a 1-day surgery, enabling the woman to go
home later that day. A sore throat, shoulder
pain, a feeling of a bloated or swollen
abdomen and general stiffness and soreness are
commonly experienced for a day or two. Normal
activities and work can soon be resumed
|
