- absence, blockage, or irreparable
damage of follopian tubes
- male infertility
- endometriosis
- unexplained infertility
- immunologic infertility
Cryopreservation
With IVF, it is possible that multiple
eggs will be retrieved. Since replacement of up to four embryos
maximizes the chances of success while minimizing the risk
of multiple gestation, it may be advantageous to store excess
embryos through cryopreservation. If conception does not result
from the treatment cycle, the stored embryos can be thawed
and transferred to the patient during a natural cycle without
her having to undergo ovulation induction and egg retrieval.
Advances
in IVF Technology
INTRA
- CYTOPLASMIC SPERM INJECTION (ICSI)
 |
Micromanipulation, the handling
of egg and sperm by microscopic instruments, is used to
improve the chances of fertilization in cases with impaired
sperm function. ACRM offers the most advanced micromanipulation
technique, called Intracytoplasmic Sperm Injection (ICSI),
in which a single sperm is injected directly into the
egg using a glass micro-needle. |
ICSI has revolutionized
the treatment of male infertility by overcoming barriers to
sperm entry into the egg. Fertilization is possible even in
cases with scant sperm or compromised sperm function. ICSI
has largely replaced Partial Zona Dissection (PZD) and Subzonal
Insertion (SUZI), the first of the micromanipulation techniques
used to treat male factor infertility.
As much as one third of
the infertility cases in the United States may be attributed
to a male factor, which may take the form of: 1) a low sperm
concentration or "low sperm count"; 2) low sperm
motility (few sperm which swim); 3) antibodies against sperm
which impair their ability to swim or to fertilize eggs; 4)
sperm which are not able to fertilize eggs because they are
not functional due to some abnormality in their structure
or biochemical make-up (they do not contain the enzyme, or
have enzymes in too low a quantity to allow fertilization);
5) combinations of some of these factors
In-vitro fertilization (IVF) has proven
to be a very good therapy for some forms of male factor. This
is because the motile (swimming) sperm can be collected and
concentrated from the husband's semen and placed in direct
contact with the egg in a culture environment in the IVF laboratory.
Through the increased number of swimming, and presumably functional,
sperm around the egg, the chances of fertilization are improved
over intercourse or intrauterine insemination.
There are cases of male factor infertility,
however, which cannot be addressed even through IVF. In these
cases, there are so few sperm or sperm which are completely
immotile (not swimming at all), that even if they are placed
in culture with the egg, no sperm cell would be able to penetrate
and fertilize the egg. In addition, there are men who only
have immature sperm available, and these may not be fully
functional.
An ideal approach to these severe forms
of male infertility is to directly inject a single sperm cell
into the egg. In this way, the sperm cell is relieved of the
work of penetrating the several layers which surround, nourish
and protect the egg. It is also apparent that relatively few
sperm are needed since only one sperm cell is required for
each egg.
Scientists in Belgium under the direction
of Dr. André Van Steirteghem, developed a method of
injecting a sperm cell into the egg and called it, appropriately,
Intra-Cytoplasmic Sperm Injection (ICSI - pronounced ick-see).
This technique allows fertilization in cases that would have
been virtually hopeless.
It is essential to recognize, however,
that even though the sperm is placed inside the egg by the
injection procedure, the fertilization process may not be
completed. Fertilization is a complex continuum of sperm and
egg interaction, not simply the entry of the sperm into the
egg. If this interaction does not ensue following delivery
of the sperm into the egg, fertilization failure may still
result.
ICSI is performed using instruments
called micromanipulators. These allow the biologist to "handle"
the cells under microscopic observation with magnification
of 200 to 400 times. The egg is gently held steady using an
instrument called a holding pipette. Using a glass micro-needle,
a single sperm is aspirated into the tip of the needle and
then carefully injected into the egg. The egg can be examined
15 to 18 hours later to determine if fertilization has occurred.
Fertilization has been achieved in cases
of extremely low sperm concentrations, absence of motility,
sperm collected directly from the testis (immature) and in
cases in which fertilization failure was experienced in previous
IVF therapy. The incidence of fertilization using ICSI has
been reported in the range of 40-60%, depending on the experience
of the laboratory and the overall sperm and egg quality. Our
experience thus far has been consistent with these reports.
The pregnancy rates achieved through
ICSI are comparable to those observed with IVF. As in IVF,
the incidence of pregnancy is dependent upon a number of factors:
the wife's age, any infertility factors she may have, the
number of embryos transferred to her uterus and uterine receptivity.
No increase in congenital malformations
in the children conceived through ICSI has been observed.
Assisted Hatching
A technique for improving the implantation
of embryos obtained through IVF is assisted hatching.
With assisted hatching, an opening is
introduced into the zona pellucida, which is the protein layer
surrounding the egg. This aids the escape of the growing embryo.
This stimulates the natural preimplantation process in which
the embryo develops and expands in size until it "hatches"
out of the zona pellucida.
Preimplantation Diagnosis
On the horizon is the ability to determine
if an embryo is carrying a genetic disease. Through preimplantation
diagnosis, a single cell from an embryo can be analyzed for
a given genetically transmitted disease, enabling patients
at risk to avoid pregnancy with an affected fetus.
Success Rates
Since reported pregnancy rates from
established programs may vary, it is important to understand
how various statistics are computed and presented. Efficacy
rates depend not only on the skills of the practitioners,
but on individual patient characteristics such as age, indication
for IVF and number of eggs retrieved and fertilized. Reported
results may include patients of all ages and indication, or
they may be categorized by age and indication.
Counseling
and Support
Embarking on a program involving the
Assisted Reproduction Techniques (ARTs) is a major decision.
Many people see it as renewed hope for conception as well
as their last resort. While the ARTs have helped many couples
overcome their infertility, they are not the answer for everyone.
For those who choose the ARTs, the process can be emotionally,
physically and financially draining, and carries with it a
tremendous amount of anxiety..
We regard emotional support and counseling
as an important adjunct to treatment. We want to help patients
maximize their coping skills during this stressful time, and
for this reason have included a session with a counselor in
the initial evaluation. This session offers couples assistance
with decision making and an opportunity to explore their feelings.
Additional sources of support and information are also available.
Resources
We encourage those considering IVF to
attend our IVF Night seminar, which is offered regularly.
The seminar covers various facets of treatment including medical
indications, treatment procedures, IVF laboratory procedures,
medications, and success rates. Or please call for times and
dates of seminars.
Resolve Of Gerogia Post Office Box 343
2480-4 Briarcliff Road Atlanta, Georgia 30329 Please see UPCOMING
EVENTS and SEMINARS
on our Website.
Telephone: (404) 233-8443 HTTP://WWW.RESOLVEOFGEORGIA.ORG
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE
HTTP://WWW.ASRM.ORG
1290 Montgomery Highway, Birmingham,
Alabama 35216-2809
Phone (205) 978 - 5000
Fax (205) 978 - 5005
E-mail: ASRM@ASRM.ORG
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