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Assisted fertilization

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This week we look at the final part of male infertility. In the previous week, we looked at achieving a pregnancy using surgery or medication and emphasized the benefit of a healthy diet and exercise. I said that most of these things may be accessed in this country. This week, we shall look at assisted fertilization.{{more}} By assisted fertilization I mean we doctors actually help the couple to achieve a pregnancy by giving nature a little helping hand. First, we get sperms by one of the several methods (sperm retrieval), then we wash and concentrate the sperms (sperm washing). The next step is pivotal. We either assist pregnancy the “natural” way (in vivo fertilization) or we do the fertilization in a test tube, then inject them into the female (in vitro fertilization or “test tube baby”).

Sperm retrieval – for men who cannot ejaculate, we ejaculate for them, using electroejaculation, a procedure I described in a previous article. Other men who can ejaculate, but in whom the sperm count is zero (azospermia), we get sperms by aspirating them from the epididymis, through the skin, using a fine needle or percutaneous epididymal sperm aspiration (PESA). The epididymis is a coiled tube attached to the testicle where the sperms go to mature. If this fails, then the procedure is repeated using a microscope under an anaesthetic or micro epididymal sperm aspiration (MESA). Sometimes there are no sperms retrieved from the epididymis even after using a microscope, so they are retrieved from the testicle or testicular by taking a small piece of the testicle and extracting the sperms from them. This is called “testicular sperm extraction” or TESE.

Sperm washing – the sperms retrieved from ejaculation naturally are collected and washed so that the abnormal sperms are removed and the normal sperms are concentrated. This increases the chances the chances of conception, using natural means or using test tubes. After sperm retrieval and or washing, one of three things is done. The sperms are either injected into the fertile woman or the sperm and the egg are mixed and injected into the fallopian tube in a subfertile woman. Sometimes the sperm is injected directly into the egg, so we know that fertilization has taken place. The fertilized egg or gamete is then injected into the fallopian tube or uterine cavity to create a pregnancy.

Pregnancy – after sperm retrieval, washing and concentration, the woman can become pregnant either by one of the following: 1.Intrauterine insemination or IUI in which the sperms are instilled directly into the uterine cavity of another fertile and ovulating woman. These women have no obvious reason for not being pregnant, apart from the partner’s low sperm count or very thick or hostile cervical mucus. This means the female’s cervical mucus prevents the man’s sperm from swimming up to fertilize the egg. Twenty percent of couples using this method get pregnant.

2. Intrafallopian gamete injection. This is a big word for pregnancy in the subfertile woman or in couples who are perfectly normal, but still cannot get pregnant. The cause could be similar to the above couple so in order to be absolutely sure we avoid the cervical mucus, we put the egg and sperms together in a test tube to allow the sperms to fertilize the egg. The mixture, which contains the fertilized eggs or gametes, is put into the fallopian tube and the fertilized eggs then descend and implant in the womb. This is called GIFT or Gamete IntraFallopian Transfer. Thirty percent of couples undergoing this procedure get pregnant. 3. ICSI or intracytoplasmic sperm injection is the state of the art that can treat virtually all couples with infertility. All that is needed is one sperm and one egg. The sperm is injected directly into the egg and the fertilized egg is then placed into the womb where it implants, this method can be used to treat virtually all types of male and female infertility, including couples in whom surgery and medical therapy have failed and those who have little time to undergo medical treatment because of age. As you would expect, the treatment is expensive, but has success rates between 50-80%, with one in three couples delivering a live baby.

Next week, I will be answering questions from my readers and these can be sent to the editor of this newspaper or to me at deshong@vincysurf.com.

For comments or question contact:

Dr. Rohan Deshong

Tel: (784) 456-2785

email: deshong@vincysurf.com

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